Public Reports on Diabetes Care Helped Drive Clinic Improvements in Wisconsin
Madison, Wisconsin - In one of the first studies of the impact of publicly reporting quality measures on outpatient care, a research team has found that clinics made improvements in diabetes care when they began publicly reporting how they were treating patients with the chronic disease.
University of Wisconsin-Madison researchers say their study of Wisconsin clinics showed that the clinics responded well to the challenge of public reporting.
"These are public reports and when health care organizations see the results, they're motivated to improve," says Dr. Maureen Smith, a professor of population health sciences and the leader of the survey. "Ultimately, this benefits patients who receive higher levels of care."
Smith, who heads the Health Innovation Program at the University of Wisconsin School of Medicine and Public Health (UWSMPH), and her colleagues surveyed 409 primary care clinics across Wisconsin. The participating 17 health systems treat about half the patients in Wisconsin and were part of the Wisconsin Collaborative for Healthcare Quality (WCHQ), which publicly reports data from its members.
Diabetes affects more than eight percent of the population. Evidence-based research shows diabetes is best managed when patients are monitored regularly for measures such as blood sugar levels, cholesterol, kidney functions and blood pressure and receive care to keep those levels within healthy limits.
The study looked at interventions aimed at the patient (such as calling them to remind them to have their blood tested); the provider (such as continuing education on diabetes management); and the system (such as creating a registry of all patients with diabetes.)
"Public reporting is one tool for improving health care," Smith says. "Our question was whether it is a good tool. It turns out that public reporting actually does push improvements in evidence-based care."
Researchers concluded that clinics with no prior programs to improve diabetes care responded to public reporting by first implementing single interventions. Those who already had projects led by their health systems or by external groups were more likely to add multiple interventions aimed at improving diabetes care.
"Public reporting seemed to improve care in two ways. In early stages, it encouraged health systems to get off the sidelines and try single interventions," Smith says. "In later stages, it encouraged multiple interventions. Thus, we believe incentives targeting physician groups should reflect incremental improvements in quality, so they reward both early and ongoing improvements."
Smith's collaborators include Alexandra Wright, an associate director with the UW Health Innovation Program; Christopher Queram, president and CEO of the Wisconsin Collaborative for Healthcare Quality; and Dr. Geoffrey Lamb, professor of general internal medicine at the Medical College of Wisconsin.
The research was also supported by the Commonwealth Foundation, the UW Institute for Clinical and Translational Research, the National Institutes of Health and the School of Medicine and Public Health's Wisconsin Partnership Program.
The study was published in the March issue of Health Affairs.
Date Published: 03/07/2012