MHQP reports significant differences in quality of care delivered by Massachusetts medical groups

Massachusetts Health Quality Partners (MHQP) announced today that despite improvement, there are significant differences in the quality of care delivered by medical groups in Massachusetts, according to its annual Quality Insights: Clinical Quality in Primary Care report.

Primary care physicians in Massachusetts are making strides to improve overall care by closing gaps in variation, according to MHQP trend data. For example, colorectal cancer screening is one area of improvement. The screening rates have improved by eight percentage points over the last three years (from 69 to 77%) and variation among medical groups has shrunk by 10 percentage points (from a 47 point difference to a 37 point difference).

But there are areas where not all health care in Massachusetts is the same. When measuring how often a group tested children with a sore throat for strep when prescribing medicine, some groups gave the recommended care 100 percent of the time, while others did so only 37 percent of the time. A variation of 63 percentage points means that patients do not get the same care in every doctor's office and that some doctors provide patients with a more appropriate level of care.

"By measuring these gaps in care, we can target areas for physicians to improve," said Barbra Rabson, executive director of MHQP. "And with Massachusetts enacting new legislation to reform health care delivery, it is critical that we publicly report on differences in the quality of care that is being delivered."

The report, available at www.mhqp.org, shows that Massachusetts' medical care is ahead of the curve in providing high-quality health care, with many scores at or above national averages. But care is not the same throughout the state, or even within a region of Massachusetts.

Patients can review information about the performance of local medical groups on a range of medical conditions including diabetes, cardiovascular disease and asthma care, antidepressant medication management, care for children with sore throats and upper respiratory infections, and other conditions.

The report illustrates areas of care of which Massachusetts can be proud, as well as opportunities for improvement. Key findings include:

• Overall, Massachusetts' primary care physicians provide high quality care.
  Massachusetts' statewide results are above the national average on 24 of 26 (92%) process of care measures (such as screening rates of testing for colorectal and breast cancers) and all five (100%) of the outcome measures (such as improvements in blood sugar levels for patients with diabetes).

• In all regions of the state, quality varies among medical groups. It matters where a patient goes to get care.
  For example, the variation in long-term monitoring of medication for depression varies by only six percentage points among regions. However, within a region such as Metro Boston, this care varies by 42 percentage points between the lowest and highest performing groups (33 to 75%).
• Large gains have been made since MHQP started reporting.
  The greatest improvements have come in women's health care with two chlamydia screening measures, which made 15 and 21 percentage point increases respectively over the seven years MHQP has been reporting these two measures.

• Over time, scores are improving.
  Some statewide measures have increased significantly in the seven years since MHQP started reporting. Well care visits for adolescents have increased from 67 to 74 percent over this time period, an improvement of seven percentage points. This score is also well above the national average, which comes in at 44 percent.

Reporting on differences in quality of care is critical as Massachusetts moves to enact legislation to improve health care delivery and meet the goals of health care reform. MHQP has been releasing data on clinical quality in primary care for the last seven years, serving as a primary resource to track trends of care in Massachusetts. "We are fortunate in Massachusetts to have an organization like MHQP that gives us the ability to identify opportunities for improvement and to monitor our progress over the course of time," said Edward Westrick, vice president of Medical Management for UMass Memorial Health Care and current chair of MHQP's Physician Council.

The new report summarizes care delivered by approximately 150 medical groups in Massachusetts, representing more than 4,000 primary care practitioners. Medical groups are organizations that employ or contract with doctors, nurses, therapists and others who treat and care for patients. Medical groups vary in size. Some groups are small, with just three or more doctors in one office; others are large, with many doctors' offices forming a medical group.

All regions of the state are represented. MHQP gathered data from five Massachusetts health plans: Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England and Tufts Health Plan.

The performance data are compiled from HEDIS®, a set of performance measures developed and maintained by the National Committee for Quality Assurance. The HEDIS® data are collected largely through insurance claims for medical office visits and procedures.

This effort contributes to MHQP's participation in the Robert Wood Johnson Foundation's Aligning Forces for Quality program, a national initiative in targeted communities across the country to improve the quality of health and health care through performance measurement and public reporting, among other efforts.