LDI Research Seminar_ Standardization under Group Incentives 4_27_12
Editor's Notes
We asked three main questions that the sort of national data available from CTS will put us in really a unique position to answer. First, how good is quality of care in the US? We have developed a comprehensive tool for measuring process quality of care which blends administrative, chart, and interview data sources for 50 or so conditions. This allows us to evaluate the quality of care that unselected respondents from the 12 intensive sites receive in a way that previous projects have not been able to. Second, how much does quality of care vary by community and demographic factors? Do diabetics in Indianapolis get better care than diabetics in Greenville? Do patients in managed care settings get better care than those in fee-for-service settings? The reason we care about the answers to this second question is because of the third - where are the greatest opportunities for improving care? Variations in observed quality of care point the validate ongoing quality improvement efforts. As Beth will show you, if Boston has higher mammography rates and a strong community based outreach program, perhaps Lansing can learn from the program and improve their rates.
Overall, 55.3% of the quality 3544 indicators triggered for medical conditions were passed. This was higher than the 43.6% of indicators in geriatric conditions that were passed.
For example, when a vulnerable elder presented with a fall with injury or multiple falls, the quality indicator states that the physician should examine the patient to detect the reason for the fall and identify problems which may be treatable so the patient will be less likely to fall again. Yet, the medical records revealed that only: 6% of patients who fell were evaluated for blood pressure standing and lying 1/4 had a vision exam 7% had a gait and balance examination, and 28% received a neurological examination. Such exams are necessary to identify patients who are weak and need physical therapy or patients with conditions such as Parkinson’s disease who need specific medication treatment.
What makes quality of care so important, is that quality is directly related to whether a vulnerable elder survives.
