Viewpoint
From Doubter to Believer
I know it’s not very Minnesotan to highlight one’s achievements, but I am simply amazed by the progress some of the clinics in our group—Family HealthServices Minnesota—have made to improve their vascular care scores, one of the measures used to rate clinics in the state. Seven years ago, I wouldn’t have thought it was possible.
In July, MN Community Measurement released statewide results for optimal vascular care. Our White Bear Lake Clinic achieved optimal care for 70 percent of 125 of its patients with heart or vascular disease. Optimal care includes controlling patients’ blood pressure and cholesterol, getting them to stop smoking, and having those who need it take an aspirin a day. Overall, the percentage of patients who received optimal vascular care in the state jumped from 37.1 percent in 2008-2009 to 39.7 percent last year. That means about 3,500 additional Minnesotans with heart disease or vascular disease are receiving better care than in the past.
It is heartening to see changes like these, and it makes me feel proud that the MMA, as one of the founders of MN Community Measurement, has led in the move to improve the quality of care in Minnesota.
As a practitioner, I know how much work it is for clinics to move the needle on these measures. So how did we do it? Our strategy is to have doctors work with each patient to create an action plan. Together, they set goals for losing weight, improving eating habits, and using medications to lower blood pressure and improve cholesterol levels. They also discuss aspirin and tobacco use.
We find that this up-front work is the key to our success. When patients share in decisions about their health care, they are more likely to achieve the goals they set. Also critical to engaging patients is convincing them that these changes will make a difference in their quality of life and decrease their risk of having a stroke or heart attack. Another thing we do is give the patient a report card with letter grades based on how well they’ve met the goals in their action plan. This allows patients to measure their progress in a way that is easy to understand. I understand why some even proudly display their report cards on their refrigerator.
To further support our patients, we’ve hired a case manager who follows up with them by phone after their office visit. In addition, we’ve implemented an electronic medical record and have a patient registry to help us keep track of each patient’s progress. We’ve also tried different tactics to ensure the examining doctor always knows when a patient’s blood pressure is out of control. We tried leaving the blood pressure cuff on the patient and putting a sticky note on the exam room door. Eventually, we came up with a color code in the electronic medical record to indicate that a blood pressure was out of range.
As I said, I am amazed at the success we’ve been able to achieve. I remember going to a MN Community Measurement meeting seven years ago and thinking the combined diabetes measure was a bad idea. I believed a 30 percent rate of optimal care using that measure was probably the maximum that could be achieved. But now my personal case load is at 60 percent. I never thought I could get there.
The experience of going from doubter to believer has convinced me that the MMA needs to continue being a champion of quality improvement. Just like patients need encouragement from their doctor to try one more time to eat right and exercise, we as physicians also need encouragement from our colleagues to help us believe we really can make a difference in these areas.