Introduction and Overview

Part Two of this Checkup summarizes how Greater Cleveland’s adult patients with diabetes are doing in relation to nationally endorsed measures of care processes and outcomes, focusing on region-wide achievement and changes in achievement from our first report. Part Three of the Checkup provides detailed data on individual practices. Collectively, this report describes 25,634 patients of 42 partner practices in 7 health care organizations for the period July 1, 2007 through June 30, 2008. Included among these are 33 practice sites in 6 health care organizations that reported in our first Checkup, for which the reporting period was calendar year 2007. The availability of these longitudinal data on 33 practices allows a first glimpse at changes in achievement over time. We report these changes only in this part of the Checkup – focusing on the region - and we will identify changes for individual practice sites in future Checkups. Our decision not to report practice-level changes with this Checkup is due, in part, to the short and variable time frame between the practices’ first knowledge of their 2007 results (February-April, 2008) and the end date for this reporting period (June 30, 2008), allowing short and variable amounts of time for practices to institute practice-related improvement processes.
 
In section B, we compare our region-wide results to the achievement of health plans nationwide on standards reported by the National Committee on Quality Assurance (NCQA) in 2007, the most recently published report. NCQA’s nine “Comprehensive Diabetes Care Measures” are a combination of process and outcome measures, including one measure of “Poor Glycemic Control” for which lower results are better. In its State of Health Care Quality publication (available at www.ncqa.org, see pp. 35-37), NCQA reports results for health plans grouped by primary insurer (Medicare, Commercial, Medicaid): in addition to this grouping, in Table 1 we add to this grouping our achievement among uninsured patients as well.

In the next few sections, we summarize region-wide achievement on Better Health’s individual and composite standards, followed by descriptions of our achievement in different sub-groupings of Greater Cleveland’s patients by race (white, African-American, Hispanic), household income (high, medium, and low, as compared to Cuyahoga County overall), estimated educational attainment (high, medium, and low, as compared to Cuyahoga County overall), and insurance (Medicare, commercial, Medicaid, and uninsured).

In section H we examine changes in region-wide achievement on Better Health’s individual and composite standards, comparing results from the current reporting period to results from calendar year 2007. 

In section I we summarize new challenges we face as a community. Included here are results from the Dartmouth Atlas Project that compare Cleveland’s results on other important diabetes measures with the results from other sites in the national Aligning Forces for Quality initiative.

In section J we describe opportunities to accelerate region-wide improvement by using the data available to us in Better Health. In particular, we display results that enable us to identify Exceptional Achievers and/or Exceptional Improvers – practices or organizations that are good outliers in their performance or performance improvement. By sharing replicable “best practices” with other organizations or practice sites, these Exceptional sites can help disseminate changes and accelerate improvement.

Finally, in section K, we briefly summarize our region-wide findings in a nationwide context and identify ways in which everyone in the community can contribute to Better Health.