Overall Achievement on Composite and Individual Standards, July 2007 - June 2008

Figures 2 and 3 highlight the region’s overall achievement on our composite Outcome Standard, its 5 component individual standards, and our composite Care Process Standard and its 4 individual standards. Included are patients cared for by 31 practices using electronic medical records as well as 11 practices using paper-based medical records for measuring their care and outcomes. These systems and their patients are described in detail in Part Three of the Checkup. Collectively, we report on 25,634 patients of the 42 partner practices at our seven reporting health care systems: Care Alliance, Cleveland Clinic, Huron Hospital, Kaiser Permanente, The MetroHealth System, Neighborhood Family Practice and NEON.

Figure 2 displays achievement on our composite and individual Outcomes standards. The composite Outcomes standard requires at least four out of five measures under good control (blood sugar [hemoglobin A1c], blood pressure, cholesterol, weight and not smoking).

Figure 2. Region-Wide Achievement on Better Health's Composite Outcome Standard and its Five Component Standards, July 2007 - June 2008


Overall, 38% of our patients met the Composite Outcome Standard. Achievement on individual standards varied. Collectively, 82% had target LDL cholesterol levels (less than 100) and/or were prescribed a statin medication; 80% were documented non-smokers; 68% had target Hemoglobin A1c levels (less than 8); 50% met target blood pressure levels (lower than 140/80), and only 30% met target levels for weight control (Body Mass Index below 30).

Figure 3 displays achievement on our composite and individual Care Processes standards. The Care Processes standard requires that all four standards be met (blood sugar test done, kidney screening or medication, eye examination done and pneumonia vaccine given.) 

Figure 3. Region-Wide Achievement on Better Health's Composite Care Process Standard and its Four Component Standards, July 2007 - June 2008


Collectively, 47% of our patients met all 4 Process Standard targets in the reporting period with the remaining 56% meeting 3 or fewer standards. 94% of patients had one or more Hb A1c test obtained, 90% had a urine test for kidney problems or were on medications to delay kidney failure, 75% had a documented Pneumococcal vaccination, and 63% had a documented eye examination during the reporting period. The rate of eye examinations was probably higher than we report here due to undocumented examinations outside of our partner practices, but the magnitude of this under-reporting is not known.