PDF of QR 2008

Contents

Executive summary

Overview

Ch1: Healthcare Utilization

            Inpatient care

            Outpatient care

            Service Area

Ch2: Measuring Quality of Care

Inpatient Care

Pediatric Care

Prevention Indicators

Patient Safety

NCQA HEDIS

Ch3: Chronic Illness in Vermont

   Diabetes -  VHR

   Diabetes AHRQ Indicators

   VPQ Learning Community

   Dartmouth Atlas

Ch4: MRSA

Ch5: End of Life Care

   Care at End of Life

   Dartmouth Atlas

Ch6: Other Reports

Glossary

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The Vermont Health Record (VHR) is a chronic disease registry tool created for use by Vermont clinicians.  Developed in 2005, the tool can be used by primary care practices to help manage treatment plans for patients with diabetes, cardio-vascular disease, and hypertension.  Most of the patients in the VHR have diabetes.  Primary care practices using the VHR range in size from a single doctor to clinics with multiple doctors.  It is designed to enable primary care physicians to identify their patients with chronic disease, particularly those patients who have diabetes, and to monitor the care that they are receiving; a yearly foot exam, yearly eye exam, or regular A1C testing.  Currently there are 4,777 patients with diabetes who have data entered in the VHR. 

The measures presented here are considered standards of care, or best practice, for the treatment of patients with diabetes. The series of graphs that are included were created using data fromthe Vermont Health Record and depict where practices are in terms of the preventative care their patients are receiving.     There are 120,000 lab values entered in the VHR and 21,000 patient visits.  Data presented on each graph includes  a stand-alone clinic with a single Primary Care Physician, a nurse and about 100 patients with diabetes in the practice (VHR1); and  a group of 13 practices owned and operated by a single hospital representing roughly 2,000 patients with diabetes (VHRG).  The third line represents all of the patients with data entered in the VHR (VHR all). 

It is common for practices to start using the VHR by tracking a few aspects of care, and increase the amount of data entered as they become more comfortable with the VHR and want to take full advantage of it as a patient management tool.  The VHR1 practice uses most aspects of the VHR to highly manage patients. (VHR1), while the clinics within the VHRG group each function separately, and vary with regard to the level at which they use the VHR as a management tool.   

The bar chart to the left shows HbA1c testing at each of the practices within the VHRG during the past 12 months.  Some clinics have noticeably low numbers while others have met the HBA1C testing guidelines for 80 or 90 percent of their patients.  However, these numbers are most likely a reflection of how each practice is using the VHR, rather than a true reflection on where they are with preventative care.  Work with the registry indicates that when clinicians begin to have access to their data through the VHR, or other registry sources, rates of compliance with best practice increases.   

The following graphs present some of the other preventative care measures that can be monitored using the VHR.  Most practices using the VHR monitor HbA1c, LDL, and blood pressure.  A majority of the patients entered into the VHR are getting their HbA1c and LDL tested annually. 

Other routine preventative care measures for patients with diabetes include annual retinal exams and foot exams.  Data from the VHR indicates that the number of recorded eye exams in the last 12 months for people with diabetes is lower than for other preventative care measures.           

Highly managed patients are much more likely to have a documented self-management goal, blood pressure in control, and documentation of smoking status.  The VHR also allows practices to monitor microalbumin testing and control, diabetes education, immunizations, and medications.

Developed as a tool to support proactive disease management, the VHR allows practices to effectively manage patients with chronic illness.    The VHR does this by helping practices identify whether patients have missed required routine check-ups, specialty care, or laboratory testing.  Some practices use the VHR to track individual patient progress; others use it to monitor their entire population of patients with diabetes. This helps providers, and their teams, to spot areas for practice-wide improvement.  Since the VHR offers practices the flexibility to manage their patients using as many or as few of the preventative care measures as they want, it should be noted that the information presented in this chapter is a reflection of the data entered in the VHR and not necessarily reflective of all of the preventative care provided to patients with diabetes.