Feb 28, 2012 - Well Care Visits for Adolescents Ages 12 to 21. 156. 91.4%. 39.2%. 52.1%. Annual Monitoring for Patients on Persistent. Medications - D...
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Clinical Quality Report 2011 HEDIS Results for Performance Year 2010
Table of Contents
Key Findings…………………………………………………………………………………………………..
i
Conclusion……………………………………………………………………………………….………...…..
iv
About This Report………………………………………………………………………………….……...…..
v
Trend Data for Process Measures…………………………………………………………………...………...
1
Trend Data for Outcome Measures……………………………………………………………………………
4
Comparisons of MA Measure Rates to NCQA National Benchmarks………………………………….…….
5
Comparisons of MA Outcome Measure Rates to the NCQA National Average and the 90th Percentile….…
7
Outcome Measures and their Corresponding Process Measures Trended for Four Years………………….…
8
Range of Medical Group Scores………………………………………………………………………………
9
Trended Variation Among Medical Groups…………………………………………………………….…….. 11 Regional Variation for Process Measures……………………………………………………………………..
13
Variation among Practices…………………………………………………………………………………….
21
Range of Medical Group Scores by Region…………………………………………………………………... 23 Graphs of Seven-Year Trend Measures……………………………………………………………………….
30
Key Findings Medical groups in Massachusetts continue to do extremely well when compared to the National NCQA Results.
MA statewide results are above the national average on 23 of 24 process measures and on all six outcomes measures. MA results are equal to or better than the national 90th percentile score on 13 of the 24 process measures and on one of six outcomes measures. The state as a whole falls below the national average on only one measure; Use of Appropriate Medications for People with Asthma Ages 12 to 50 (MA score: 89%; national average: 92%). Between the performance years 2009 and 2010, there was virtually no decline in the performance rates for Massachusetts. Three measures had a positive rate increase over the two years of 2 points and above, appropriate testing for children with Pharyngitis, Chlamydia screening ages 16-20, and follow-up of care of ADHD medications – initiation phase (Table 1).
As a state, MA has improved over time on all process measures that can be trended for 7 years (Table 2).
The largest improvements have come in women’s health care with the 2 chlamydia screening measures (15 and 19 percentage point increases) and well-child visits for infants, which has increased 7 percentage points between PY 04 and this year. Smaller improvements were seen in anti-depression medication management (3 points for the acute phase and 5 points for the continuation phase), well care visits for adolescents (3 points), diabetes care (testing HbA1c: 2 points), and well-child visits for 3-6 year olds (2 points).
All outcome measures also trended positively over the 5 years they have been calculated (Table 3). The largest improvements over five years were in LDL-C control for patients with cardiovascular conditions (10 point improvement from 61% to 71%), LDL-C control for comprehensive diabetes care (9 point improvement from 47% to 56%), and blood pressure control for comprehensive diabetes care (9 point improvement from 66% to 75%). There was a 4 point improvement in both controlling high blood pressure (general population) and HbA1c poor control for comprehensive diabetes care. Most measures show wide variation in performance among medical groups in MA, suggesting there is room for improvement among the groups even as the state as a whole is doing quite well (Table 7). o Of the 24 process measures reported across medical groups half showed variations of 40 percentage points or higher between the highest and lowest performing medical groups. The measures with the highest variation were: o Chlamydia Screening in women ages 16-20 (70 percentage point variation) o Annual Monitoring for Patients on Persistent Medication Total Rate (59 percentage points) o Chlamydia Screening in Women ages 21 to 24 (54 percentage points) o Use of Spirometry Testing in the Assessment and Diagnosis of COPD (53 percentage points) i
o Well Care Visits for Adolescents ages 12-21 (52 percentage points) o Annual Monitoring for Patients on Persistent Medications Diuretics (51 percentage points)
Only 2 process measures showed variations of 20 percentage points or lower. These are the same measures as last year, with approximately the same variation in medical group scores. o Use of Appropriate Medications for People with Asthma - Ages 5 to 11 (10 percentage points) o Comprehensive Diabetes Care - HbA1c Testing (20 percentage points)
For 9 of the 24 processes measures, the medical group high score was 100%, two more measures than achieved this distinction in 2009. The measures were: o o o o o o o
Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Respiratory Infection (URI) Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11 Use of Appropriate Medications for People with Asthma: People Ages 12 to 50 Comprehensive Diabetes Care - Medical Attention for Nephropathy Comprehensive Diabetes Care - HbA1c Testing Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening
The two new measures to reach this distinction were: o Comprehensive Diabetes Care- LDL-C Screening o Well-Child Visits first 15 Months of Life
Variation among Regions There is very little variation in scores across the six regions within Massachusetts and all regions do well when compared to National NCQA Benchmarks (Table 9). o Of the 24 process measures that are publicly reportable at the medical group level, 13 showed across region variation of equal or fewer than 5 percentage points. o All six regions performed at or above the NCQA National 90th Percentile for 5 process measures and at or above the National Average for a total of 16 measures. There were 3 measures publicly reportable at the medical group level with a regional variation of 10 percentage points or greater: o Chlamydia Screening in Women ages 16 to 20 varied by 13 percentage points with Metro Boston at 66% to Metro West at 53%. o Colorectal Cancer Screening was the highest in Metro Boston at 82%, and lowest in Western MA at 72%, a difference of 10 percentage points. o Use of Spirometry Testing in the Assessment and Diagnosis of COPD ranged from 51% in Western MA to 38% in Central MA, a difference of 13 points. ii
There was almost no regional variation for six measures: o There was only a 2 point difference in the high and low regional scores for Breast Cancer Screening, and both asthma measures: Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11, and Use of Appropriate Medications for People with Asthma: Ages 12 to 50. o There was only a 3 point difference in the high and low regional scores for Appropriate Treatment for Children with Upper Respiratory Infection, Comprehensive Diabetes Care – HbA1c Testing, and Well Child Visit in the First 15 Months of Life.
Variation Among Practice Sites The variation among practices for measures where at least 50% of practice sites met the thresholds of 3+ physicians and 30 or more patients was analyzed (Table 10). The following was of note:
The measure with the highest practice variation was Appropriate Testing for Children with Pharyngitis. 163 practices had a score for this measure, with a variation of 88 points between the lowest score of 12% and the highest at 100%.
The measure with the least amount of practice variation was Use of Appropriate Medications for People with Asthma – ages 5 to 11, with a variation of 8 points between the lowest score of 92% and highest score of 100%.
Variation within Regions Central MA showed the least variation among its medical groups with only 1 measure (Annual Monitoring for Patients on Persistent Medication-Total) varying by 40 percentage points or more (Table 11):
Metro Boston and Northeastern each had 4 measures with a large variation in medical group scores. Southeastern had 3, and Western MA and MetroWest each had 2.
There were a few measures that showed high variation in medical group scores in the majority of regions:
The measure that showed the highest variation within regions was Chlamydia Screening in Women Ages 16 to 20. This measure showed high variation in 3 of the 6 regions. Well care visits ages 12-21 had variation of over 30 percentage points in all 6 regions. Colorectal Cancer Screening also showed a high variation in medical group scores in all regions. The difference between the high and low scores ranged from 22% in MetroWest MA to 39% in Northeastern MA. Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11 had low variation in all of the regions, ranging from 1 percentage point in Western MA to 8 percentage points in Central MA.
iii
Conclusion Overall the Quality Insights CQ Analytic Report demonstrates that the quality of health care provided to Massachusetts residents continues to be outstanding across the entire Commonwealth. The key areas of focus for the state might be performance on measures where the following is true:
The Massachusetts rate is lower than the national average: o Use of Appropriate Medications for People with Asthma: People Ages 12-50
Both the Massachusetts rate and the national rate are low: o Use of Spirometry Testing in the Assessment and Diagnosis of COPD o Follow-up of Care of Children Prescribed ADHD medication, both initiation and continuation phases o Antidepressant Medication Management –Effective Continuation Phase Treatment
There is high variation across medical groups, suggesting there is room for improvement among the groups even as the state as a whole is doing quite well: o Chlamydia Screening (ages 16-20 and ages 21-24) o Annual Monitoring of Patients on Persistent Medications – Total Rate o Use of Spirometry Testing in the Assessment and Diagnosis of COPD o Well Care Visits for Adolescents Ages 12 -21 o Annual Monitoring of Patients on Persistent Medications - Diuretics
Details on all of the findings described above can be found in the following report.
iv
About MHQP Massachusetts Health Quality Partners (MHQP) is a not for profit broad-based coalition of providers, health plans, purchasers, consumers and government agencies working together to promote improvement in the quality of health care services in Massachusetts. Through its Quality Insights reports, MHQP provides stakeholders and the public with valid and reliable clinical quality and patient experience of care information. MHQP staff works closely with MHQP’s Physician Council, MHQP’s Health Plan Council, the Massachusetts Medical Society and others to design reports that take advantage of the best available data. We also collaborated with dedicated individuals from medical groups and physician networks in order to ensure that provider data is attributed to the practice sites and medical groups in which they practiced during the measurement year. Our reports can be viewed on our website, www.mhqp.org.
The Clinical Quality Report The Quality Insights: Clinical Quality in Primary Care Report (CQ Report) compares the performance of medical groups and practice sites on the delivery of preventive and chronic care services. The most recent CQ Report includes 2010 performance results and state and national benchmarks as well as trends from 2004 to 2010. In this report MHQP aggregates physician clinical process and outcomes data from five Massachusetts health plans— Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, and Tufts Health Plan. The clinical performance measures included in this report are drawn from Healthcare Effectiveness Data and Information Set (HEDIS®), a set of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). The HEDIS® data are collected largely through insurance claims for hospitalizations, medical office visits, and procedures. To ensure that HEDIS® stays current, NCQA annually convenes a broad-based group representing employers, consumers, health plans and others to decide on the content of HEDIS®.
The Quality Insights CQ Analytic Report This Quality Insights CQ Analytic Report which follows provides an analysis of aggregated HEDIS® process and outcome measures that may be publicly reported on the MHQP website. Process measures, which are reported at the medical group and state level, and outcomes measures, which are reported at the state level only, are compared to the statewide and national NCQA benchmarks. In addition, a subset of the process measures is trended over seven years to show statewide changes in clinical quality performance. The outcome measures are trended for five years. Finally this report includes analyses of the variation in scores across Massachusetts and within six geographic regions in the Commonwealth.
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Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Trend Data for Process Measures Two-year Trend Table 1: Process Measures Trended for Two Years Note: Shaded measures show a change of ≥ ±2%
MA Rate, HEDIS 11, Performance Year 2010
MA Rate, HEDIS 10, Peformance Year 2009
Change
93.4%
90.1%
3.4%
60.2%
57.2%
3.0%
47.7%
45.2%
2.5%
63.7%
61.9%
1.8%
94.2%
92.5%
1.7%
Antidepressant Medication Management - Effective Acute Phase Treatment
68.8%
67.8%
0.9%
Antidepressant Medication Management - Effective Continuation Phase Treatment
53.1%
52.2%
0.9%
91.4%
90.6%
0.8%
94.9%
94.2%
0.7%
92.8%
92.1%
0.6%
78.1%
77.5%
0.6%
74.1%
73.5%
0.6%
Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
97.5%
97.0%
0.5%
Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening
92.4%
92.0%
0.4%
78.4%
78.1%
0.3%
Annual Monitoring for Patients on Persistent Medications Diuretics
83.9%
83.7%
0.2%
Comprehensive Diabetes Care - Medical Attention for Nephropathy
89.6%
89.4%
0.2%
Annual Monitoring for Patients on Persistent Medications Total rate
83.6%
83.5%
0.1%
83.2%
83.1%
0.1%
Measure Name Appropriate Testing for Children with Pharyngitis Chlamydia Screening in Women Ages 16 to 20 Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase Chlamydia Screening in Women Ages 21 to 24 Well-Child Visits first 15 Months of Life
Comprehensive Diabetes Care - LDL-C Screening Appropriate Treatment for Children with Upper Respiratory Infection (URI) Well-Child Visits Ages 3 to 6 Colorectal Cancer Screening Well Care Visits for Adolescents Ages 12 to 21
Use of Imaging Studies for Low Back Pain
Breast Cancer Screening
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
1
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Trend Data for Process Measures Two-year Trend Table 1: Process Measures Trended for Two Years Note: Shaded measures show a change of ≥ ±2%
MA Rate, HEDIS 11, Performance Year 2010
MA Rate, HEDIS 10, Peformance Year 2009
Change
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
44.0%
44.0%
0.0%
Annual Monitoring for Patients on Persistent Medications ACE Inhibitors or ARBs
84.1%
84.1%
0.0%
93.9%
94.0%
-0.1%
86.7%
86.8%
-0.1%
89.5%
89.8%
-0.3%
Measure Name
Comprehensive Diabetes Care - HbA1c Testing Cervical Cancer Screening Use of Appropriate Medications for People with Asthma: People Ages 12 to 50
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
2
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Trend Data for Process Measures Seven-year trend for Publicly Reportable Process Measures Table 2: Process Measures Trended for Seven Years Note: Shaded measures show a change of ≥ ± 4%
Measure Name
Ma Rate, Ma Rate, Ma Rate, Ma Rate, Ma Rate, Ma Rate, Ma Rate, Change HEDIS11, HEDIS10, HEDIS09, HEDIS08, HEDIS07, HEDIS06, HEDIS05, from PY10 PY09 PY08 PY07 PY06 PY05 PY04 HEDIS05 to HEDIS11
Chlamydia Screening in Women Ages 21 to 24
63.7%
61.9%
57.4%
52.9%
50.6%
48.2%
44.8%
18.9%
Chlamydia Screening in Women Ages 16 to 20
60.2%
57.2%
54.5%
50.8%
48.8%
46.6%
45.0%
15.2%
Well-Child Visits first 15 Months of Life
94.2%
92.5%
96.1%
94.4%
96.4%
91.7%
87.5%
6.8%
Antidepressant Medication Management - Effective Continuation Phase Treatment
53.1%
52.2%
50.9%
50.7%
51.1%
49.8%
48.6%
4.6%
Antidepressant Medication Management - Effective Acute Phase Treatment
68.8%
67.8%
66.8%
66.7%
66.7%
65.2%
65.6%
3.2%
Well Care Visits for Adolescents Ages 12 to 21
74.1%
73.5%
74.2%
72.9%
72.6%
70.8%
71.1%
3.0%
Comprehensive Diabetes Care HbA1c Testing
93.9%
94.0%
93.0%
95.5%
92.0%
94.7%
92.2%
1.7%
92.8%
92.1%
92.7%
92.3%
91.3%
91.5%
91.2%
1.6%
Well-Child Visits Ages 3 to 6
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
3
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Trend Data for Outcome Measures Outcome Measures Trended for Five Years Table 3: Outcome Measures Trended for Five Years Note: Shaded measures show a change of ≥ ± 4%
MA Rate, MA Rate, MA Rate, MA Rate, MA Rate, HEDIS 11, HEDIS 10, HEDIS 09, HEDIS 08, HEDIS 07, PY 10 PY 09 PY 08 PY 07 PY 06
Measure Name
Change from HEDIS 07 to HEDIS 11
Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Control
70.9%
67.5%
67.9%
68.0%
61.4%
9.5%
Comprehensive Diabetes Care - LDL-C Controlled (less than 100 mg/dl)
56.1%
53.0%
53.9%
51.0%
46.9%
9.2%
Comprehensive Diabetes Care - Blood Pressure Control <140/90 mm Hg
74.6%
73.6%
71.7%
68.9%
66.0%
8.6%
71.3%
71.6%
71.1%
68.9%
67.3%
4.0%
84.6%
83.0%
82.5%
81.3%
80.7%
3.9%
Controlling High Blood Pressure
Comprehensive Diabetes Care - Poor HbA1C Control (>9.0%) (Inverted for the purpose of ranking)
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
4
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Comparisons of MA Measure Rates to NCQA National Benchmarks Table 4: Comparisons of MA Process Rates to the NCQA National Average and the 90th Percentile Orange Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th
Blue Shading
(darker shading in print) = MA did equal to or better than the NCQA National Average
Black Shading
(darkest shading in print) = MA did worse than the NCQA National Average
MA Rate
National Average
National 90th Percentile
Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
97.5%
96.7%
99.2%
Appropriate Treatment for Children with Upper Respiratory Infection (URI)
94.9%
85.1%
94.5%
94.2%
76.3%
89.6%
93.9%
89.9%
94.2%
93.4%
77.6%
90.5%
92.8%
71.6%
84.5%
92.4%
88.9%
93.7%
91.4%
85.6%
91.0%
Comprehensive Diabetes Care - Medical Attention for Nephropathy
89.6%
83.6%
89.6%
Use of Appropriate Medications for People with Asthma: People Ages 12 to 50
89.5%
91.8%
95.0%
86.7%
77.0%
83.2%
Annual Monitoring for Patients on Persistent Medications ACE Inhibitors or ARBs
84.1%
81.6%
86.5%
Annual Monitoring for Patients on Persistent Medications Diuretics
83.9%
81.0%
86.1%
Annual Monitoring for Patients on Persistent Medications Total rate
83.6%
80.9%
85.9%
83.2%
70.8%
79.5%
78.4%
74.2%
82.0%
78.1%
62.6%
74.2%
74.1%
42.7%
60.2%
68.8%
64.7%
73.5%
63.7%
45.7%
61.4%
Measure Name
Well-Child Visits first 15 Months of Life
Comprehensive Diabetes Care - HbA1c Testing Appropriate Testing for Children with Pharyngitis Well-Child Visits Ages 3 to 6
Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening Comprehensive Diabetes Care - LDL-C Screening
Cervical Cancer Screening
Breast Cancer Screening Use of Imaging Studies for Low Back Pain Colorectal Cancer Screening Well Care Visits for Adolescents Ages 12 to 21 Antidepressant Medication Management - Effective Acute Phase Treatment Chlamydia Screening in Women Ages 21 to 24
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
5
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Comparisons of MA Measure Rates to NCQA National Benchmarks Table 4: Comparisons of MA Process Rates to the NCQA National Average and the 90th Percentile Orange Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th
Blue Shading
(darker shading in print) = MA did equal to or better than the NCQA National Average
Black Shading
(darkest shading in print) = MA did worse than the NCQA National Average
MA Rate
National Average
National 90th Percentile
60.2%
40.8%
53.9%
Antidepressant Medication Management - Effective Continuation Phase Treatment
53.1%
48.3%
56.7%
Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase
47.7%
38.8%
49.0%
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
44.0%
41.7%
52.2%
Measure Name Chlamydia Screening in Women Ages 16 to 20
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
6
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Comparisons of MA Outcome Measure Rates to the NCQA National Average and the 90th Percentile Table 5: Comparisons of MA Outcome Measure Rates to the NCQA National Average and the 90th Percentile Orange Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th
Blue Shading
(darker shading in print) = MA did equal to or better than the NCQA National Average
Black Shading
(darkest shading in print) = MA did worse than the NCQA National Average
MA Rate
National Average
National 90th Percentile
74.6%
65.7%
75.9%
71.3%
63.4%
74.1%
Comprehensive Diabetes Care - Good HbA1c Control (< 8.0%)
71.2%
62.3%
72.0%
Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Control
70.9%
59.9%
72.0%
Comprehensive Diabetes Care - LDL-C Controlled (less than 100 mg/dl)
56.1%
47.7%
57.2%
Comprehensive Diabetes Care - Poor HbA1c Control (> 9.0%) (Lower is better)
15.4%
27.3%
16.8%
Measure Name Comprehensive Diabetes Care - Blood Pressure Control <140/90 mm Hg Controlling High Blood Pressure
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
7
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Outcome Measures and their Corresponding Process Measures trended for Four Years Table 6: Outcome Measures and Their Corresponding Process Measures Trended for Four Years HEDIS 11
HEDIS 10
HEDIS 09
HEDIS 08
Change HEDIS 08-11
Screening
93.4%
94.0%
93.0%
95.5%
-1.6%
Control
84.6%
83.0%
82.5%
81.3%
3.3%
Screening
91.4%
90.6%
91.1%
90.9%
0.5%
Control
56.1%
53.0%
53.9%
51.0%
5.0%
Measure Diabetes HbA1C Diabetes LDL-C
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
8
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores Orange Shading Blue Shading
Table 7: Range of Medical Group Scores (lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
124
11.7%
81.5%
69.8%
151
36.5%
95.3%
58.7%
130
26.9%
81.3%
54.4%
65
14.3%
67.4%
53.2%
156
39.2%
91.4%
52.1%
145
46.9%
97.6%
50.7%
150
47.4%
94.8%
47.4%
94
41.7%
87.1%
45.4%
150
55.4%
100.0%
44.6%
94
33.3%
76.3%
43.0%
135
50.9%
91.3%
40.4%
90
59.6%
100.0%
40.4%
151
62.5%
96.0%
33.5%
Comprehensive Diabetes Care - Medical Attention for Nephropathy
150
66.7%
100.0%
33.3%
Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase
37
29.8%
60.6%
30.8%
Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening
114
73.5%
100.0%
26.5%
Use of Appropriate Medications for People with Asthma: People Ages 12 to 50
106
73.7%
100.0%
26.3%
Appropriate Treatment for Children with Upper Respiratory Infection (URI)
98
75.0%
100.0%
25.0%
Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs
146
72.2%
97.2%
25.0%
Measure Name
Chlamydia Screening in Women Ages 16 to 20 Annual Monitoring for Patients on Persistent Medications - Total rate Chlamydia Screening in Women Ages 21 to 24 Use of Spirometry Testing in the Assessment and Diagnosis of COPD Well Care Visits for Adolescents Ages 12 to 21
Annual Monitoring for Patients on Persistent Medications - Diuretics Colorectal Cancer Screening Antidepressant Medication Management Effective Acute Phase Treatment
Comprehensive Diabetes Care - LDL-C Screening Antidepressant Medication Management Effective Continuation Phase Treatment Use of Imaging Studies for Low Back Pain
Appropriate Testing for Children with Pharyngitis Breast Cancer Screening
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
9
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores Orange Shading Blue Shading
Table 7: Range of Medical Group Scores (lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Measure Name
Well-Child Visits Ages 3 to 6 Well-Child Visits first 15 Months of Life Cervical Cancer Screening Comprehensive Diabetes Care - HbA1c Testing Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
2/28/2012
Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
106
75.0%
98.6%
23.6%
82
76.7%
100.0%
23.3%
153
70.8%
93.8%
23.1%
150
80.0%
100.0%
20.0%
38
90.3%
100.0%
9.7%
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
10
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Trended Variation Among Medical Groups Table 8: Measures Trended for 5 Years, Medical Group Variance between Lowest and Highest Score HEDIS 11, PY 10
HEDIS 10, PY 09
HEDIS 09, PY 08
HEDIS 08, PY 07
HEDIS 07, PY 06
MA MA MA MA MA Rate 10 Var 10 Rate 09 Var 09 Rate 08 Var 08 Rate 07 Var 07 Rate 06 Var 06
Measure Name Antidepressant Medication Management - Effective Acute Phase Treatment Antidepressant Medication Management - Effective Continuation Phase Treatment
68.8%
45.4%
67.8%
41.7%
66.8%
49.4%
66.7%
36.4%
66.7%
39.5%
53.1%
43.0%
52.2%
47.3%
50.9%
49.4%
50.7%
41.0%
51.1%
43.5%
83.2%
33.5%
83.1%
26.8%
81.7%
27.0%
80.1%
27.6%
80.2%
27.6%
86.7%
23.1%
86.8%
27.0%
87.5%
24.5%
90.5%
20.9%
88.3%
43.8%
60.2%
69.8%
57.2%
54.0%
54.5%
65.3%
50.8%
48.4%
48.8%
51.4%
63.7%
54.4%
61.9%
39.9%
57.4%
46.9%
52.9%
45.5%
50.6%
45.7%
93.9%
20.0%
94.0%
15.3%
93.0%
17.0%
95.5%
18.1%
92.0%
17.8%
91.4%
44.6%
90.6%
46.5%
91.1%
44.1%
90.9%
46.6%
89.0%
37.3%
89.6%
33.3%
89.4%
32.4%
88.3%
39.6%
88.3%
34.4%
84.4%
27.6%
94.2%
23.3%
92.5%
21.3%
96.1%
35.6%
94.4%
38.8%
96.4%
28.2%
92.8%
23.6%
92.1%
35.8%
92.7%
38.5%
92.3%
37.1%
91.3%
26.1%
Breast Cancer Screening
Cervical Cancer Screening
Chlamydia Screening in Women Ages 16 to 20
Chlamydia Screening in Women Ages 21 to 24
Comprehensive Diabetes Care HbA1c Testing
Comprehensive Diabetes Care LDL-C Screening
Comprehensive Diabetes Care Medical Attention for Nephropathy
Well-Child Visits first 15 Months of Life
Well-Child Visits Ages 3 to 6
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
11
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Trended Variation Among Medical Groups Table 8: Measures Trended for 5 Years, Medical Group Variance between Lowest and Highest Score HEDIS 11, PY 10
HEDIS 10, PY 09
HEDIS 09, PY 08
HEDIS 08, PY 07
HEDIS 07, PY 06
MA MA MA MA MA Rate 10 Var 10 Rate 09 Var 09 Rate 08 Var 08 Rate 07 Var 07 Rate 06 Var 06
Measure Name Well Care Visits for Adolescents Ages 12 to 21
Comprehensive Diabetes Care Poor HbA1c Control (> 9.0%) (Lower is better)
Comprehensive Diabetes Care LDL-C Controlled (less than 100 mg/dl)
74.1%
52.1%
73.5%
45.0%
74.2%
51.5%
72.9%
55.6%
72.6%
48.7%
15.4%
16.5%
17.0%
22.3%
17.5%
15.2%
18.7%
17.7%
19.3%
25.5%
56.1%
36.4%
53.0%
36.5%
53.9%
44.1%
51.0%
25.7%
46.9%
45.8%
71.3%
15.6%
71.6%
16.0%
71.1%
17.4%
68.9%
11.4%
67.3%
27.4%
94.9%
25.0%
94.2%
38.6%
92.9%
30.5%
92.3%
39.3%
90.3%
35.9%
93.4%
40.4%
90.1%
62.8%
87.6%
72.7%
82.3%
68.1%
80.2%
77.7%
78.1%
47.4%
77.5%
37.0%
75.0%
43.2%
68.9%
47.2%
69.4%
59.0%
78.4%
40.4%
78.1%
35.0%
77.4%
44.4%
79.8%
33.1%
79.9%
30.7%
Controlling High Blood Pressure
Appropriate Treatment for Children with Upper Respiratory Infection (URI) Appropriate Testing for Children with Pharyngitis
Colorectal Cancer Screening
Use of Imaging Studies for Low Back Pain
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
12
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Regional Analyses Regional Variation for Process Measures Table 9: Regional Variation for Process Measures Orange Shading Blue Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th (darker shading in print) = MA did equal to or better than the NCQA National Average
Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Southeastern MA
85.4%
84.1%
81.6%
86.5%
Central MA
84.4%
84.1%
81.6%
86.5%
MetroWest MA
84.3%
84.1%
81.6%
86.5%
Northeastern MA
84.0%
84.1%
81.6%
86.5%
Metro Boston
83.3%
84.1%
81.6%
86.5%
Western MA
81.3%
84.1%
81.6%
86.5%
Regional Variation:
4%
Annual Monitoring for Patients on Persistent Medications - Diuretics Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Southeastern MA
85.3%
83.9%
81.0%
86.1%
Central MA
84.3%
83.9%
81.0%
86.1%
MetroWest MA
84.2%
83.9%
81.0%
86.1%
Northeastern MA
83.9%
83.9%
81.0%
86.1%
Metro Boston
83.2%
83.9%
81.0%
86.1%
Western MA
81.0%
83.9%
81.0%
86.1%
Regional Variation:
4%
Annual Monitoring for Patients on Persistent Medications - Total rate Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Southeastern MA
84.9%
83.6%
80.9%
85.9%
Central MA
84.0%
83.6%
80.9%
85.9%
MetroWest MA
83.8%
83.6%
80.9%
85.9%
Northeastern MA
83.5%
83.6%
80.9%
85.9%
Metro Boston
82.9%
83.6%
80.9%
85.9%
Western MA
80.8%
83.6%
80.9%
85.9%
Regional Variation:
2/28/2012
4%
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13
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Regional Analyses Regional Variation for Process Measures Table 9: Regional Variation for Process Measures Orange Shading Blue Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th (darker shading in print) = MA did equal to or better than the NCQA National Average
Antidepressant Medication Management - Effective Acute Phase Treatment Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
MetroWest MA
70.9%
68.8%
64.7%
73.5%
Northeastern MA
70.2%
68.8%
64.7%
73.5%
Metro Boston
69.5%
68.8%
64.7%
73.5%
Southeastern MA
68.6%
68.8%
64.7%
73.5%
Western MA
68.5%
68.8%
64.7%
73.5%
Central MA
64.5%
68.8%
64.7%
73.5%
Regional Variation:
6%
Antidepressant Medication Management - Effective Continuation Phase Treatment Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Northeastern MA
55.5%
53.1%
48.3%
56.7%
MetroWest MA
55.1%
53.1%
48.3%
56.7%
Metro Boston
53.3%
53.1%
48.3%
56.7%
Southeastern MA
52.9%
53.1%
48.3%
56.7%
Western MA
52.6%
53.1%
48.3%
56.7%
Central MA
47.1%
53.1%
48.3%
56.7%
Regional Variation:
8%
Appropriate Testing for Children with Pharyngitis Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
MetroWest MA
95.7%
93.4%
77.6%
90.5%
Northeastern MA
94.3%
93.4%
77.6%
90.5%
Southeastern MA
93.8%
93.4%
77.6%
90.5%
Western MA
92.2%
93.4%
77.6%
90.5%
Central MA
91.9%
93.4%
77.6%
90.5%
Metro Boston
91.1%
93.4%
77.6%
90.5%
Regional Variation:
2/28/2012
5%
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
14
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Regional Analyses Regional Variation for Process Measures Table 9: Regional Variation for Process Measures Orange Shading Blue Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th (darker shading in print) = MA did equal to or better than the NCQA National Average
Appropriate Treatment for Children with Upper Respiratory Infection (URI) Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Western MA
97.0%
94.9%
85.1%
94.5%
Metro Boston
96.7%
94.9%
85.1%
94.5%
MetroWest MA
96.0%
94.9%
85.1%
94.5%
Central MA
95.3%
94.9%
85.1%
94.5%
Northeastern MA
94.2%
94.9%
85.1%
94.5%
Southeastern MA
94.0%
94.9%
85.1%
94.5%
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Metro Boston
84.3%
83.2%
70.8%
79.5%
Northeastern MA
83.8%
83.2%
70.8%
79.5%
Southeastern MA
83.2%
83.2%
70.8%
79.5%
MetroWest MA
82.1%
83.2%
70.8%
79.5%
Western MA
82.0%
83.2%
70.8%
79.5%
Central MA
81.8%
83.2%
70.8%
79.5%
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Northeastern MA
87.9%
86.7%
77.0%
83.2%
Metro Boston
87.5%
86.7%
77.0%
83.2%
Southeastern MA
86.9%
86.7%
77.0%
83.2%
MetroWest MA
86.7%
86.7%
77.0%
83.2%
Central MA
85.6%
86.7%
77.0%
83.2%
Western MA
83.0%
86.7%
77.0%
83.2%
Regional Variation:
3%
Breast Cancer Screening Region
Regional Variation:
2%
Cervical Cancer Screening Region
Regional Variation:
2/28/2012
5%
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15
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Regional Analyses Regional Variation for Process Measures Table 9: Regional Variation for Process Measures Orange Shading Blue Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th (darker shading in print) = MA did equal to or better than the NCQA National Average
Chlamydia Screening in Women Ages 16 to 20 Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Metro Boston
65.5%
60.2%
40.8%
53.9%
Southeastern MA
62.5%
60.2%
40.8%
53.9%
Northeastern MA
61.3%
60.2%
40.8%
53.9%
Western MA
59.2%
60.2%
40.8%
53.9%
Central MA
54.2%
60.2%
40.8%
53.9%
MetroWest MA
52.7%
60.2%
40.8%
53.9%
Regional Variation:
13%
Chlamydia Screening in Women Ages 21 to 24 Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Metro Boston
67.0%
63.7%
45.7%
61.4%
Northeastern MA
65.2%
63.7%
45.7%
61.4%
Western MA
63.2%
63.7%
45.7%
61.4%
Southeastern MA
62.1%
63.7%
45.7%
61.4%
Central MA
61.9%
63.7%
45.7%
61.4%
MetroWest MA
60.8%
63.7%
45.7%
61.4%
Regional Variation:
6%
Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Central MA
95.0%
92.4%
88.9%
93.7%
MetroWest MA
93.5%
92.4%
88.9%
93.7%
Metro Boston
93.2%
92.4%
88.9%
93.7%
Southeastern MA
92.5%
92.4%
88.9%
93.7%
Northeastern MA
92.2%
92.4%
88.9%
93.7%
Western MA
88.5%
92.4%
88.9%
93.7%
Regional Variation:
2/28/2012
6%
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16
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Regional Analyses Regional Variation for Process Measures Table 9: Regional Variation for Process Measures Orange Shading Blue Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th (darker shading in print) = MA did equal to or better than the NCQA National Average
Colorectal Cancer Screening Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Metro Boston
82.1%
78.1%
62.6%
74.2%
Northeastern MA
79.1%
78.1%
62.6%
74.2%
Southeastern MA
78.8%
78.1%
62.6%
74.2%
Central MA
75.4%
78.1%
62.6%
74.2%
MetroWest MA
75.2%
78.1%
62.6%
74.2%
Western MA
71.8%
78.1%
62.6%
74.2%
Regional Variation:
10%
Comprehensive Diabetes Care - HbA1c Testing Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
MetroWest MA
95.1%
93.9%
89.9%
94.2%
Northeastern MA
94.5%
93.9%
89.9%
94.2%
Metro Boston
94.4%
93.9%
89.9%
94.2%
Southeastern MA
93.8%
93.9%
89.9%
94.2%
Central MA
93.7%
93.9%
89.9%
94.2%
Western MA
91.7%
93.9%
89.9%
94.2%
Regional Variation:
3%
Comprehensive Diabetes Care - LDL-C Screening Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Northeastern MA
92.8%
91.4%
85.6%
91.0%
Southeastern MA
92.3%
91.4%
85.6%
91.0%
MetroWest MA
91.9%
91.4%
85.6%
91.0%
Metro Boston
91.0%
91.4%
85.6%
91.0%
Central MA
90.6%
91.4%
85.6%
91.0%
Western MA
87.1%
91.4%
85.6%
91.0%
Regional Variation:
2/28/2012
6%
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Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Regional Analyses Regional Variation for Process Measures Table 9: Regional Variation for Process Measures Orange Shading Blue Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th (darker shading in print) = MA did equal to or better than the NCQA National Average
Comprehensive Diabetes Care - Medical Attention for Nephropathy Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Northeastern MA
91.2%
89.6%
83.6%
89.6%
MetroWest MA
90.8%
89.6%
83.6%
89.6%
Metro Boston
90.1%
89.6%
83.6%
89.6%
Western MA
88.8%
89.6%
83.6%
89.6%
Southeastern MA
88.6%
89.6%
83.6%
89.6%
Central MA
87.6%
89.6%
83.6%
89.6%
Regional Variation:
4%
Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Metro Boston
51.9%
47.7%
38.8%
49.0%
MetroWest MA
50.2%
47.7%
38.8%
49.0%
Northeastern MA
48.4%
47.7%
38.8%
49.0%
Western MA
48.4%
47.7%
38.8%
49.0%
Southeastern MA
45.7%
47.7%
38.8%
49.0%
Central MA
43.2%
47.7%
38.8%
49.0%
Regional Variation:
9%
Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11 Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Metro Boston
98.6%
97.5%
96.7%
99.2%
MetroWest MA
97.7%
97.5%
96.7%
99.2%
Southeastern MA
97.5%
97.5%
96.7%
99.2%
Western MA
97.5%
97.5%
96.7%
99.2%
Central MA
97.1%
97.5%
96.7%
99.2%
Northeastern MA
97.0%
97.5%
96.7%
99.2%
Regional Variation:
2/28/2012
2%
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
18
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Regional Analyses Regional Variation for Process Measures Table 9: Regional Variation for Process Measures Orange Shading Blue Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th (darker shading in print) = MA did equal to or better than the NCQA National Average
Use of Appropriate Medications for People with Asthma: People Ages 12 to 50 Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Western MA
90.7%
89.5%
91.8%
95.0%
Southeastern MA
90.4%
89.5%
91.8%
95.0%
MetroWest MA
89.9%
89.5%
91.8%
95.0%
Northeastern MA
89.2%
89.5%
91.8%
95.0%
Central MA
88.8%
89.5%
91.8%
95.0%
Metro Boston
88.4%
89.5%
91.8%
95.0%
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Metro Boston
82.9%
78.4%
74.2%
82.0%
MetroWest MA
79.7%
78.4%
74.2%
82.0%
Southeastern MA
78.1%
78.4%
74.2%
82.0%
Northeastern MA
77.9%
78.4%
74.2%
82.0%
Western MA
77.4%
78.4%
74.2%
82.0%
Central MA
74.5%
78.4%
74.2%
82.0%
Regional Variation:
2%
Use of Imaging Studies for Low Back Pain Region
Regional Variation:
8%
Use of Spirometry Testing in the Assessment and Diagnosis of COPD Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Western MA
51.2%
44.0%
41.7%
52.2%
MetroWest MA
48.1%
44.0%
41.7%
52.2%
Metro Boston
44.4%
44.0%
41.7%
52.2%
Northeastern MA
44.3%
44.0%
41.7%
52.2%
Southeastern MA
42.0%
44.0%
41.7%
52.2%
Central MA
38.1%
44.0%
41.7%
52.2%
Regional Variation:
13%
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
19
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Regional Analyses Regional Variation for Process Measures Table 9: Regional Variation for Process Measures Orange Shading Blue Shading
(lighter shading in print) = MA did equal to or better than the NCQA National 90th (darker shading in print) = MA did equal to or better than the NCQA National Average
Well Care Visits for Adolescents Ages 12 to 21 Region
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Northeastern MA
77.9%
74.1%
42.7%
60.2%
MetroWest MA
75.1%
74.1%
42.7%
60.2%
Southeastern MA
74.6%
74.1%
42.7%
60.2%
Western MA
72.1%
74.1%
42.7%
60.2%
Metro Boston
69.0%
74.1%
42.7%
60.2%
Central MA
68.6%
74.1%
42.7%
60.2%
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Northeastern MA
94.2%
92.8%
71.6%
84.5%
MetroWest MA
93.4%
92.8%
71.6%
84.5%
Southeastern MA
93.3%
92.8%
71.6%
84.5%
Western MA
92.7%
92.8%
71.6%
84.5%
Central MA
90.2%
92.8%
71.6%
84.5%
Metro Boston
89.1%
92.8%
71.6%
84.5%
Regional Rate
MA Rate
NCQA Nat Avg
NCQA 90th Percentile
Southeastern MA
95.5%
94.2%
76.3%
89.6%
Northeastern MA
95.2%
94.2%
76.3%
89.6%
Metro Boston
93.2%
94.2%
76.3%
89.6%
Western MA
93.2%
94.2%
76.3%
89.6%
Central MA
92.9%
94.2%
76.3%
89.6%
MetroWest MA
92.6%
94.2%
76.3%
89.6%
Regional Variation:
9%
Well-Child Visits Ages 3 to 6 Region
Regional Variation:
5%
Well-Child Visits first 15 Months of Life Region
Regional Variation:
2/28/2012
3%
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
20
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Variation Among Practices Table 10: Variation Among Practices - Measures to be Reported at Medical Group or State Level (no measures will be reported at the site level) Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Number of Practices with 3+ Physicians and ≥ 30 Patients
Practice Rate, Highest
Practice Rate, Lowest
Variation between Practices
163
100.0%
11.6%
88.4%
128
84.2%
1.4%
82.8%
256
90.8%
11.7%
79.1%
259
94.6%
26.9%
67.7%
452
96.2%
29.4%
66.8%
397
98.1%
36.5%
61.6%
414
100.0%
43.8%
56.3%
381
100.0%
52.8%
47.2%
261
97.2%
51.3%
45.9%
Comprehensive Diabetes Care - Retinal Eye Exams
365
100.0%
54.1%
45.9%
Antidepressant Medication Management Composite
67
76.3%
30.6%
45.8%
Antidepressant Medication Management Effective Continuation Phase Treatment
67
76.3%
33.3%
43.0%
Annual Monitoring for Patients on Persistent Medications - Diuretics
359
98.2%
56.1%
42.1%
413
96.6%
56.7%
39.9%
408
98.3%
61.1%
37.2%
67
88.2%
51.1%
37.2%
371
100.0%
63.6%
36.4%
370
100.0%
66.7%
33.3%
244
100.0%
66.7%
33.3%
137
100.0%
70.4%
29.6%
Measure Name Appropriate Testing for Children with Pharyngitis Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
Chlamydia Screening in Women Ages 16 to 20 Chlamydia Screening in Women Ages 21 to 24 Well Care Visits for Adolescents Ages 12 to 21 Annual Monitoring for Patients on Persistent Medications - Total rate
Colorectal Cancer Screening Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs Use of Imaging Studies for Low Back Pain
Cervical Cancer Screening Breast Cancer Screening
Antidepressant Medication Management Effective Acute Phase Treatment Comprehensive Diabetes Care - LDL-C Screening Comprehensive Diabetes Care - Medical Attention for Nephropathy
Well-Child Visits Ages 3 to 6 Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
21
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Variation Among Practices Table 10: Variation Among Practices - Measures to be Reported at Medical Group or State Level (no measures will be reported at the site level) Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Number of Practices with 3+ Physicians and ≥ 30 Patients
Practice Rate, Highest
Practice Rate, Lowest
Variation between Practices
Appropriate Treatment for Children with Upper Respiratory Infection (URI)
177
100.0%
71.9%
28.1%
Use of Appropriate Medications for People with Asthma: People Ages 12 to 50
99
100.0%
73.7%
26.3%
370
100.0%
76.4%
23.6%
154
100.0%
77.1%
22.9%
32
100.0%
91.7%
8.3%
Measure Name
Comprehensive Diabetes Care - HbA1c Testing Well-Child Visits first 15 Months of Life Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
22
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores by Region Table 11: Range of Medical Group Scores by Region Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Measure Name
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
Central MA Annual Monitoring for Patients on Persistent Medications - Total rate Colorectal Cancer Screening Well Care Visits for Adolescents Ages 12 to 21 Chlamydia Screening in Women Ages 21 to 24 Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase Chlamydia Screening in Women Ages 16 to 20 Use of Spirometry Testing in the Assessment and Diagnosis of COPD Breast Cancer Screening Use of Imaging Studies for Low Back Pain Annual Monitoring for Patients on Persistent Medications - Diuretics Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs Use of Appropriate Medications for People with Asthma: People Ages 12 to 50 Appropriate Testing for Children with Pharyngitis Comprehensive Diabetes Care - LDL-C Screening Well-Child Visits Ages 3 to 6 Appropriate Treatment for Children with Upper Respiratory Infection (URI) Comprehensive Diabetes Care - Medical Attention for Nephropathy Well-Child Visits first 15 Months of Life Comprehensive Diabetes Care - HbA1c Testing Cervical Cancer Screening Antidepressant Medication Management Effective Acute Phase Treatment
2/28/2012
22
36.5%
94.8%
58.3%
21
47.4%
83.6%
36.3%
21
41.9%
74.5%
32.6%
16
49.6%
80.0%
30.4%
5
29.8%
59.0%
29.2%
16
36.5%
63.0%
26.5%
9
27.0%
50.0%
23.0%
22
65.9%
88.6%
22.7%
18
62.9%
84.7%
21.9%
21
74.4%
95.9%
21.5%
21
74.7%
95.7%
21.0%
12
73.7%
92.9%
19.2%
10
78.4%
97.3%
18.9%
22
78.8%
97.0%
18.2%
13
76.5%
93.8%
17.3%
11
82.5%
98.9%
16.4%
21
79.2%
95.5%
16.2%
11
84.8%
98.0%
13.2%
21
84.9%
97.8%
12.9%
22
77.8%
90.5%
12.7%
10
59.8%
71.5%
11.7%
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
23
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores by Region Table 11: Range of Medical Group Scores by Region Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Measure Name
Antidepressant Medication Management Effective Continuation Phase Treatment Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
10
43.6%
54.5%
10.9%
17
89.6%
100.0%
10.4%
6
90.3%
98.3%
8.0%
26
46.9%
91.7%
44.8%
26
55.4%
97.3%
41.9%
20
33.7%
74.5%
40.8%
16
59.6%
100.0%
40.4%
20
50.6%
87.1%
36.5%
8
17.3%
48.7%
31.4%
25
51.5%
82.2%
30.6%
26
69.4%
99.8%
30.4%
25
64.7%
94.0%
29.3%
19
48.1%
75.9%
27.8%
26
63.2%
90.2%
27.1%
22
57.7%
81.3%
23.6%
16
76.7%
98.3%
21.6%
18
80.0%
100.0%
20.0%
18
77.6%
95.8%
18.2%
25
73.7%
90.3%
16.6%
24
74.2%
89.7%
15.5%
25
72.9%
88.1%
15.1%
Metro Boston Annual Monitoring for Patients on Persistent Medications - Diuretics Comprehensive Diabetes Care - LDL-C Screening Antidepressant Medication Management Effective Continuation Phase Treatment Appropriate Testing for Children with Pharyngitis Antidepressant Medication Management Effective Acute Phase Treatment Use of Spirometry Testing in the Assessment and Diagnosis of COPD Well Care Visits for Adolescents Ages 12 to 21 Comprehensive Diabetes Care - Medical Attention for Nephropathy Colorectal Cancer Screening Chlamydia Screening in Women Ages 16 to 20 Annual Monitoring for Patients on Persistent Medications - Total rate Chlamydia Screening in Women Ages 21 to 24 Well-Child Visits first 15 Months of Life Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening Well-Child Visits Ages 3 to 6 Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs Use of Imaging Studies for Low Back Pain Breast Cancer Screening
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
24
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores by Region Table 11: Range of Medical Group Scores by Region Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Measure Name
Use of Appropriate Medications for People with Asthma: People Ages 12 to 50 Cervical Cancer Screening Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase Comprehensive Diabetes Care - HbA1c Testing Appropriate Treatment for Children with Upper Respiratory Infection (URI) Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
21
79.3%
94.1%
14.7%
25
78.0%
91.7%
13.7%
4
45.2%
54.8%
9.6%
26
89.4%
98.7%
9.3%
16
91.7%
100.0%
8.3%
5
95.3%
100.0%
4.7%
7
11.7%
65.6%
53.9%
8
26.9%
72.8%
45.9%
8
50.5%
80.5%
30.0%
9
69.0%
94.9%
25.9%
9
62.0%
84.4%
22.4%
8
69.4%
84.2%
14.8%
4
47.1%
60.0%
12.9%
9
76.9%
89.8%
12.9%
9
83.9%
96.6%
12.7%
5
47.6%
59.7%
12.1%
9
74.5%
86.5%
12.0%
6
86.7%
98.4%
11.8%
8
86.3%
97.7%
11.5%
6
87.9%
99.0%
11.1%
9
79.7%
90.4%
10.7%
MetroWest MA Chlamydia Screening in Women Ages 16 to 20 Chlamydia Screening in Women Ages 21 to 24 Well Care Visits for Adolescents Ages 12 to 21 Comprehensive Diabetes Care - Medical Attention for Nephropathy Colorectal Cancer Screening Use of Imaging Studies for Low Back Pain Use of Spirometry Testing in the Assessment and Diagnosis of COPD Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs Comprehensive Diabetes Care - LDL-C Screening Antidepressant Medication Management Effective Continuation Phase Treatment Breast Cancer Screening Appropriate Testing for Children with Pharyngitis Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening Well-Child Visits first 15 Months of Life Cervical Cancer Screening
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
25
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores by Region Table 11: Range of Medical Group Scores by Region Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Measure Name
Annual Monitoring for Patients on Persistent Medications - Total rate Antidepressant Medication Management Effective Acute Phase Treatment Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase Annual Monitoring for Patients on Persistent Medications - Diuretics Well-Child Visits Ages 3 to 6 Use of Appropriate Medications for People with Asthma: People Ages 12 to 50 Comprehensive Diabetes Care - HbA1c Testing Appropriate Treatment for Children with Upper Respiratory Infection (URI) Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
9
78.1%
88.3%
10.2%
5
64.6%
74.0%
9.4%
3
43.6%
52.5%
8.9%
9
80.6%
89.3%
8.8%
6
89.2%
94.0%
4.8%
7
88.3%
92.4%
4.1%
9
93.0%
96.9%
3.9%
6
94.9%
97.9%
3.0%
2
98.3%
100.0%
1.7%
Northeastern MA Well Care Visits for Adolescents Ages 12 to 21 Chlamydia Screening in Women Ages 16 to 20 Antidepressant Medication Management Effective Acute Phase Treatment Antidepressant Medication Management Effective Continuation Phase Treatment Colorectal Cancer Screening Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Respiratory Infection (URI) Use of Spirometry Testing in the Assessment and Diagnosis of COPD Well-Child Visits Ages 3 to 6 Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase Use of Imaging Studies for Low Back Pain Breast Cancer Screening
2/28/2012
30
41.1%
91.4%
50.3%
28
31.8%
76.0%
44.2%
23
41.7%
84.4%
42.7%
23
33.3%
75.0%
41.7%
28
54.1%
93.2%
39.1%
22
67.9%
100.0%
32.1%
23
75.0%
100.0%
25.0%
13
29.5%
53.4%
23.9%
26
75.0%
98.6%
23.6%
10
38.5%
60.5%
22.0%
28
70.0%
90.6%
20.6%
29
70.3%
89.8%
19.5%
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
26
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores by Region Table 11: Range of Medical Group Scores by Region Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Measure Name
Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening Annual Monitoring for Patients on Persistent Medications - Diuretics Comprehensive Diabetes Care - Medical Attention for Nephropathy Chlamydia Screening in Women Ages 21 to 24 Annual Monitoring for Patients on Persistent Medications - Total rate Well-Child Visits first 15 Months of Life Comprehensive Diabetes Care - HbA1c Testing Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs Comprehensive Diabetes Care - LDL-C Screening Cervical Cancer Screening Use of Appropriate Medications for People with Asthma: People Ages 12 to 50 Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
23
80.5%
100.0%
19.5%
28
71.3%
90.0%
18.7%
28
82.8%
100.0%
17.2%
27
53.7%
70.2%
16.5%
29
75.1%
90.9%
15.8%
21
86.5%
100.0%
13.5%
28
86.8%
99.5%
12.7%
28
77.4%
90.0%
12.6%
28
88.1%
100.0%
11.9%
29
80.1%
91.7%
11.6%
26
84.3%
95.2%
10.9%
11
94.4%
100.0%
5.6%
Southeastern MA Use of Spirometry Testing in the Assessment and Diagnosis of COPD Well Care Visits for Adolescents Ages 12 to 21 Chlamydia Screening in Women Ages 16 to 20 Antidepressant Medication Management Effective Continuation Phase Treatment Chlamydia Screening in Women Ages 21 to 24 Annual Monitoring for Patients on Persistent Medications - Total rate Colorectal Cancer Screening
Comprehensive Diabetes Care - Medical Attention for Nephropathy Comprehensive Diabetes Care - LDL-C Screening
2/28/2012
23
14.3%
66.7%
52.4%
41
39.2%
88.9%
49.7%
32
34.8%
81.5%
46.7%
25
38.0%
76.3%
38.3%
36
43.1%
80.0%
36.9%
39
58.5%
92.6%
34.1%
41
61.3%
94.8%
33.4%
40
66.7%
99.6%
32.9%
40
66.7%
99.5%
32.8%
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
27
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores by Region Table 11: Range of Medical Group Scores by Region Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Measure Name
Antidepressant Medication Management Effective Acute Phase Treatment Appropriate Testing for Children with Pharyngitis Use of Imaging Studies for Low Back Pain Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase Breast Cancer Screening Annual Monitoring for Patients on Persistent Medications - Diuretics Use of Appropriate Medications for People with Asthma: People Ages 12 to 50 Well-Child Visits Ages 3 to 6 Appropriate Treatment for Children with Upper Respiratory Infection (URI) Cervical Cancer Screening Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs Comprehensive Diabetes Care - HbA1c Testing Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11 Well-Child Visits first 15 Months of Life
Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
25
54.5%
86.6%
32.1%
22
70.5%
99.5%
29.1%
37
60.4%
88.2%
27.8%
11
32.8%
60.6%
27.8%
41
68.7%
96.0%
27.2%
38
75.6%
97.6%
22.0%
30
78.4%
100.0%
21.6%
23
76.3%
96.5%
20.2%
23
80.0%
100.0%
20.0%
42
74.2%
93.8%
19.6%
38
75.3%
92.8%
17.5%
40
85.0%
100.0%
15.0%
32
84.8%
98.8%
14.0%
11
90.9%
100.0%
9.1%
17
88.5%
97.2%
8.8%
21
27.8%
80.5%
52.7%
20
50.9%
91.3%
40.4%
31
46.9%
82.6%
35.6%
8
32.0%
67.4%
35.4%
22
40.7%
75.0%
34.3%
26
52.9%
83.8%
31.0%
Western MA Chlamydia Screening in Women Ages 21 to 24 Use of Imaging Studies for Low Back Pain Well Care Visits for Adolescents Ages 12 to 21 Use of Spirometry Testing in the Assessment and Diagnosis of COPD Chlamydia Screening in Women Ages 16 to 20 Colorectal Cancer Screening
2/28/2012
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
28
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Range of Medical Group Scores by Region Table 11: Range of Medical Group Scores by Region Orange Shading Blue Shading
(lighter shading in print) = Measures with a range of 40 percentage points or higher (darker shading in print) = Measures with a range of 20 percentage points or lower
Measure Name
Comprehensive Diabetes Care - LDL-C Screening Breast Cancer Screening Antidepressant Medication Management Effective Continuation Phase Treatment Annual Monitoring for Patients on Persistent Medications - ACE Inhibitors or ARBs Cholesterol Management for Patients with Cardiovascular Conditions--LDL-C Screening Annual Monitoring for Patients on Persistent Medications - Diuretics Annual Monitoring for Patients on Persistent Medications - Total rate Cervical Cancer Screening Comprehensive Diabetes Care - HbA1c Testing Comprehensive Diabetes Care - Medical Attention for Nephropathy Antidepressant Medication Management Effective Acute Phase Treatment Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Respiratory Infection (URI) Well-Child Visits first 15 Months of Life Use of Appropriate Medications for People with Asthma: People Ages 12 to 50 Follow-up of Care of Children Prescribed ADHD Medications - Initiation Phase Well-Child Visits Ages 3 to 6 Use of Appropriate Medications for People with Asthma: Children Ages 5 to 11
2/28/2012
Number of Publicly Reportable Medical Groups with ≥ 30 Patients
Medical Group Rate, Lowest
Medical Group Rate, Highest
Range of Medical Group Scores
25
68.3%
97.1%
28.8%
25
62.5%
90.9%
28.4%
11
36.6%
64.9%
28.3%
25
72.2%
97.2%
25.0%
16
73.5%
93.8%
20.2%
23
72.6%
92.8%
20.2%
26
75.4%
95.3%
19.8%
26
70.8%
90.1%
19.4%
26
80.0%
99.2%
19.2%
26
77.6%
96.2%
18.7%
11
61.0%
78.9%
18.0%
14
84.3%
100.0%
15.7%
19
86.8%
100.0%
13.2%
11
87.9%
100.0%
12.1%
10
85.2%
97.1%
11.9%
4
46.2%
56.7%
10.5%
20
86.8%
96.9%
10.1%
3
98.6%
100.0%
1.4%
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
29
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Graphs of Seven-Year Trend Measures
Antidepressant Medication Management Effective Acute Phase Treatment 100% 95% 90% 85% 80% 75% 70% 65% 60% 04
05
06
07
08
09
10
Antidepressant Medication Management - Effective Continuation Phase Treatment 100% 90% 80% 70% 60% 50% 40% 04
2/28/2012
05
06
07
08
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
09
10
30
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Chlamydia Screening in Women Ages 16 to 20 100% 90% 80% 70% 60% 50% 40% 30% 04
05
06
07
08
09
10
Chlamydia Screening in Women Ages 21 to 24 100% 90% 80% 70% 60% 50% 40% 30% 04
2/28/2012
05
06
07
08
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
09
10
31
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Comprehensive Diabetes Care - HbA1c Testing 100% 95% 90% 85% 80% 75% 70% 65% 60% 04
05
06
07
08
09
10
09
10
Well-Child Visits first 15 Months of Life 100% 95% 90% 85% 80% 75% 70% 65% 60% 04
2/28/2012
05
06
07
08
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
32
Quality Insights: Primary Care in Massachusetts Analysis of 2011 Clinical Quality Performance Results and Trends
Well-Child Visits Ages 3 to 6 100% 95% 90% 85% 80% 75% 70% 65% 60% 04
05
06
07
08
09
10
09
10
Well Care Visits for Adolescents Ages 12 to 21 100% 95% 90% 85% 80% 75% 70% 65% 60% 04
2/28/2012
05
06
07
08
© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621
33