Massachusetts Health Quality Partners


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.

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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.

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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

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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

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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

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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

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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

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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

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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%

© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621

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%

© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621

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%

© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621

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%

© Massachusetts Health Quality Partners • www.mhqp.org • 617-600-4621

17

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