A Dose of Data a Day Keeps Physicans Au Fait
In a new column launched this week, Rob Davis, Executive Director of the US-based Outpatient Quality Improvement Network, looks at how medical benchmarking and dashboards can help doctors make better decisions in patient care.
If you ask a physician how many of their hypertensive patients have blood pressure levels under control, the likely response is, "at least 90%." But the actual data suggests the control rate is much lower.
The difference between a doctor’s perception of a patient’s condition and the patient’s actual state is not a reflection on the doctor’s skill or level of professionalism. What it does highlight is the importance of using hard data in decision making processes. Perception is not reality. Being a data-driven doctor helps physicians provide the best care to their patients.
So just what do I mean by "data-driven"?
I don’t just mean running laboratory tests – although clearly important in medicine for diagnosing a condition. Being data-driven goes further than that. As in other industries, it’s about providing useful information that is actionable.
For medicine, that means information that helps a physician answer questions such as: how does my patient compare with established standards? What might other doctors be doing from which I can learn? How effective is the regime that I’ve prescribed for my patient? Should I be considering other treatment options?
Physicians should know how their patient treatment compares to their colleagues and have easy access to data that helps them determine which of their patients need attention and what progress they have made over time.
Electronic health records are an important step in the right direction. The US government is encouraging physicians to move their practices to electronic health records and to "meaningfully use" the data provided. Physicians who learn to fully utilize the value provided by information derived from data will lead the way in better serving their patients and in helping to control costs such as care from chronic illness.
One example of the successful macro use of data is the Hypertension Initiative.
Dr. Brent Egan, MD, began working with Primary Care Physicians to fight cardiovascular disease a little over ten years ago. At the time, South Carolina had the dubious honor of leading the nation in cardiovascular disease. There were many reasons for South Carolina’s plight. Demographics and lifestyle certainly contributed, but also at fault was lack of data and lack of options for Primary Care Physicians to get help for their most treatment resistant patients. See http://worst2first.musc.edu
Dr. Egan began the mission of moving South Carolina from worst to first in cardiovascular health. So was born the Hypertension Initiative, a collaborative effort among doctors, other healthcare providers, their patients and academics to reduce the incidence of high blood pressure in the state.
A decade later, South Carolina has made great progress. Cardiovascular mortality rates have moved from 383 per 100,000 population in 1999 to 265 in 2007. That is a 31% improvement (2007 is the latest CDC data available for comparison). This happened while many of South Carolina’s neighboring Southeastern US States remained at the bottom of the rankings. South Carolina has made good progress fighting a century-old problem.
As is often the case with improvement stories many things happened to help with the transformation. Building a network of Certified Hypertension Specialists to help with the most treatment resistant patients was one contributor. Public awareness and community engagement were others. (e.g. Dr. Egan and his colleagues adapted traditional Southern recipes which were high in fat, sugar and calories to healthier versions in keeping with the DASH diet. He made the "DASH Diet Southern Style" recipe book available free of charge online).
All these things helped, but of critical importance was the role that data played.
Dr. Egan invited primary care physicians to participate in the network to share data and information (without identifying patients, of course). Dr. Egan and his team developed a report that transformed this data into information physicians can use. At first it was as simple as comparing the blood pressure control rates for one set of patients with the control rates of other physicians in the network. Over time, lab data and prescriptions were added. Effectively it’s a medical "dashboard" that allows physician to compare the regimen they use to that used in the network. Control rates are also reported, again for the use of the individual physician in improving patient outcomes.
As would be expected, some providers greeted the data with disbelief, contempt and skepticism —"surely you have made a mistake in collecting and reporting this data!" However, doctors became more comfortable with the reports and learned to use them to understand changes they needed to make.
A small sample of the report received by each physician is shown here. The dashboard is a quick way to for a physician to benchmark their results with those of the other network physicians. This example allows them to see performance for national standards established by NCQA (National Committee for Quality Assurance) and by PQRI (Product Quality Research Institute).
For instance, in the above example, the John Doe Practice can see that his patients are meeting the NCQA goal of <140/
Participating physicians have seen their efforts to embrace best practices rewarded with improved patient outcomes. The reports continue to be improved with feedback from those who use them. The usage has increased and the outcomes continued to improve.
Proof indeed, that data can go a long way to making both physician and patient feel better.
Editor’s Note: The Data Driven Doctor is a new column providing commentary on the intersection of Quality and Healthcare. The author, Rob Davis, has spent much of his career leading successful quality efforts for business and now brings that perspective to healthcare. Commentary is provided, not from a trained medical perspective, but in a spirit of working with healthcare providers who are interested in using quality to improve patient outcomes. He is currently serving as the Executive Director of the Outpatient Quality Improvement Network. Follow Rob on www.twitter.com/DataDocs