from the Robert Wood Johnson Foundation was integral to the redesign of the treatment protocols of Cincinnati Children’s Hospital Medical Center’s Cystic Fibrosis Center.
Transparency as a Transformational Tool
One critical tool for promoting improvement is broad transparency. By linking provider performance to patient outcomes and measuring providers’ utilization rates and performance against internal and external benchmarks, organizations can improve the quality and value of care provided and become better stewards of limited resources. Because most clinicians and organizations lack important data on their own performance and how it relates to that of their peers, such transparency empowers them to improve their performance and helps them improve care processes, reduce variations in practice, and reduce waste. Highly efficient organizations have been able to sustain transformational change by using internal performance information beyond administrative data to drive improvement efforts (Edwards et al., 2011; James and Savitz, 2011); an example is presented in Box 9-6. External transparency may also help organizations improve performance.
Transparency on Primary Care Performance
Yields Improvements at Denver Health
To improve performance and reduce variation in practice among primary care providers in 2006 Denver Health began developing preventive health and chronic disease patient registries for the 100,000 users of its community health center network. By using a single patient identifier to link care from multiple sites to each patient and focusing on high-impact, high-opportunity areas such as diabetes care, hypertension care, and cancer screening, Denver Health developed a system for monitoring provider performance, tracking service utilization, and supporting clinicians in managing patients between visits. To help clinicians understand their own performance, Denver Health created performance report cards with information aggregated across patients and time and populated by nearly real-time data. The report cards included transparent, unblinded data on clinicians’ performance by site and by provider, and reduced variation and improved overall performance. Since their inception, Denver Health’s report cards have led to a nearly twofold increase in colorectal cancer screening rates, a 20 percent increase in breast cancer screening rates, and an increase in hypertension control rates from 60 to 72 percent.
SOURCE: Cosgrove et al., 2012.