Important steps in heart care are becoming faithfully followed by physicians, demonstrating how consistent and persistent performance measurement can improve practices that make a difference in a patient's recovery, according to a report by the National Committee for Quality Assurance, Washington.
In fact, the NCQA's State of Health Care Quality documents significant improvements in more than a dozen key measures of clinical performance for the third year in a row. "Those gains will save lives and money," NCQA President Margaret O'Kane said.
Foremost among the gains was the dramatic progress in providing key medications and preventive treatment for coronary disease. In 2001 health plans reporting results to the NCQA said beta blockers were prescribed to 92.5% of post-heart-attack patients who should have received the drug. That's an increase of 30 percentage points over 1996, when the NCQA began tracking the practice and found only 62.5% of such patients were prescribed beta blockers.
The improvement has "saved 10,000 lives already," O'Kane said. "That's enormous." Beta blockers have been found to decrease a patient's odds of having another heart attack and increase probability of long-term survival by up to 40%.
In the case of another heart-management practice, cholesterol screening, health plans reported that 77% of patients received screening in 2001, compared with 59% in 1998. Among patients with high cholesterol, 59% had their cholesterol levels controlled and managed, compared with 45% when the NCQA started measuring compliance in 1999 -- a 50% improvement over two years.
"That's the payoff for measuring quality," O'Kane said. "But we have work to do. A large part of the healthcare system still doesn't measure anything."
Information for the report was voluntarily submitted by 271 commercial, Medicare and Medicaid plans representing 71 million people, or 28% of Americans. Information on nearly three-fourths of Americans is not available or not collected, she said.
For the first time, the report included performance results for Medicare+Choice and Medicaid health plans, although the statistics were for 2000, not 2001. Comparing 2000 data, Medicare plans were significantly better at managing diabetes than commercial plans. Annual eye exams, for example, were provided to 63% of Medicare enrollees, compared with 48% of enrollees in commercial plans. In 2001 commercial plans improved their percentage to 52%.
Medicaid plans underperformed in most areas measured, especially in diabetes care and in breast cancer and cholesterol screening. Eye exams, for example, were given to only 43% of diabetes patients. And Medicaid plans reported cholesterol levels were under control for only 28% of people with high cholesterol, compared with 53% in commercial and Medicare plans in 2000.
Click here for a PDF of the report.