How physician profiles improve quality of care
Craft persuasion strategy and choose data with care
It's perfectly obvious that profiling and reviewing the care patterns of the physicians in your group practice could improve care, but the doctors might not share your zeal. In fact, you'll be wise to plan persuasion strategies just as thoughtfully as you plot the data collection.
The first move, suggests Gregory Angstman, MD, medical director of the Wabasha (MN) Clinic, in the Mayo Health System, is to engage the group in a hypothetical discussion exploring the use of care pattern data - if they were available. The objective, Angstman says, is to draw the following three-point consensus:
· Look at data about our practice patterns.
· Specify what data are needed.
· Specify what we will do with that data.
Angstman concedes that such a consensus probably will not emerge from the first meeting. But instead of giving up, move into a resistance management strategy.
Resistance management 101Involve one cooperative doctor to help persuade the naysayers, Angstman recommends. "Find a sympathetic physician who understands the need for profiling data and get him or her to be your liaison." It helps if your liaison can relate to the reluctant ones with first-hand experience in using medical practice data.
Let your ally lead the discussions whenever possible. He suggests providing preliminary care pattern data to share with the group. Start with the "vital few - events that generate a lot of work or a lot of cost," he says. To find them, identify these characteristics:
· the most common diagnoses;
· diagnoses which result in the highest frequency of service usage;
· chronic problems that account for the highest costs to the provider group or to the patients.
From those data, highlight where the highest costs occur, either by provider or by diagnoses. "If people are still not interested," he continues, "show them their group's data compared to regional data for the same procedures and time periods. At that point, I've never seen a doctor who wasn't interested. But that's not to say they will not attack the messenger." (In a future issue of QI/TQM, we'll explain how to find low-cost or free data from which to start your group practice profiles.)
One of their earliest encounters with physician profiles led the Wabasha staff to question their poor showings on influenza immunizations. "Like with many preventive procedures, probably our biggest reason [for the shortfall] was missed opportunities to deliver the care," notes Angstman. In discussing their findings, Wabasha's doctors realized exactly how it happened. When patients came in for one kind of care, providers usually neglected to ask about preventive procedures that could easily be done during the visit.
"We started to consider every contact with a patient as an opportunity to immunize," he explains. Instead of leaving it to each provider's memory, they designed a checklist for nurses to cover when they took patients into the exam rooms. If patients met any or all of the following criteria, it triggered an order for a flu shot:
· age 65-plus;
· heart disease, diabetes, or chronic broncho-pulmonary disease;
· employment in health care, nursing home, or school.
The checklist worked so well that the doctors took themselves out of the loop and the nurses gave shots to eligible patients. Next, the clinic set up immunization sessions on Tuesday afternoons and Thursday mornings. Patients could make appointments for flu and Pneumovax shots at reduced fees of $19.50 and $28.50.
By systematically removing barriers and using each contact as an opportunity to offer flu shots, Wabasha Clinic more than doubled their immunization rate between 1991 and 1997. (For year by year details, see the graph on influenza immunizations, above.)
[For further information on introducing and using physician group practice profiles, contact Gregory Angstman, MD. Telephone: (612) 565-4571. E-mail: [email protected]]
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