Public Health Researchers Score Medical Groups

Researchers at UC Berkeley's School of Public Health recently documented the high variation of quality care found when comparing U.S. medical groups. This new nationwide study involved nearly 700 medical groups by evaluating their practices with regards to chronic illnesses.

The researchers attempted to chart the reasons for the high variation in care by scoring medical groups with 20 or more doctors on their practices in dealing with patients with asthma, congestive heart failure, depression and diabetes. These chronic illnesses represent about 75 percent of total health care costs in the U.S.

"High performing groups on average did seven times better on various measures than low performing groups. But overall there is considerable room for improvement," said Stephen M. Shortell, Dean of UC Berkeley's School of Public Health. "For example, only 1 percent of all medical groups in the U.S. that we studied do all of the recommended processes for all of the conditions studied."

According to findings, the main differences between high and low performing groups were in the use of recommended care management processes and electronic health records. Involvement in quality improvement and use of external reporting varied across medical groups.

"The high performing groups were much more committed to organized quality improvement efforts and were much more likely to report quality results to outside bodies," Shortell said.

One-hour interviews were conducted with medical directors or the president of each medical group to obtain the findings. The use of care management structures were measured, including "disease registries, treatment guidelines, patient self-management programs, use of electronic health records, participation in quality improvement activities, presence of financial rewards for improving quality of care and requirements for external reporting of quality results to public bodies," Shortell said.

"We focused on the measures chosen based on review of the literature and, in particular, a widely accepted approach to better chronic illness care called the chronic care model," Shortell said. "We essentially measured the specific elements of the chronic care model. We focused on various prevention practices such as whether or not the medical group had smoking cessation practices in place."

Though the findings were not surprising to researchers, the findings were, however, generally consistent with the thinking of health policy leaders, researchers said.

Following the significant findings, groups such as the Medicare Program and California Pay for Performance Demonstration Program, have already begun drawing on the research to implement and improve current programs.

But as the first widespread, systematic study documenting quality improvement initiatives and external reporting accountability to the performance of medical groups, the study has important implications for developing future programs.

"The findings have very important implications in regard to developing a national set of quality performance measures, providing resources for electronic health information technology adoption, rewarding medical groups for superior performance and developing external reporting requirements," Shortell said.

Furthermore, the results of the study can have effects on the general public as well as it may help them to better navigate the complex healthcare system as it currently stands.

"For the general public it means that you need to give as much or more attention to choosing your medical group as you do to choosing an individual doctor within the group," Shortell said. "Look for a group with electronic record capability, ask about their quality improvement initiatives, and what their approach is to treating patients with chronic illness. Also ask to see their score on various quality measures where they are available."

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