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Diabetes care pays off with three-star rating for Family Practice Medical Center

WILLMAR -- Every month, Family Practice Medical Center compiles a report on each patient with diabetes who visited the clinic within the past month.

It's all there for the doctors to see: how their diabetic patients are faring with their blood sugar levels, cholesterol and blood pressure. Whether the patient is taking daily aspirin to lower the risk of heart disease. Whether the patient is using tobacco.

"They can see which diabetic patients are not at optimal levels and which ones are due for exams," said Stacey Zondervan, patient services supervisor for the eight-physician family practice clinic.

Armed with this knowledge, Family Practice Medical Center then can work harder to deliver the best-quality care for patients with chronic disease, she said.

It's a strategy that has paid off by helping the clinic earn a three-star rating from Minnesota Community Measurement this summer for how well it manages its patients with diabetes.

Thirty-three percent of these patients reached target numbers this past year for management of type 1 and type 2 diabetes.

"We're wowed by that number," Zondervan said. "We have had an improvement of 20 percent within three years."

Across Minnesota, medical providers are seeing gains in the level of care for diabetes. The numbers are tracked and reported by the nonprofit Minnesota Community Measurement, whose database covers more than 300 clinics where most Minnesotans receive their primary care.

Jim Chase, executive director of Minnesota Community Measurement, said optimal diabetes care is up by an average of three percentage points, after hitting a plateau last year.

"The lesson is, don't take a couple of data points as a trend," he said. "We're seeing a pretty big increase. Groups more and more are saying they're very engaged in these numbers and they're seeing them improve."

Family Practice Medical Center has been working to improve diabetes care for about seven years -- three years before Minnesota Community Measurement began collecting data.

It has been a learning process, Zondervan said.

"When we first started, our numbers were low because we just weren't getting people in. They weren't being screened," she said.

That discovery prompted a clinic-wide effort to find better ways of identifying and tracking these patients.

For instance, the clinic now keeps track of how often its 600-some patients with diabetes see their doctor each year. If it's been too long, the patient gets a letter or phone call.

When a diabetic patient calls for a prescription refill, clinic staff use the occasion as a chance to see how recently the patient's blood glucose was tested. There's a more rigorous effort to check and record blood pressure whenever the patient comes to the clinic.

"We really became more aware of what our diabetic patients were doing," Zondervan said.

This type of approach is being adopted by many medical groups as they become more aggressive in managing diabetes, Chase said. "They're not just waiting for the person to show up."

Minnesota Community Measurement has been collecting data for more than four years now, and some trends are beginning to appear.

For instance, clinics with larger numbers of low-income patients have not been scoring as high.

"I think we're starting to see a little more impact of who the patients are," Chase said.

Minnesota Community Measurement wants to begin collecting socioeconomic data in an effort to better identify strategies that can be tailored to specific patient groups, he said.

"We have more diversity across the state. How do we address that?" he said.

The latest batch of results also showed that clinics with electronic health records are scoring better -- seven percentage points higher on average.

Four years ago, Minnesota Community Measurement believed it was unlikely that any medical group would score more than 40 percent on optimal diabetes care, Chase said.

The composite of five measures is "very hard to achieve," he said.

But as clinics make progress and their scores go up, it now seems possible for some medical groups to reach the 60 percent range, he said. "We don't really know what the upper limit is. We're just focusing right now on improving."

The performance measures have been a motivator for Family Practice Medical Center, Zondervan.

"Internally we have changed a number of our processes as a result of Community Measurement and pay for performance," she said. "Certainly it has raised the bar... Whether the public is aware of the numbers or not, we're motivated to change our system, and as a result the public is going to have better care."