MINNEAPOLIS, June 30, 2008 - Clinics with electronic health records provided better diabetes care in 2007 than those relying on paper records, according to MN Community Measurement.

The Minneapolis-based nonprofit that measures the performance of clinics released diabetes and vascular care scores Monday. Other clinic scores will be released this fall. Click here for diabetes and vascular care rankings. 

In diabetes care, clinics with electronic medical records (EHRs) scored seven percentage points better on the diabetes measure than paper-based clinics, according to a MN Community Measurement press release.

MN Community Measurement includes five components of care, when it assesses diabetes care: control of blood sugar levels; control of blood pressure; control of cholesterol; daily use of aspirin, and tobacco cessation. 

Optimal diabetes care jumped from 14 percent of patients in 2006 to 24 percent of patients in 2007 among the 170 clinics that submitted data in both years.

The overall rate for optimal diabetes care improved from 14 percent to 17 percent for all 318 clinics.   

 “We’ve been measuring diabetes care for several years, and we are observing that some clinics are consistently performing at the highest levels and standing out from their competitors on the basis of quality,” said Jim Chase, executive director of MN Community Measurement.

For example, Fairview Health Systems’ Oxboro Clinic in Bloomington has reported the state’s highest percentage of diabetes patients in optimal control for the past two years, improving from 36 percent in 2006 to 48 percent in 2007.

Clinics that are performing well tend not to rely on physician's memories and have systems that inform physicians about missing care items, Chase said.

Successful clinics also tend to track patients and remind them of the need to come in for an appointment. The tracking also allows clinics to provide patients with missed diabetes care, even when the patient is in the clinic for another reason, he said.

Many successful clinics also have care managers or dieticians on staff who follow up and educate diabetic patients, Chase said.

A final trait of successful clinics is that they meet throughout the year to analyze their data and strategize about improving it, he said.

"What I've heard from clinicians is that blood pressure management is the hardest score to change," he said.

Biased against community clinics?
A common complaint about MN Community Measurement scores is that they do not account for the fact that some clinics have patients that are more difficult to treat.

Chase said  a quick scan of the data shows a clinics location and patient population might have a negative effect on scores.  

"As we get better at this as a community, I suspect we may see some more stratification between clinics based on race, ethnicity, and income," he said. 

However, clinics shouldn't use that as an excuse. There are clinics in challenged communities that perform average or better than average on the diabetes measure, he said. 

First-time vascular disease scores
MN Community Measurement also released its optimal vascular care measure for the first time. The statewide rate was 33 percent of patients achieving optimal scores in four areas of vascular care: blood pressure; cholesterol level; daily use of aspirin, and tobacco cessation. 

The highest-scoring clinic for vascular care reported that 62 percent of patients had cholesterol, blood pressure and other indicators in optimal control, while just 7 percent of patients at the lowest-scoring clinic did.

Wide variation is also seen on the optimal diabetes care measure, with the percent of patients meeting targets for blood sugar, cholesterol, blood pressure and other factors ranging from 48 percent at the highest-scoring clinic to zero at the lowest.

More accurate
MN Community Measurement said its data is more reliable than ever before because the nonprofit increasingly relies on data that clinics submit directly, rather than on claims data from insurers.  Direct submission allows a clinic’s entire population with diabetes or vascular disease to be included. Clinics that directly submit data stands at 329 for vascular care and 318 for diabetes care.