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Doctors get report cards; Better than average, but not perfect.

Byline: Aaron Nicodemus

How well does your doctor's office measure up?

The fifth annual "Quality Insights: Clinical Quality in Primary Care Report" found that the performance of 150 of the state's medical groups exceeds national averages in 28 of 30 measures studied.

The report highlighted, however, wide disparities in how well medical groups in Central Massachusetts monitor the kidney function of diabetics, and how often the groups screen patients for colorectal cancer. Of the 25 Central Massachusetts medical groups assessed by the study, 15 scored average or poorly in monitoring kidney function, while 11 scored average or poorly in screening for colorectal cancer.

Over-prescribing antibiotics was another problem spot in the report from Massachusetts Health Quality Partners. Four out of every five medical groups rated by the study prescribed antibiotics to adults with bronchitis, even when the infection was viral and antibiotics probably wouldn't help a patient recover. Over-prescription of antibiotics is a national problem, though, with only 25 percent of medical groups nationwide avoiding over-prescribing antibiotics.

The region's medical centers did very well in testing the blood sugar of diabetics and treating children's asthma, the report stated. Overall, the state's doctors exceeded the national average in screening for cholesterol and on wellbeing checks for children.

MHQP officials said physician performance has risen since the reports were first published in 2004.

"We are greatly heartened by the improvements statewide, but there is still far too much variation in performance among medical groups across the state," said Barbra Rabson, MHQP's executive director.

The organization is a coalition of doctors, hospitals, health plans, purchasers, consumers and government agencies. The report is based on 2007 data from Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Tufts Health Plan and Health New England and does not include Medicaid or Medicare patients.

The results of the study are available at Not every doctor's office is included; small practices were excluded if they did not have sufficient patient data.

Dr. Michael H. Kelleher, medical director for quality and medical management at the Fallon Clinic in Worcester, said the research helps his group improve care for specific patient groups, such as those with diabetes.

In June of last year, Fallon Clinic hired 14 nurses and medical assistants to track the care of all diabetics in Fallon's care. In addition to creating an electronic medical registry for diabetics, the group tracks patient appointments and prescriptions, orders tests and consultations, and makes all the information available to the doctor before the patient's visit.

"We're trying to make sure these patients don't fall through the cracks," he said.

But the results published yesterday won't reflect those changes, he said, because the data is two years old.

"I think next year, and the year after that, we'll see pretty dramatic improvement," he said.

Edward Westrick, vice president of medical management at UMass Memorial Health Care, said that transitioning more than 100 UMass medical offices to electronic medical records happened, in part, due to the results of past MHQP studies. At a cost of $20,000 to $25,000 per doctor's office to implement, electronic medical records are expensive.

"On some of the measures, we weren't doing very well in 2003," he said. The data "gave us more justification to do what we needed to do anyway."



CUTLINE: (P) Barbra Rabson, executive director of Massachusetts Health Quality Partners. (C) "Quality Insights: Clinical Quality in Primary Care"
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Title Annotation:MONEY
Publication:Telegram & Gazette (Worcester, MA)
Article Type:Clinical report
Date:Apr 3, 2009
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