CHI Health Nephrology is happy to report a 95% success rate upon review of their 1st quality performance indicator!
This is phenomenal news! And there is more to this story. Here at CHI Health Nephrology, we want to provide you with the best care in the nation. Our patients expect that. We expect that of ourselves. So how can we achieve that goal in an objective fashion? We need to compare how well (or how poorly) we are doing compared with the nation, and the way to do that is by reporting quality metrics.
Quality metrics is one of the latest buzzwords in healthcare. What is it, and why is it important? Quality metrics is a way for an organization to measure how well they are doing on a certain performance indicator. The reports are important because it gives you, the consumer, an objective way to evaluate our performance as kidney doctors. We decided that our goal for ’09-’10 was to identify diabetic patients with protein in their urine (a risk factor for heart disease death) and make sure that those patients are taking an ACE inhibitor such as benazepril. An ACE inhibitor is a blood pressure medication that is available in a generic formulation that decreases protein in the urine and significantly decreases heart disease risk when taken.
The literature suggests that despite all of the evidence in favor of this form of treatment, only 43% of older diabetics with protein in their urine receive an ACE inhibitor (J Gen Intern Med. 2006 April; 21(4): 315–319). This suggests a major quality problem — there is a cheap, effective, beneficial therapy for patients that 57% of the population is not taking! Therefore, if we can increase the number of people getting treated, we can save lives.
So the results are in: CHI Health Nephrology has 95% of our population on appropriate treatment, which represents a whopping 52% higher score than the national average!
After the high-fives, the “hip, hip, horrah!” and the pats on the back, I was asked how I felt about scoring 95% when the average goal rate attainment is 43%. I replied, “why didn’t we get 100%”?… And I am serious! We are in the top percentile of the country in terms of goal rate attainment, and in general, I’m a “glass is half full” kind of guy. So why was I unhappy with our results?
I was shocked that some our patients were “missed.” I eat, drink, breathe, and sleep ACE inhibitors in diabetic kidney patients with protein in their urine. I strongly believe the therapy is the right thing to do for our patients. I have the CHI Health Pharmacy $4.99 drug list framed on my wall next to a picture of my beautiful wife and children. During every patient encounter, I review whether an ACE inhibitor is indicated. In fact, I write so much benazepril that I can spell it backwards (lirpezaneb) while chewing a piece of gum and hopping up and down on one leg. So why didn’t we get 100%?
To err is human. Things can get overlooked. And that is why I embrace these performance measures/quality metrics because a person can’t be perfect all the time. The beauty of the CHI Health system is that we are encouraged to constantly strive for perfection. The PROCESS of reviewing our population in an attempt to improve quality alerted us to the few patients that we missed. And instead of crying over spilt milk and using the cliched term “it is what it is,” we decided to find out WHY the few patients weren’t getting the therapy they were supposed to. By the end of the week, everyone was either getting the appropriate therapy or had documentation why they were not able to receive it. The result = zero patients missed. Now I am happy!
Here is a take-home pearl for you: if you happen to be a diabetic with protein in your urine and you are not taking one of the “prils,” please ask your doctor why. And as always, if there are any concerns from a nephrology standpoint, we are here to help facilitate.
I hope you enjoyed our latest blog. We plan to continue to report our quality metrics in the future with the goal of giving you, our patients, “world class” care.