3 variables that drive clinical results

By Josh Gray | December 13, 2017

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Healthcare payers increasingly seek to reward or penalize providers based on the quality of care they provide, quality that’s measured — if in part and imperfectly — through a set of practice-reported measures.

It makes sense, then, that healthcare leaders, and providers themselves, would do well to understand and replicate the qualities of organizations that excel on these measures, while avoiding the pitfalls of those that struggle.

At athenahealth research, we set out to determine how top organizations differ from the rest, tapping into performance data from our national network of providers. After examining 39,000 primary care practices in thousands of locations and in organizations of various sizes, we zeroed in on a set of core operational metrics that correlate with improved clinical outcomes.

Our research measured practice performance on two key reported quality measures — colorectal cancer screening and hypertension control. These measures are included in many pay-for-performance contracts and reflect two critical components of clinical quality: the prevention or early diagnosis of common diseases and management of patients with chronic diseases.

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In the data visualization above, you can activate the toggle for any combination of three operational metrics: M.D. retention rate, portal adoption rate and clinical EDI rate (which essentially measures how “wired” a practice is by comparing the number of inbound documents received electronically and by fax). By moving the slide for each metric to the left and right, you can see how the clinical performance for an average athenahealth practice compares to one that is better — or worse — on each operational metric.

For example, a practice on the athenahealth network with performance in the top decile on all metrics performs colorectal cancer screenings on 30 percentage points more of its patient panel than practices in the lowest decile — an improvement you can visualize by sliding all of the bars over to the right.

Portal adoption has the highest correlation with performance, perhaps because providers with high portal adoption rates are better at patient engagement in general. A top decile practice by that metric reports colorectal cancer screening rates that are 11 percentage points higher than rates of practices with average portal adoption.

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Here, we’ve visualized the correlations between three metrics — M.D. retention, portal adoption and patient no-show rates — and effective documented hypertension control. In this case, a practice that has top performance in all of these metrics documents hypertension control at a rate that is on average 5 percentage points higher than groups that are average for those metrics. Similarly, a practice in the lowest-performing decile on each operational metric underperforms on hypertension control by the same amount.

For more insight, read coverage of our quantitative research into key performance indicators and best management practices of top-performing practices.