Updates from the BTSD Data for Quality Project Right Care Initiative - - PowerPoint PPT Presentation

Updates from the BTSD Data for Quality Project

Right Care Initiative Annual Summit, November 14, 2016

Allen Fremont, MD. Ph. D

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Data for Quality Project (DQP)

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Brief history and assessment of San Diego Data Group (2011-2015)

• Established to create safe venue for data

sharing and foster collaboration on efforts to make SD a heart attack & stroke free zone

• Traditional focus on improving performance

within individual organizations

• Equal emphasis on trends in combined data

across organizations and collective action toward reducing cardiovascular risks throughout the region’s population.

• By fostering collaboration among health care
• rganizations that collectively serve a large

portion of population DFQ Group helped form foundation for a growing number of novel, innovative initiatives in San Diego.

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Data Group Quickly Picked Up Steam

4 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 200,000

2010 2011 2012 2013 2014

Group 2 Group 3 Group 5 Group 1 Group 6 Group 7 Group 4 Group 8

BTSD SD Data Group Begins

Potential Impact BP Control in Hypertensives

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20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 200,000 2010 2011 2012 2013 2014 BP Uncontrolled BP Controlled

74 percent of the 176,000 hypertensives had BP controlled in 2014 Each 1 percentage point improvement = 1,760 more hypertensives with BP control in SD 46, 100

BP uncontrolled

129, 814

BP controlled

Projected Overall BP Control Rate in Hypertensives to 2018

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83% 84% 82% 72% 74% 76% 78% 80% 82% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2010 (n=2) 2011 (n=2) 2012 (n=4) 2013 (n=7) 2014 (n=8) 2015 (n=8) 2016 (n=8) 2017 (n=8) 2018 (n=8)

Percentage with BP Controlled

Goal is for 2 percent per year improvement in overall rate of BP Control through 2018 (and increasing DQP population to >200k)

2015-2016 rate

Drop in rate due to several large groups with lower rates

Examples Areas of Focus 2016

Interactive Tableau files are now available for use by provider groups participating in DQP

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Potential Focus on Gender Differences in CVD Risk Reduction

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• 0.6%

4.1% 0.5%

• 4.0%
• 5.0%
• 4.0%
• 3.0%
• 2.0%
• 1.0%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0%

DM: BP <140/90 DM: LDL <100 Men Women

Source: 2015 BTSD DQP Group Data

In contrast to gender gaps for most measures which are small or favor women, gaps in LDL control relatively large and favor men

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Interactive maps show combined counts and HTN BP control rates by zip code

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BP control rates may vary by local area (zipcode) served

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Group F HTN control rates Group E HTN control rates Darker shades of blue better performance; darker red shades worse

• performance. Source: 2015-16 BTSD DQP data.

DQP participants can also highlight potential “hotspots” where quality across DQP Group’s lower than other areas

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Cluster of zip codes around Escondido area with lower than expected DM LDL control rates

Are DM LDL control rates lower than expected for all groups

• r just some?

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zip code group A group B group C group D group E group F group G combined Count groups >30 in area avg 41 60 N/A 58 68 51 40 57

Difference

92025 N/A N/A

• 10.7

0.5 N/A

• 0.4
• 12.6

4 92026 N/A

• 2.1

N/A 5.7

• 10.6
• 7.7
• 2.4
• 8.4

5 92027 N/A

• 4.1

N/A 1.3

• 2.4
• 4.3

3.3

• 8.7

5 92029 N/A 1.7 N/A

• 10

3.2 N/A 2

• 1.4

4 92082 N/A 1.2 N/A

• 6.2

N/A N/A

• 5.7
• 14.2

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In Escondido area, several but not all group’s LDL control rates are below their expected rate. The gap varies by specific zip code within the hotspot and some groups performing better than their expected rate.

Difference (percentage pts) in LDL control rate between each Group’s zip code and SD rate

DM LDL Control by Poverty (2015, Q4, Zip Code rates)

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DM LDL Control Rates (%)

Data source: LDL control data reported by 6 medical groups to the Be There San Diego Data group for Q4 of

• 2015. Rates are not presented for ZIP codes that include fewer than 30 individuals with hypertension (n=95).

Percent of population with household income below poverty level derived from 5-year ACS estimates (2010- 2014) . Denominator size and number of groups serving area shown for selected zip codes.

% households < poverty level

Relationship between DM LDL Control rate and poverty rate across zip codes differed for some DQP Groups

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Data source: Blood pressure control data reported for Q4 of 2015. Observations entail percent adequately controlled BP for a given zip code and Group so that multiple observations are observed for each zipcode (N=85). Percent of population with household income below poverty level derived from 5-year ACS estimates (2010-2014)

Overall Correlation coefficient=-0.34 (p=0.01)

Group D Correlation coefficient= 0.26 (p=0.07) Group E Correlation coefficient=

• 0.22 (p=0.09)

10 20 30 40 50 60 70 80 90 100 Fitted values 10 20 30 40 pct_lthpov Fitted values pct_ldlcontrol_G Fitted values

Group G Correlation coefficient= 0.20 (p=0.09)

10 20 30 40 50 60 70 80 90 100 Fitted values 10 20 30 40 pct_lthpov Fitted values pct_ldlcontrol_F Fitted values

Group F Correlation coefficient=

• 0.37 (p=0.01)

Several zip codes in Escondido area with notably lower LDL control rates than expected across low and high poverty levels

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DM LDL Control Rates (%) % households < poverty level

Expected Rate Negative

• utliers

San Diego Trends in AMI and HTN Control

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Data sources: Data for Quality Group reporting and AMI data from Hospital Discharge Data, (CA OSHPD), County of San Diego, Health & Human Services Agency, Epidemiology & Immunization Services Branch

72% 74% 76% 71% 71% 79%

50 55 60 65 70 75 80 20 40 60 80 100 120 140 160 180 2010 2011 2012 2013 2014 2015

% Patients with controlled BP County AM I hospitalization rate (per 100K)

San Diego Trends in AMI and HTN control

SD County AMI hospitalization rate % Patients with HTN and controlled BP %Patients with DM and controlled BP

How do Patterns of AMI Hospitalization Rates vary by Zip Code and Year?

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AMI hospitalization Rate Trends by SRA (2010-2014)

Questions and Discussion

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