Web site offers checkup on the quality of medical care in Minnesota

A nonprofit Minnesota health organization released data this week that, at first glance, gives hope of going to a Web site to determine which health-care provider offers the best care.

A nonprofit Minnesota health organization released data this week that, at first glance, gives hope of going to a Web site to determine which health-care provider offers the best care.

But critics -- and even the site's developers -- say comparison shopping for health care isn't yet that easy, and the data isn't primarily meant for that purpose.

"If you use it [for comparison shopping] you're not getting the full value out of it," said Carl Heltne, president of the Duluth Clinic. "Instead, it gives you a tool and a door to talk with your physician."

The quality reports by Minnesota Community Health provided on list 12 areas of care for problems ranging from diabetes to chlamydia. The group reports what percentage of patients at each health-care institution received "optimal" care in 2005 for each health problem.

"These are the types of quality indicators that physicians agreed are the things they want for their patients," said Jim Chase, executive director of Minnesota Health Care.


Users can compare quality of care against other hospitals in a city, as well as against more than 100 health-care providers across the rest of the state. The results tend to show that one clinic might excel in some areas while lagging in others. In other words, there's no one way to determine which clinic provides the best care.

For example, 89 percent of St. Luke's hospital patients received the proper asthma medication management, the highest in the region. Statewide, that number is 91 percent.

But for patients who have diabetes, only 1 percent received optimal care at St. Luke's, while 6 percent received it at the Duluth Clinic. The SuperiorHealth Medical Group tied the state average with 9 percent.

Does that mean patients should go to St. Luke's for asthma care but SuperiorHealth Medical Group for diabetes care?

No, said Sandra Barkley, who oversees clinic care as St. Luke's vice president.

"What I don't like about the data is that the sample size is really small," she said.

The data, which was gathered from commercial health insurance plans, Medicare and Medicaid claims, and random audits of medical charts, sometimes use a sample size of as low as 60 patients for many of the measures, Chase said.

For Barkley, that's too low.


Barkley said she expects that in the future the site will be able to incorporate more patient data to have more accurate results. Until then, "it's not reflective of the universe of all patients we take care of," she said.

The diabetes data also raise another question: Does it mean the vast majority of people with diabetes in Duluth aren't getting optimal care?

Not necessarily.

For a clinic to provide optimal diabetes care, its patients have to meet several standards that are largely up them to maintain, including having good blood pressure, blood sugar and cholesterol levels; using aspirin daily; and not smoking. They're strict criteria that only an average of 9 percent of patients across the state were able to achieve.

"This is not a measure where we expect 100 percent," Chase said. "There is a big patient role."

Chase said the site indicates areas where hospitals and clinics can improve, something he believes the report already has done.

Since Minnesota Community Health began publishing the yearly data in 2004, a statewide improvement has been seen in care for diabetes, asthma and high blood pressure.

Chase believes that making the data transparent -- available to the public -- has pushed health-care providers to improve.


"There has been great interest from hospitals in acknowledging that there are gaps in care and they can improve," Chase said.

Heltne said information on the site, such as where health clinics exceed care or have areas to improve, should be used by patients to ask their doctors if they're receiving the best possible care. And, he said, doctors should use it to learn how to best work with their patients on treatment.

"We have to figure out better ways to motivate patients to meet these standards," he said.

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