Quality Corp Loses Leader While Facing Challenges
October 29, 2010 -- With the imminent departure of Nancy Clarke who’s led the Oregon Health Care Quality Corporation for the past five years, daunting challenges await her successor who’s expected to be named in mid-November.
“I’m bowing out completely and taking a break from healthcare; it’s time to turn it over to someone else who can take it to the next stage.” said Clarke, who intends to pursue her love of jazz music and to travel.
As the state’s leading organization to improve the quality of healthcare by bringing together physicians, hospitals, insurers, policymakers and consumers, the Quality Corp has played a dominant role. Its website, PartnerforQualityCare.org, is the essence of transparency, shedding a light on how well clinicians and hospitals are doing.
“We know our work has changed the practice behavior,” said Clarke, who’s been focused on encouraging partnerships within the healthcare system, demonstrating that “we can have a very trusted process to measure quality,” calling that her most important accomplishment. “We help patients know what to ask for and hold the physicians and nurses accountable for what’s more likely to happen.”
Currently 11 health insurers participate, along with 130 medical groups representing more than 300 clinics around the state. “We truly are a multi-stake holder organization, and brought a real product to the Quality Corp,” Clarke added. “We don’t just talk but have gotten something done.”
When it comes to gathering information about quality, Clarke works with physicians on how to use information to drive change, allowing them to “see behind the curtain and look at the data that the scores are based on.” This isn’t true in other places around the country, she said. “We know that our work has changed the practice behavior. We make a unique contribution and don’t just send scores out from some headquarters in the sky.”
Heading into the future, a huge challenge awaits the Quality Corp – its sustainability. “In the last few years we created a product and demonstrated its usefulness,” Clarke said. “Now how can we demonstrate that value so it’s financed over the long term? The question is -- how we can make this relevant and useful to medical groups, purchasers and hospitals and put us on a sustainable financial footing? It’s not all about just quality, but quality and efficiency, and we have the data.”
The Quality Corp derives 1/3rd of its budget from the Robert Wood Johnson Foundation. Starting next May, those funds will lead to a three-pronged effort – examining low back pain, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD).
“A lot of people want to work together on these because it’s an opportunity for cost reduction and improving care,” Clarke said.
Oregon has extremely high rates of back surgery based on Dartmouth Atlas data, with the Hospital Service Areas (HSAs) for the four largest metropolitan areas – Portland, Eugene, Salem and Bend – among the top seven out of 3,437 HSAs in the country, according to Clarke.
Oregon’s outpatient rate for people who’ve had an MRI – without trying recommended treatments such as physical therapy – is 36.2 percent compared to a national average of 32.7 percent. Cost is a huge factor. In 1998, the direct healthcare costs attributable to low back pain were estimated at $26.3 billion in the U.S. Indirect costs related to days lost from work are also substantial with approximately 2 percent of the work force compensated for back injuries each year.
A large proportion of adult Oregonians could be impacted by better management of
acute low back pain, Clarke said, citing a report in the Annals of Internal Medicine by Dr. Roger Chou which showed that low back pain was the fifth most common reason for all physician visits in this country. “We need to align the benefit design and the payment so that patients get early intervention that doesn’t proceed to chronic back pain.”
In Oregon, a major cost of CHF and COPD is a result of hospital readmissions, which range from 19.9 to 27.2 percent compared to a national average of 24.5 percent. Additionally, Oregon is listed as worse than average for complete instructions given at discharge for heart failure patients, with a 2007 rate of 67.1 percent compared to the national average of 76.8 percent, suggesting steps can be implemented to reduce readmits.
Conversely, CHF and COPD are chronic conditions that primarily affect adults 65 years
and older. For example, in 2006, 91 percent of heart failure hospitalizations in Oregon occurred among people over the age of 55 years.
The prevalence of CHF and COPD in Oregon is consistent with U.S. rates but results in more deaths than the U.S. average. The 2009 AHRQ State Snapshots lists Oregon (41.4 percent) as worse than the all-state average (32.3 percent) for in-hospital congestive heart failure deaths. Better management of these conditions and reductions in readmissions may decrease the hospital death rates, Clarke said.
There are 18 hospitals in Oregon participating in the RWJ hospital quality network (HON). Each hospital is participating in one or more of the three HON collaborative topic areas – increasing emergency department throughput; reducing readmissions and improving language services.
For More Information
To learn more about the work of the Oregon Health Care Quality Corporation, visit http://q-corp.org/