I have been in many quality improvement meetings where that question was asked. The answer? Because that is patient centered care! If a blood pressure of 130/80 is more protective for older and high-risk patients, that is what we should be shooting for. If patients do better with a hemoglobin A1c of 7, achieved with certain medications, that is what we should achieve in most patients, but we don’t even come close to that.
Control of high blood pressure to 140/90 is only achieved in 44% of patients and declining in the United States overall. Kaiser Permanente in Northern California controls blood pressure to 140/90 in 90% of their patients with high blood pressure. That is the benchmark. Control of blood pressure, sugar, and cholesterol concurrently in diabetes is only about 20% in our country. Patients with diabetes should be on a statin. Just over half of American patients with diabetes are on anything to control lipids.
Minnesota measures achievement of these concurrent goals by provider group and reports them to the public.
The D5 for Diabetes
The D5 is a set of five treatment goals that when reached together, represent the gold standard for managing diabetes. D5 resources were created by MNCM to make it easier for people with diabetes to work with their health care provider and set and achieve goals to better manage the disease. When a person achieves D5 success, they reduce their risk for complications such as heart attack, stroke and problems with their kidneys, eyes and nervous system.
The five goals of the D5 include:
1. Control blood pressure
2. Lower bad cholesterol
3. Maintain blood sugar
4. Be tobacco-free
5. Take aspirin as recommended
The Ridgeview Excelsior Clinic in Minnesota achieves the D5 (optimal medical therapy) in their patients with diabetes 72% of the time. That is what can be accomplished. Eleven other clinics achieve OMT in 60% or more of their patients. Therefore, 60% D5 achievement represents a good benchmark. Even in Minnesota, there are three clinics with a D5 performance of 13% or less. That is enormous variation. No other industry would tolerate that. Because we tolerate it, too many patients are needlessly dying, having amputations, becoming blind, and going on dialysis.
So what is the difference between the providers who achieve a blood pressure control rate of 90% vs. the 44% in usual care? The high performing practices set up the systems to improve hypertension and diabetes management. They invariably use a population health tool to find patients who are not at goal, who have never been seen, or have not had a test or visit within a specified window. They have primary care teams using protocols with nurse practitioners or pharmacists who are authorized to make changes in treatment without consulting a physician. They use analytics to determine baseline and quarterly performance and provide triggers to the teams to address gaps in care. They use those analytics to plan improvement. The best performing groups don’t have better doctors or more compliant patients. They have the systems to produce the D5 or optimal medical therapy product much more consistently.
So, yes, you should be held accountable for achieving optimal medical therapy in your patients with diabetes and artery disease. It should be reported to the public. Your pay should be higher if you accomplish higher rates of OMT. Why? Because that is patient-centered care. We can help you with implementing the systems and protocols if you need that.
Absolutely! Promoting proven Lifestyle;e Optimization Measures must be part of this as well with ht ultimate goal to eliminate unnecessary and dangerous unproven drugs, procedures, devices, tests to reduce suffering and eliminate preventable premature deaths. We ALL are responsible to save the US economy from collapsing!