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Show - Utah: 27.3% Relative Improvement National Median: 9.9% Relative Improvement -5% 5% 10% 15% Average Relative Improvement 20% 25% 30% Figure 1. Average Improvement on Inpatient Clinical Topic Areas, by State. National Median: 19.6% Relative Improvement Utah: 16.3% Relative Improvement o% 5% 10% 20% 25% 30% Average Relative Improvement Figure 2. Average Improvement on Outpatient Clinical Topic Areas, by State. tern-BRFSS) show for both PPV and influenza immunization a rising trend of vaccine coverage in Utah and nationally. Year-by-year comparisons show somewhat unusually high rates for Utah in the baseline year. What appears to be a lack of improvement for Utah in the pre-post comparison reported in the clinical performance monitoring system looks more like random variation about a rising trend in an eight-year time series analysis. Similar to the inpatient data, it is extremely difficult to assess what factor(s) caused the statewide improvement in the outpatient topics. Implementation of process changes within individual clinics, although effective, would require significant community buy-in to affect statewide performance since there are hundreds of clinics in the state. Partnering with community groups to establish educational interventions has been successful but the effectiveness of these efforts is also difficult to quantify. Challenges to implementation of these systems include staff commitment level, and more importantly the notion that these interventions require financial resources but return on investment is difficult to quantify. Although it is well known that increased preventive care will save payers money, the effects on operating costs in the fee-for-service environment have not yet been quan- tified. CONCLUSIONS The results of the second cycle of measurement from the national clinical performance monitoring system reflect successes, challenges, and opportunities in health care quality improvement in Utah. Overall, Utah has seen impressive gains related to medication usage, screening and prevention, and effectiveness of hospital processes. Work in most of these clinical topic areas will continue over the next QIO contract cycle-the 7th Scope of Work-and will be expanded to include quality indicators from the nursing home and home health settings. As this work continues, it is important to recognize that, while the measures in the national clinical performance monitoring system are important in their own right, they are indicators of health care quality and not health care quality itself. Effective improvement strategies must seek not only to close the narrowly defined performance gaps observed in these measures, but also to identify and address the more fundamental systems issues that produce such gaps. Utah's Health: An Annual Review Volume DC 136 |