From skepticism to commitment
In Washington D.C. recently with Chris Queram as part of the Robert Wood Johnson Foundation Connect project (see “From the president & CEO” column in this issue), John Weigelt, M.D. of Froedtert & The Medical College of Wisconsin (MCW) had the opportunity to tell an enlightening story about the impact of WCHQ.

Dr. Weigelt, professor of surgery and associate dean of clinical quality for MCW and medical director of quality for Froedtert Hospital, had just taken charge of the institutions’ joint quality office in 2003. Within his first six months on the job, the first public report was released from WCHQ on diabetes care. MCW physician results did not look good. Dr Weigelt recalls that the data showed only 70 percent of MCW's diabetic patients were under good control and 20 percent had not even been tested in the past year.

MCW physicians were not pleased with these results and their response was typical of many physicians when their performance is challenged. They believe data is at fault or just wrong. Dr. Ann Nattinger, one of the lead physicians for MCW’s primary care providers, carefully reviewed the data and shared her findings with her colleagues: the data were accurate and the results valid. The quality of care was not at the level assumed by the physicians. “Once convinced, our physicians set out to improve the care they provided to their patients,” said Dr. Weigelt. “We adopted a number of efforts designed to change physician behavior and increase patient support.” These included:

• Reminding physicians about the benefits of diabetic control in terms of reduced complications and reduced hospitalizations
• Monthly feedback to physicians about their diabetic patients' control rates
• Improving patient education brochures
• A reconnection with patients to emphasize patient centric care

The results of this effort have been significant and rewarding. The next year, 80 percent of the patients had their diabetes under control and those not tested within the year had fallen to 5 percent. Those gains have been maintained and even enhanced over the years. MCW physicians are now closing in on 90 percent for diabetes control and non-testing is less than 5 percent.

Today, the MCW physicians use the data as an important gauge for tracking their performance in delivering high quality care and engaging patients in their own care. “This experience had a remarkable effect on our physician group and subsequently, their patients. We learned how to value our WCHQ data and use it to improve care. Data is necessary to drive change and improve the quality of medical care. The data collection and reporting efforts spearheaded by WCHQ were key to our improvement efforts,” said Dr. Weigelt.

“In addition, we have used this experience to improve care for a number of different patient populations ranging from the acutely injured patient to those with chronic heart disease. And now, when I present WCHQ data to our physicians, I rarely feel the need to bring my Kevlar vest,” joked Dr. Weigelt.

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