Population Health Metrics
We are constantly looking for ways to make it easier for you to know and act on your individual care needs. We discuss preventive care at most visits, provide easy access to upcoming health needs through MyChart, and will often reach out to you if you are overdue for a particular test.
We routinely measure how well we are doing in reaching our membership with important services and set goals to improve. When setting goals, Yale Health refers to a large national data source called HEDIS (Healthcare Effectiveness Data and Information Set) that tracks the performance of organizations like ours around the country. HEDIS gives us an idea of how we are performing compared with other similar organizations.
We share some of these measures with you below.
Breast Cancer Screening
What is being done to improve breast cancer screening rates?
- Preventive Health letters remind women about getting mammograms at least once every 2 years.
- Wait times for mammograms are dependent on location, but are generally booking anywhere from 1 to 4 months out.
Cervical Cancer Screening
What is being done to improve screening rates?
- Preventive Health letters remind women about getting screened for cervical cancer screening.
- Exploring other types of beneficial outreach to patients.
- Interdepartmental collaboration to improve screening rates.
Colorectal Cancer Screening
What is being done to improve screening rates?
- Preventive Health letters remind people between the ages of 45 and 75 that they are due for screening.
- Monthly mailing of FIT tests to those due for annual FIT testing.
- Monthly reminder letters sent to those who have not returned their FIT.
- Panel Management meetings for those due for screening.
- Monthly reminders to those due for screening. These letters are sent 6 months after the Preventive Health letters.
Controlling High Blood Pressure in People with Hypertension
What is being done to improve blood pressure control rates?
- Encouragement of patients to take home BP readings prior to telehealth visits.
- Panel management meetings with clinicians and their MAs.
- Letter to patients who have not had an in-office BP reading in at least 1 year.
Control of Diabetes (A1c <8)
What is being done to improve A1c control rates?
- Panel management meetings with clinicians and their MAs.
- Quarterly lab reminder letters to patients overdue.
- Diabetes education classes held virtually once per month.
Cholesterol-Lowering Medication* Use Among People with Diabetes
What is being done to improve screening rates?
- Panel management meetings review the use of statins.
- Provider-based outreach to those patients who should be taking statins but are not.
*Common statin medications include atorvastatin or simvastatin
Cholesterol-Lowering Medication Use Among People with Heart Disease
What is being done to improve statin use among our patients?
- Panel management meetings review the use of statins.
- Provider-based outreach to those patients who should be taking statins but are not.
Adolescents who Received at Least 1 Dose of the HPV Vaccine*
What is being done to improve HPV compliance rates?
- Starting in 2013, letters are mailed to parents 1 week prior to their child’s upcoming Well-Child visit in order to encourage HPV vaccination.
2-Year-Olds who Received 2 Doses of the Flu Vaccine
What is being done to improve flu immunization compliance?
- During flu season, letters to patients encouraging flu vaccination are sent to parents.
- Reminder letters are also sent mid-flu season to those parents whose children have not yet been vaccinated.