Member Stories

Neighborhood Family Practice Achieves Better Blood Pressure Control for Patients Living with Diabetes

About NFP

Neighborhood Family Practice (NFP) was founded in 1980 in response to a concern that residents of Cleveland’s near west side lacked access to primary health care. A Federally Qualified Health Center (FQHC), NFP spans twelve neighborhoods across Cleveland, focusing on providing high quality primary care in a medical home setting.

The Challenge

As NFP has continued to expand their operations, their goal has been to improve overall patient satisfaction by optimizing care delivery systems and maximizing care team roles.

The Solution

Upon learning how Acuere functions as an aggregation tool, Neighborhood Family Practice made it available to site managers and improvement team members to help them achieve their goals. For instance, to achieve their goal of 95% empanelment, a site manager is able to run a list of patients with no primary care provider (PCP) and develop strategies with the front office staff to guide the patient in their PCP selection or properly assign one as needed. The ability for staff to run diabetes registries to close gaps in care and for recalls has helped NFP control blood pressure for 77% of their patients living with diabetes across the organization.

The Results

Acuere lets NFP see how all its sites are doing, so they are able to easily identify bright spots, and sites can learn from one another. Locations that utilize ancillary staff such as pharmacists, wellness coaches, and a diabetes educator, or that have intensive case management working with primary care, deliver better outcomes despite the challenges of the population. In fact, two of the NFP satellite clinics have achieved better blood pressure control than NFP as a whole: Detroit Shoreway is at 84% and The Centers Rocky River is at 90%, while NFP is at 77% overall.

Acuere also provides NFP the ability to benchmark with other community health centers across the nation and against the OCHIN collaborative. Being able to share the data at the provider, site, and organization level creates an environment of healthy competition, resulting in better documentation practices and knowledge sharing to improve performance.