The care of chronically ill Minnesotans is still suffering from COVID-19's shock to the health care system, an influential clinical report shows.

While clinics are making gains in management of depression and diabetes, they are losing ground in other areas, according to MN Community Measurement's 2022 data, published Thursday. Only 55% of patients had their vascular disease adequately managed in 2022, down from 60% in 2019.

Clinic scores varied. Entira's Hugo clinic had nearly 67% of its vascular disease patients at optimal health, which means they had low blood pressure, refrained from smoking, and took daily aspirin and statin drugs. NorthPoint Health & Wellness Center in Plymouth only got 22% of its patients to that level last year.

Scores for vascular care generally worsened for the top and bottom clinics, said Julie Sonier, executive director of MN Community Measurement, a nonprofit agency that uses clinics' electronic records to calculate their performance.

"What I hoped we would see was sort of more consistent improvement back toward at least where we were before the pandemic," she said.

Thursday's report allows patients to look up their own clinics across several measures, including vascular disease, which can lead to heart attacks and strokes.

Sonier said the 2022 scores likely reflect the struggles for clinics since the pandemic with finances and a shortage of nurses and other caregivers.

Clinical quality "is just one of the many things on their plates," she said, "and some of the others are pretty urgent, like you have to stay in business."

MN Community Measurement also compares the actual performance of clinics with their expected performance based on the age and insurance status of their patients and the poverty level of surrounding communities. The goal is to produce fairer data for clinics with more challenging patient populations, but those serving low-income communities still tend to fare worse in the annual report card.

Hennepin Healthcare clinics in Minneapolis were expected to keep 47% of vascular disease patients at optimal health but only reached 36%. By comparison, France Avenue Family Physicians in Edina achieved a 68% rate, above its target of 58%.

Entira Family Clinics in the east metro have long been top performers. Three of its five clinics beat expectations for vascular disease in 2022, including an East Side clinic with a diverse patient population.

Entira invested in care coordinators who follow up with patients after appointments — making sure those with depression keep therapy appointments and those with diabetes receive medication. Dr. Lori Bethke, Entira's chief medical officer, said the success stems from familiarity.

"We know our patients really well and they know us really well," she said. "We have created this connection that helps us as providers be able to influence them in a way that is positive and meaningful."

Bethke, like some Minnesota doctors, has qualms about the grading system. She would rather be graded on the amount of time she counsels patients on smoking instead of on the percent who ignore her.

"I don't put the cigarette in their mouth and light it up for them," she said.

On the other hand, she recalled telling a patient every year for 15 years to quit smoking. The patient finally quit two years ago.

"It does pay off in the end in our patients' lives," she said.

Had all Minnesota clinics met target goals for 2022, another 7,623 patients with vascular disease would be at optimal health, MN Community Measurement estimated.

Northwest Family Physicians has long ranked among the most cost efficient clinic groups in Minnesota, providing colonoscopies, allergy tests and other diagnostics in-house so patients don't have to pay for extra visits. However, one of its clinics was below expectations for vascular care in 2022 and all three fell short on diabetes care.

COVID-19 might have scared people from going to the doctor two years ago, but that isn't an excuse today, said Theresa Molnau, Northwest's chief operating officer. It's tough to be graded on patients' adherence to doctors' orders, but the group might be able to improve by connecting more patients to support services, she said.

"Whether [people are] smoking or taking aspirin or not really has no relationship to COVID, other than their access to care," she said.

Twelve Sanford Health clinics in western Minnesota fell below expectations for vascular care, which is frustrating because the system is among the best at medication and blood pressure management, said Dr. Jeremy Cauwels, Sanford's chief physician.

Elevated smoking rates in rural Minnesota hurt Sanford's performance, he said. The system also lost nurses and others amid the pandemic and is still recruiting more who can then do things like check in with patients and counsel them after clinic visits.