Bridging the Gap between Personal and Population Health

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• Bridging the Gap between Personal and Population
  Health
• A T2 Translational Dissemination Science Effort
• Quality Improvement Insights and Lessons Learned
• From the Health Disparities Collaboratives (HDC)
• and other HRSA Systems Collaboratives
• Clinical Translational Science Awards (CTSA)
• Community Engagement Steering Committee
• Conference Call --- July 25, 2008

Ahmed Calvo, MD, MPH, Acting Deputy Director U.S.
Department of Health and Human Services Health
Resources and Services Administration Center for
Quality, Office of the Administrator
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HRSAs Mission

• Mission HRSA provides national leadership,
  program resources and services needed to improve
  access to culturally competent, quality health
  care.
• Goals As the Nations access agency, HRSA
  focuses on uninsured, underserved, and special
  needs populations in its goals and program
  activities
• 1 Improve Access to Health Care. 
• 2 Improve Health Outcomes. 
• 3 Improve the Quality of Health Care. 
• 4 Eliminate Health Disparities. 
• 5 Improve the Public Health and Health Care
  Systems. 
• 6 Enhance the Ability of the Health Care System
  to Respond to Public Health Emergencies.  
• 7 Achieve Excellence in Management Practices

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HDC Vision Changing PracticesChanging Lives

• To expand access to high quality, culturally and
  linguistically competent primary and preventive
  care for underserved, uninsured, and underinsured
  Americans.
• The Health Disparities Collaboratives strive to
  achieve excellence in practice using
  evidence-based methods through the following
  goals
• Generate and document improved health outcomes
  for underserved populations
• Transform clinical, operation, and financial
  practices through the Expanded Care Model and the
  Model for Improvement
• Develop infrastructure, expertise and
  multi-disciplinary leadership to support and
  drive improved health status and organizational
  systems and
• Build strategic partnerships.

Quality Improvement applied translational
dissemination science (T2 ).
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Key Concept Medical Home within the HDC implies
seamless responsible coordination of care within
the community, within health care organizations,
and within their internal and external systems,
based on care models for appropriate
evidence-based handoffs
Public Health POPULATION BASED AGGREGATE
DATA and Personal Health
INDIVIDUAL FAMILY
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Lesson Learned re Medical Home Composite
Measures HDC cancer screening quality measure
using a relay-race analogy good health care
needs coordinated hand-offs

• For 54 yr old twin sisters differences of
  quality of cancer screening can be shown by a
  composite measures, say if one had a mammogram
  Pap but her sister also had evidence-based CRC
  screening. There clearly is a difference in
  quality.

• Relay team gets no credit if the baton is
  dropped no matter how excellent the first runner
  is.

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Care South Carolina Equity Composite Measures
Source CareSouth Carolina (used with permission)
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Types of HRSA Collaboratives

• Disease Collaboratives Diabetes, Cardiovascular,
  Depression, Asthma, HIV/AIDS, Oral Health

2) Business Case Redesign Collaboratives
Patient-Flow, Advanced Access, Advanced
Finance, Lean Systems
3) Prevention Collaboratives Cancer Screening,
Diabetes Prevention, General Prevention
4) Community Systems Collaboratives Organ
Transplant Collaboratives Perinatal and
Patient Safety Collaborative Workforce
Development Collaborative Health
Promotion/Education Collaboratives
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The Prevalent Delivery of Care
31 Staffing Ratio
Delays Waits for access 1-12 weeks
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The Expanded Care Model
Prepared Proactive Community is critical - and
may need COPC to reduce health disparities
Workforce Staffing Is also Critical
EBMgmt (Not just EBM) include true respect for
patients time
Communities of Practice are critical
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The Original Institute for Healthcare Improvement
(IHI) Learning ModelBreakthrough Series (1998)
Participants
Select Topic
Time for setting aims, allocating resources,
preparing baseline data leading to the first 2
day meeting.
Pre-work
P
Identify Change Concepts
P
A
A
D
D
S
S
Planning Group
LS 2
LS 1
LS 3
Action period 1 Adapt and test the ideas for
improved system of care
Action period 2 further develop the system of
care at the pilot site and spread the system to
other sites
Supports E-mail
Visits Phone Assessments Senior
Leader Reports
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Historical Perspective of the HRSA Health
Disparities Collaboratives as a National
Framework for Change (1998-2008)
Evidence-Base Developed by Partners
Establish National Agenda
Small scale pilots for the purpose of developing
the change package to facilitate rapid deployment
of a new evidence-base
Pilots
Identify Measures, Priorities
Supporting National Learning Communities For
Best Practices

• Population
• Health
• Mgt.
• Registries
• Reporting

• Executing
• National
• Health
• Policy
• Public
• Private
• Partnerships

Adapting Evidence Base-- BTS, Care Model, Model
for Improvement
National Vision For Transformation
National FACULTY
Supports www.healthdisparities.net Regional
Infrastructure www.hdnr.org Phone TA
Monthly Measures and Senior Leader Reports
National Faculty Consultants Topical
Conference calls
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x
Building the BridgesTo Cross the Quality
Chasm Depiction of what the HRSA Health
Disparities Collaboratives have been doing from
the point of view of the National Faculty Feb
28, 2007 Paper
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HDC Summary Status

• The Health Disparities Collaboratives have
  reached
• over 85 of all of the health centers
  nationally.

2) All HRSA Bureaus are using Virtual Offices
(VOs) housed in the Knowledge Management
System (KMS).
3) A wide variety of HDC pilots and
demonstrations have been completed showing
that primary health care can be improved
systematically.
4) The HDC has accumulated considerable
sophisticated Quality Improvement (QI) expertise
using the business case lessons, the Expanded
Care Model, and the Model for Improvement, as
well as adult learner models such as the
Collaborative Learning Model.
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The Next Generation of the HRSA Collaboratives
1) HRSA has begun a new national Collaborative
The Patient Safety and Clinical Pharmacy
Services Collab (PSPC).
2) The PSPC is integrating lessons learned from
all of the collaboratives into a new systems
collaborative that plans to integrate
patient-centered primary health care.
3) The PSPC approach is being modeled within
HRSA, via an Inter-Bureau Core Team, and
funding from various Bureaus/Offices, all
working together as a team.
4) The PSPC Learning Session 1 is August 14-15
and will involve about 90 Community Teams
nationally.
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HRSA Knowledge Management System
Single access portal for HRSA grantees in the
field www.healthdisparities.net
Outcome Data
Help Desk
Communication
Library/ Search engine
Measures Database Aggregate Reporting
Capabilities
Tier 1, 2, 3 Improvement Support Accumulated
Knowledge Base
PUBLIC AREA
Virtual offices/ ListServs
REGISTERED USERS
IT Inventory
Secured Facility
All hardware and software applications, back-up,
and development systems
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Contact Information

• Ahmed Calvo, MD, MPH
• Acting Deputy Director
• HRSA Center for Quality
• 5600 Fishers Lane, Room 7-100
• Rockville, Maryland, 20857
• 301.594.4293
• ahmed.calvo_at_hrsa.hhs.gov
• www.healthdisparities.net
• www.hrsa.gov/patientsafety
• www.hrsa.gov/healthliteracy/training