Changing Practice Changing Lives

1
Changing Practice Changing Lives

• The Health Disparities Collaboratives
• West Central Cluster
• Sustain and Spread Summit
• New Team Member Orientation
• November 8, 2004

2
The Burden of Chronic Disease

• Nearly 125 million people in the United States
  live with some kind of chronic medical condition
• Accounts for 70 of all deaths in the U.S.
• Accounts for more than 60 of nations medical
  care costs
• Direct cost of care is 510 billion per year
• Source Health Disparities Collaborative Pre-work
  Manual, May 2003 Collaborative Charter Problem
  Statement

3
Crossing the Quality ChasmA New Health System
for the 21th Century Don Berwick, IHI,
President CEO

• Report of the Institute of Medicines Committee
  on Quality of Care in America
• Between the health care we have and the care we
  could have lies not just a gap, but a chasm.
• In its current form, habits and environment,
  American health care is incapable of providing
  the public with the quality health care it
  expects and deserves.
• Labels the problem as design, not people and then
  it asks for a change

4
Why is Chronic Care Such a Challenge?

• The current care systems cannot do the job.
• Trying harder will not work.
• Changing care systems will.

5
The Health Disparities Collaboratives (HDC)

• Launched in 1998
• BPHC in collaboration with
• IHI
• MacColl Institute
• Other National Partners

6

BPHC Mission and Goals of the HDC

• Eliminate Health Disparities
• Ensure 100 Access

7
Presidents Initiative to Expand Health Centers

• By 2006
• 1200 new and expanded health centers
• Increase patients from 10 to 16 million
• Goals for FY 2003 exceeded
• 100 New Access Points (NAPs) (10 gt target)
• 88 Expanded Medical Capacity (8 gt target)
• 125 Service Expansions

BPHC 8/03
8
HDC2003
Health Disparities Collaboratives Progress
Total of 134 teams 21 cancer, 26 CVD, 24
depression, 63 diabetes. Patient impact NOW in
combination with other collaboratives 173,548
HDC2002
Total of 135 teams 16 asthma, 20 CVD, 37
depression, 62 diabetes. Patient lives impacted
by end of year, inclusive of all collaboratives
141,319
HDC2001-Asthma
21 teams. Patient lives impacted, inclusive of
other collabs 96,148
HDC2001
Total of 97 teams 62 diabetes/34 CVD
participating. Patient lives impacted at end of
year, inclusive of previous 3 collaboratives
77,401
IHI BTS 2000
23 Asthma and 17 Depression teams. Patient lives
impacted at end of Phase 1, inclusive of
HDC1999,2000 42,889

HDC2000
125 diabetes teams participating. Patient lives
at end of Phase 1, inclusive of HDC1999 37,007
HDC1999
5 teams participated in the IHI Chronic
Conditions I Collaborative, immediately serving
as the lead teams for the HDC1999 with 88
diabetes teams participating. Infrastructure
included cluster directors and there was an
identified need for IS Specialists. Patient
lives impacted 13,387 
1999 2000 2001 2002 2003
Current as of 11-30-03 chupke_at_nibcomp.com
9
Building for FutureHDC Pilots

• Diabetes Prevention Pilot
• Prevention Pilot
• healthy weight, tobacco use, blood pressure,
  cholesterol, immunizations, lead screening, oral
  health, includes all lifecycles
• Redesign/Finance (RedeFin) Pilot
• Perinatal/Risk Management
• Expert Panel and planning 2004

10
The Cluster Structure
11
The 3 HDC Models

• Learning Model A performance-based learning
  method that supports a community of learners to
  apply, adapt, share, and generate knowledge, and
  spread positive change
• Chronic Care Model A population-based model that
  relies on knowing which patients need care,
  assuring that they receive evidenced-based care
  and actively aids them to participate in their
  own care
• Improvement Model (AKA PDSA Cycle) How to test
  changes in a system of care in a fast efficient
  way, ensures that changes are an improvement, and
  expands the changes throughout the practice

12
Learning Model
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
D
A
D
S
S
Planning Group
LS 1
LS 3
LS 2
Congress beyond
Action period 2 further develop the system of
care at the pilot site and spread the system to
other sites
Action period 1 Adapt and test the ideas for
improved system of care
Supports E-mail
Visits Listserv Phone Assessments
Senior Leader Reports
13
Planned Care Model
14
Care Model
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Prepared, Proactive Practice Team
Informed, Activated Patient
Productive Interactions
Functional and Clinical Outcomes
15
Organization of Health Care

• Visible senior leader support
• Clear goals reflected in
• Business plan
• Policies Procedures
• Improvement strategy

16
Community Linkages

• Partnerships
• Effective programs
• Coordination of Partnerships

17
Self-Management Support

• Emphasis on the patient role
• Standardized assessment
• Effective interventions
• Care-planning problem-solving

18
Decision Support

• Evidence-based guidelines
• Specialist expertise
• Provider education
• Guidelines for patients

19
Delivery System Design

• Team Staff roles and tasks
• Planned visits
• Group Visits
• Continuity
• Regular follow-up

20
Clinical Information System

• Registry (PECS)
• Care reminders
• Relevant subgroups
• Individual care planning

21
Break (10 Minutes)
22
Improvement Model (PDSA Cycle)
23
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
24
The PDSA Cycle for Learning and Improvement
Associates in Process Improvement
25
Why Test?

• Increase your belief that the change will result
  in improvement.
• Document how much improvement can be expected
  from the change.
• Learn how to adapt the change to conditions in
  the local environment.
• Evaluate costs and side-effects of the change
• Minimize resistance upon implementation.

26
Repeated Use of the Cycle
Changes That Result in Improvement
DATA
Hunches Theories Ideas
27
Summary of Results

• Improved Patient Outcomes
• Staff Satisfaction
• Reduced Costs
• Increased Clinic Efficiency
• Spread to other Providers
• Spread to other Conditions
• Spread to other Sites

28
Tennis Ball Exercise
29
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
30
Score Sheet
31
Score Sheet
32
Score Sheet
33
Score Sheet
34
A Day In the Life of a Team Member
35
Day to Day Tasks of Team Leaders Supporting
Team Members

• Education!
• Engagement of clinic staff and providers in the
  HDC
• Organizational Skills
• Team meetings and/or huddles
• Mindfulness

36
Challenges and Avenues to Overcome Them

• Team huddles
• Setting ground rules
• Staff members calling in sick, vacation, etc.,
  need for cross-training
• The belief that the HDC is additional work
• Integrating the work of the HDC into the daily
  routine and job descriptions
• Buy-in
• Avoiding burn out

37
Reporting Process and Resources
38
Reporting Process

• Reports are uploaded to the HDNR Website
• www.hdnr.org
• Senior Leader Narrative Submitted Quarterly
• (Jan 1st, April 1st, July 1st, Oct. 1st)
• Data Reported Monthly
• Excel Measure Graphs
• Registry Summary Reports

39
Conference Calls

• Monthly Condition Specific Conference Calls
• Diabetes
• Cardiovascular Disease
• Depression
• Cancer
• Quarterly WCC Phase 2 Conference Calls

40
Listservs

• WCC Phase 2 Team Listserv- Contact your State
  Coordinator to be added
• wccphase2_at_tachc.org
• Condition Specific Listservs-Contact Siobhan
  Moran at smoran_at_IHI.org to be added
• Diabetes1_at_list.healthdisparities.net
• Cardiovascular_at_list.healthdisparities.net
• Depression1_at_list.healthdisparities.net

41
National Support
State and Partner support
Cluster Infrastructure
Health Center
State/Local
Public
Directors, IS, State Coordinators, Steering
Committees
Private
National Directors, Technical Experts,
Coordinating Committee
42
West Central Cluster Contacts

• Wendy J. Latham, West Central Cluster Director,
  [phone], wlatham_at_tachc.org  
• April Sartor, WCC Program Assistant, (512)
  329-5959, asartor_at_tachc.org 
• Jessica Sanchez, MSN, FNP, Team Support
  Manager/Interim Colorado/New Mexico State
  Coordinator, [phone], jessica_at_cchn.org  

43
WCC State Coordinators

• Arkansas Christina Reaves-Powell, Chronic
  Disease Prevention Collaborative Coordinator,
  [phone], creaves-powell_at_chc-ar.org 
• Utah, Wyoming, Oklahoma, Louisiana
  Richard Moore, PA-C, Chronic Care Collaborative
  Coordinator, [phone] ext. 27,
  ccc_at_auch.org 

44
WCC State Coordinators

• North and South Dakota, Montana
  Sarah Imig, L.C.S.W., Collaborative
  Coordinator, [phone], Ext. 236,
  sarah_at_champsonline.org  
• Texas Juanita Lambie, Collaborative Coordinator,
  [phone], jlambie_at_tachc.org 

45
WCC IS Specialists

• Lisa Woo Revelett, Data Management and Technical
  Support Team Leader, [phone],
  lrevelett_at_tachc.org 
• Dan Martin, Data Management and Technical Support
  Specialist, [phone], Ext. 229,
  dan_at_champsonline.org 

46
National Strategic Partnerships

• DM/Cardiovascular CDC, NIDDK, IHI
• Asthma EPA,CDC, IHI
• HIV HIV/AIDS Bureau
• Depression SAMHSA, IHI
• Cancer NIH/NCI, ICIC, CDC, IHI
• Evaluation AHRQ
• In Development
• Prevention NCI, CDC, MCHB, IHI
• Diabetes Prevention CDC, NIDDK, IHI
• Finance/Redesign IHI, NACHC

47
Websites

• Texas Association of Community Health Centers
  (TACHC) www.tachc.org
• http//www.tachc.org/HDC/Overview.asp
• http//www.tachc.org/HDC/eLearning.asp
• Community Health Association of the Mountain
  Plains States (CHAMPS)
• http//www.champsonline.org/ 
• Health Disparities Collaboratives
• http//www.healthdisparities.net

48
Websites (contd)

• Health Resources and Services Administration
  (HRSA)
• http//www.hrsa.gov/
• National Institute of Health
• http//www.nih.gov/
• Bureau of Primary HC
• http//www.bphc.hrsa.gov/
•  The Bureau of Primary Health Care LEAP Program
• http//www.medschool.lsuhsc.edu/dfp/leap.html

49
Websites (contd)

• Institute for Healthcare Improvement (IHI)
• http//www.ihi.org/ 
• National Association of Community Health Centers
  (NACHC)
• http//www.nachc.com/ 
• Migrant Clinicians Network
• http//www.migrantclinician.org/ 
• Centers for Disease Control (CDC)
• http//www.cdc.gov/diabetes/ 

50
Websites (contd)

• Substance Abuse and Mental Health Services
  Administration (SAMHSA)
• http//www.samhsa.gov/ 
• National Cancer Institute
• http//www.nci.nih.gov/
• National Health Care for the Homeless Council
• http//www.nhchc.org/Network/aboutnetwork.htm

51
Websites (contd)

• Improving Chronic Illness Care (ICIC)
• http//www.improvingchroniccare.org/
• HDNR Reporting
• http//www.hdnr.org/hdreporting/
• PECS Downloads and Updates
• http//www.pecs-cis.org  

52
Thank You!!

• Success is the sum of small efforts, repeated
  day in and day out.
• Robert Collier author

53
Questions/Comments Concerns?