Post on 24-Dec-2015
Linking Clinical Care and Communities Linking Clinical Care and Communities for Improved Preventionfor Improved Prevention
Web SeminarWeb Seminar
Sept. 1, 2011Sept. 1, 2011
Follow this event on Twitter Follow this event on Twitter Hashtag: #AHRQIXHashtag: #AHRQIX
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Using the Webcast ConsoleUsing the Webcast Console
What Is the Health CareWhat Is the Health CareInnovations Exchange? Innovations Exchange?
Publicly accessible, searchable database of health Publicly accessible, searchable database of health service delivery innovative strategies and toolsservice delivery innovative strategies and tools
Successes and attemptsSuccesses and attempts Innovators’ stories and lessons learnedInnovators’ stories and lessons learned Expert commentariesExpert commentaries Learning and networking opportunitiesLearning and networking opportunities New content posted to the Web site every two New content posted to the Web site every two
weeksweeks
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Innovations Exchange Innovations Exchange Web Event SeriesWeb Event Series
How to find archived materialsGo to the Events & Podcasts tab on our site: http://
www.innovations.ahrq.gov. A transcript of this event along with the slides will be available in a week.
Next EventsLook for announcements
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HousekeepingHousekeeping
For help, notify the Vcall team through the For help, notify the Vcall team through the question window at the bottom right hand question window at the bottom right hand side of the screen.side of the screen.
To refresh your screen, hit f5.To refresh your screen, hit f5. Recording, slides, and transcript available Recording, slides, and transcript available
on Web site by next week.on Web site by next week. Today’s slides are available now.Today’s slides are available now.
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Submitting QuestionsSubmitting Questions
Today’s Event ModeratorToday’s Event Moderator
Tess Miller, DrPHTess Miller, DrPH
Director, Prevention & Care Management Portfolio, Center Director, Prevention & Care Management Portfolio, Center for Primary Care, Prevention & Clinical Partnershipsfor Primary Care, Prevention & Clinical Partnerships
Agency for Healthcare Research and Quality (AHRQ)Agency for Healthcare Research and Quality (AHRQ)
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AHRQ’sAHRQ’s MissionMission
To improve the quality, safety, To improve the quality, safety, efficiency, and effectiveness of health care efficiency, and effectiveness of health care
for all Americans for all Americans
Health care providers, patients, policymakers, Health care providers, patients, policymakers, payers, administrators, and others use payers, administrators, and others use
AHRQ research findings to improve health care AHRQ research findings to improve health care quality, accessibility, and outcomes of carequality, accessibility, and outcomes of care
AHRQ’s PortfoliosAHRQ’s Portfolios
Comparative EffectivenessComparative Effectiveness
Health Information TechnologyHealth Information Technology
Innovations & Emerging IssuesInnovations & Emerging Issues
Patient SafetyPatient Safety
Prevention/Care ManagementPrevention/Care Management
ValueValue
P/CM Portfolio P/CM Portfolio Strategic GoalsStrategic Goals
1.1. To support clinical decision making for To support clinical decision making for preventive services through the preventive services through the generation of new knowledge, the generation of new knowledge, the synthesis of evidence, and the synthesis of evidence, and the dissemination and implementation of dissemination and implementation of evidence-based recommendationsevidence-based recommendations
P/CM PortfolioP/CM PortfolioStrategic GoalsStrategic Goals
2.2. Support the evidence base for and Support the evidence base for and implementation of activities to improve implementation of activities to improve primary care and clinical outcomes primary care and clinical outcomes through:through:
Health care redesignHealth care redesign Clinical-community linkagesClinical-community linkages Self management supportSelf management support Integration of health information technologyIntegration of health information technology Care coordinationCare coordination
AHRQ’s GoalAHRQ’s Goal
To understand whether fostering linkages To understand whether fostering linkages between between clinical clinical practices and community practices and community organizations enhances delivery of organizations enhances delivery of preventive services and ultimately improves preventive services and ultimately improves health outcomeshealth outcomes
To understand how to foster and sustain To understand how to foster and sustain linkageslinkages
Potential Benefits of LinkagesPotential Benefits of Linkages
Creating sustainable linkages between primary care Creating sustainable linkages between primary care and community settings can be a WIN-WIN-WINand community settings can be a WIN-WIN-WIN Patients: Increased patient access to preventive and Patients: Increased patient access to preventive and
chronic care serviceschronic care services Clinicians: Ability to refer out to services in the setting Clinicians: Ability to refer out to services in the setting
where their patients live, work, and play where their patients live, work, and play Communities: The services that they work hard to provide Communities: The services that they work hard to provide
will get used more, leading to better care and potentially will get used more, leading to better care and potentially sustained funding sustained funding
Community settings have the ability to offer intense, Community settings have the ability to offer intense, ongoing, accessible services that may not be ongoing, accessible services that may not be possible in primary care practicespossible in primary care practices
AHRQ’s ActivitiesAHRQ’s Activities
Co-sponsor of Co-sponsor of Prescription for HealthPrescription for Health First environmental scan and summit 2008First environmental scan and summit 2008 2009-20102009-2010
– Environmental scanEnvironmental scan
– Case studiesCase studies
– Summit of stakeholders to develop a national strategy Summit of stakeholders to develop a national strategy for promoting linkagesfor promoting linkages
Development of Innovations Exchange page to Development of Innovations Exchange page to facilitate the ongoing collaborative work of facilitate the ongoing collaborative work of Summit participants and interested stakeholdersSummit participants and interested stakeholders
Conceptual Model for Linkages Conceptual Model for Linkages
Our InnovatorsOur Innovators
Wayne Action Teams for Community Health (WATCH);
Eastern Carolina College of Nursing
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Centers for Disease Control and Prevention
(CDC)
Colorectal Cancer Screening and Tobacco Cessation in a Free Primary
Care Program for the Uninsured
Carol Ann King, DNP, FNP-BCCarol Ann King, DNP, FNP-BCWATCH Lead Nurse PractitionerWATCH Lead Nurse Practitioner
Clinical Assistant ProfessorClinical Assistant ProfessorEast Carolina University College of NursingEast Carolina University College of Nursing
What is WATCH?What is WATCH?Wayne Action Teams for Community Health Wayne Action Teams for Community Health
Grant and donation-funded since 2000Grant and donation-funded since 2000 Safety net primary health care for the Safety net primary health care for the
uninsureduninsured No charge to the patientsNo charge to the patients Over 10,000 registered patientsOver 10,000 registered patients 1,000 patient visits per month1,000 patient visits per month
WATCH Mobile UnitWATCH Mobile Unit
North Carolina Prevention Collaborative
Joint project with Kate B. Reynolds Charitable trust, Joint project with Kate B. Reynolds Charitable trust, UNC Dept. of Family Medicine, Wake AHECUNC Dept. of Family Medicine, Wake AHEC
1 year quality improvement program 1 year quality improvement program Improvement of office systemsImprovement of office systems CRC screening —only 16% screenedCRC screening —only 16% screened Tobacco use very prevalent with high risk population—Tobacco use very prevalent with high risk population—
40% use tobacco, only 66% offered tobacco cessation 40% use tobacco, only 66% offered tobacco cessation
Why Colorectal Cancer and Why Colorectal Cancer and Tobacco Use?Tobacco Use?
CRC: Third leading cancer diagnosis in 2009CRC: Third leading cancer diagnosis in 2009– 90% survival if localized90% survival if localized– 68% survival if regional68% survival if regional– 10% survival with distant metastasis10% survival with distant metastasis
Deaths can be reduced by 33% with CRC screening Deaths can be reduced by 33% with CRC screening beginning at 50 (CDC)beginning at 50 (CDC)
Socioeconomic and racial disparitiesSocioeconomic and racial disparities High rates of tobacco related mortality and morbidityHigh rates of tobacco related mortality and morbidity Can we do the screening and interventions Can we do the screening and interventions
necessary to address these issues?necessary to address these issues?
Evidence for InterventionsEvidence for Interventions
Three options: fecal occult blood tests, sigmoidoscopy, & Three options: fecal occult blood tests, sigmoidoscopy, & colonoscopycolonoscopy
Annual three-card FOBTs done on 3 different samplesAnnual three-card FOBTs done on 3 different samples Referral for positive resultsReferral for positive results Tobacco assessmentTobacco assessment Stages of Change Model/PDSA CycleStages of Change Model/PDSA Cycle Multilevel interventionsMultilevel interventions
PartnershipsPartnerships
StaffStaff PatientsPatients Local ProvidersLocal Providers HospitalHospital NC State NC State
ResourcesResources
YMCAYMCA
– In-house In-house clinicclinic
– Mutual GoalsMutual Goals
– Access to Access to mutual mutual servicesservices
– CounselingCounseling
PartnershipsPartnerships
Population investmentPopulation investment Overall community cost savingsOverall community cost savings Building capacityBuilding capacity Mutual benefits and goMutual benefits and goalsals
RecommendationsRecommendations
Promote your Promote your programprogram
OutcomesOutcomes Integrate into the Integrate into the
communitycommunity Help others with Help others with
their goalstheir goals
Discussion/ImplicationsDiscussion/Implications
WATCH able to WATCH able to implement CRC implement CRC screeningscreening
CRC Risk CRC Risk Reduction Reduction EducationEducation
Tobacco cessation Tobacco cessation and reduction and reduction focusfocus
Committed to the Committed to the endend
Trial and errorTrial and error CommitmentCommitment Integrated into Integrated into
existing workflowexisting workflow Policy and Policy and
procedureprocedure
Lessons LearnedLessons Learned
Communicate!Communicate!Revised patient instructionsRevised patient instructionsTrainingTrainingTake advantage of opportunity to screen and Take advantage of opportunity to screen and
educateeducatePatients “buy-in” because provider recommended Patients “buy-in” because provider recommended
No Such Thing as “Free Care”No Such Thing as “Free Care”
$773 for the $773 for the samplesample
$3,500 annually$3,500 annually $1600 staffing for $1600 staffing for
samplesample $8,000 annually$8,000 annually $11.87 per patient$11.87 per patient $475 per polyp $475 per polyp
detectiondetection
Case PresentationsCase Presentations
56 year-old male:56 year-old male: Never screened, no known risks, symptoms or signs, positive FOBTNever screened, no known risks, symptoms or signs, positive FOBT Precancerous polyps removedPrecancerous polyps removed
45 year-old female45 year-old female:: 30 year smoker, 2 packs/day30 year smoker, 2 packs/day Quit and remains tobacco-freeQuit and remains tobacco-free YMCA full membershipYMCA full membership
SustainabilitySustainability
Build costs into Build costs into budgetbudget
Find community Find community partnerspartners
Local, state, and Local, state, and federal resourcesfederal resources
Multiple staff Multiple staff trainedtrained
RemindersReminders Time and repetitionTime and repetition
LaTonya Chavis Keener, MSLaTonya Chavis Keener, MS
RACIAL AND ETHNIC APPROACHES TO
COMMUNITY HEALTH
RACIAL AND ETHNIC APPROACHES TO
COMMUNITY HEALTH
Cooperative Agreement U50DP422161-05
To eliminate disparities in health status experienced by racial and ethnic minority populations in key areas
Goals for REACH 2010Goals for REACH 2010
Focus: Cardiovascular Disease & DiabetesFocus: Cardiovascular Disease & Diabetes Based on disease prevention strategiesBased on disease prevention strategies NW Area of Charlotte (approximately 14 NW Area of Charlotte (approximately 14
defined neighborhoods)defined neighborhoods) 95% African American95% African American
Coalition PartnersCoalition Partners
Carolinas Healthcare System University Park Neighborhood Association Mecklenburg County Health Department Cluster I Neighborhood Leadership McCrorey Family YMCA Substance Abuse Prevention Services, Inc. North Carolina Department of Health and Human
Services
Risk Factor Reduction
Participation in Regular Exercise
Smoking Cessation
Blood Pressure
Reduction
Smoking
Cholesterol Reduction
Lay Health Advisors
Educate, Motivate, Recruit, Reinforce
-Enhanced access-Community campaigns-Point of decision prompts-Social Support
-Faith-based settings-Smoking bans-Media Campaigns
Healthy Dietary Habits
-Community Campaigns-Point of Contact Interventions-School Standards
Weight Reduction
Community-Based Primary Prevention Interventions
BehaviorChanges
RiskFactorReduction
-Disease Management
-Quality Improvement
Use of Primary Medical Care
Interventions
““But what it did for me is….help me with my self-esteem. It helped But what it did for me is….help me with my self-esteem. It helped me! I began to exercise, I started at the Y too. I came down here me! I began to exercise, I started at the Y too. I came down here for my financial reasons, I came down here because they have the for my financial reasons, I came down here because they have the
same things down here as they do at the Y, and I exercise, I learned same things down here as they do at the Y, and I exercise, I learned about nutrition because we have the nutritional program here, and about nutrition because we have the nutritional program here, and I’m a lot more outgoing. You would never believe that I was very, I’m a lot more outgoing. You would never believe that I was very,
very, very introverted, very.”very, very introverted, very.”
- Neighborhood Resident- Neighborhood Resident
Neighborhood Farmer’s Market
““It’s just like a meeting place on Saturday It’s just like a meeting place on Saturday mornings, you know, everybody be up there on mornings, you know, everybody be up there on
Saturday mornings to get your little Saturday mornings to get your little vegetables, you stand around and talk. vegetables, you stand around and talk.
Somebody will give you advice on how to cook Somebody will give you advice on how to cook them.”them.”
- Neighborhood Farmers’ Market Customer- Neighborhood Farmers’ Market Customer
Percent Reporting Diabetes
0
5
10
15
20
25
Percent
Males 17.8 19.3 21 19 23.3
Females 17.7 15.7 19 21.1 17.8
Total 17.7 16.9 19.8 20.2 19.9
Year 1 Year 2 Year 3 Year 4 Year 5
Data Analysis by National Opinion Research Center (NORC) and ABT
Increased knowledge of diabetes & community resourcesIncreased knowledge of diabetes & community resources Healthier eating habits (5 or more servings of fruits & Healthier eating habits (5 or more servings of fruits &
vegetables per day)vegetables per day) Greater physical activityGreater physical activity Decrease in reported complications Decrease in reported complications Greater adherence to recommendations for eye examsGreater adherence to recommendations for eye exams Mixed success in adherence to recommendations for foot Mixed success in adherence to recommendations for foot
examsexams
Impact of Charlotte REACH Impact of Charlotte REACH 2010 on Diabetes:2010 on Diabetes:
Data Analysis by National Opinion Research Center (NORC) and ABT
Neighborhood-operated Farmers’ Market remains in community
Diabetes Nurse position maintained at Carolinas Healthcare System
Lay Health Advisors and neighborhood leaders continue to lead efforts
Sustainability
““I think overall I think of the community at large, all I think overall I think of the community at large, all over everyone is encouraging better health, exercise, over everyone is encouraging better health, exercise,
eating better, and the fact that we encourage friends and eating better, and the fact that we encourage friends and family to come, you know, is a real plus, and I think it’s family to come, you know, is a real plus, and I think it’s
like a snowball effect the more we talk about it, the like a snowball effect the more we talk about it, the better we look. As you said we got to walk the walk to better we look. As you said we got to walk the walk to talk the talk, and by losing weight, health, and people talk the talk, and by losing weight, health, and people
commenting, you know, it does make a difference.”commenting, you know, it does make a difference.” - Charlotte REACH LHA - Charlotte REACH LHA
http://www.annfammed.org/cgi/content/full/2/2/103
Additional InformationAdditional Information
Innovator Contact Innovator Contact InformationInformation
Carol Ann King: Carol Ann King: kingca@ecu.edu LaTonya Chavis Keener: LaTonya Chavis Keener:
lchavis@cdc.gov lchavis@cdc.gov
The Innovations ExchangeThe Innovations Exchange
Visit our Web site:Visit our Web site:
http://www.innovations.ahrq.gov/
Follow up on Twitter:Follow up on Twitter:
#AHRQIX#AHRQIX