HRSA Health Disparities HRSA Health Disparities Collaboratives 2006Collaboratives 2006

Ahmed Calvo, M.D., M.P.H., FAAFPU.S. Department of Health and Human ServicesHealth Resources and Services AdministrationBureau of Primary Health CareDivision of Clinical Quality

Care South Carolina Community Care South Carolina Community Health CenterHealth Center

Most Frequent Diagnoses in Most Frequent Diagnoses in Health Center Encounters, 1998–Health Center Encounters, 1998–20042004Alcohol and drug abuse, along with other mental Alcohol and drug abuse, along with other mental health disorders take over as most prevalent health disorders take over as most prevalent encounter diagnosesencounter diagnoses

0

1

2

3

4

5

6

7

8

9

10

1998 2001 2004

1.5M

1.4M

3.5M

2.5M

3.0M

Millions ofEncounters

2.3M

2.3M

1.7M

Mental Health

Diabetes

Hypertension

National Data–HRSA UDS

1.9M

Quality Improvement: Quality Improvement: Quick History of Health Centers Quick History of Health Centers (HCs) in the HRSA HDC Program(HCs) in the HRSA HDC Program

1998 2006 5 HCs ~850 HCs Nationally

>90% of HCs in HDC 1,100 teams to date

EXCELLENT OUTCOMES

Institute for Healthcare Improvement Don Berwick, M.D., Boston

What Is a Collaborative?What Is a Collaborative?

A collaborative is an intensive, concentrated effort to facilitate breakthrough transformations in the clinical and operational performance of clinical teams and their organizations, based on what already works.

The entire effort is an evidence-based approach using ideas that are known to work effectively at the clinical sites and in the management information systems.

Why Is the Collaborative Why Is the Collaborative Designed in This Manner?Designed in This Manner?

Science of system –Science of system – change designed to: change designed to:

Define, document, and disseminate ideas Define, document, and disseminate ideas Accelerate improvement and achieve resultsAccelerate improvement and achieve results Build clinical leaders and systems of changeBuild clinical leaders and systems of change Based on the Institute of Medicine (IOM) Based on the Institute of Medicine (IOM)

definition of quality of care involving six definition of quality of care involving six distinct dimensionsdistinct dimensions

Six Aims of HDC Quality Six Aims of HDC Quality Improvement: STEEEP Climb to Improvement: STEEEP Climb to Higher GroundHigher Ground

S – Safe

T – Timely

E – Effective

E – Efficient

E – Equitable

P – Patient Centered

Reference: Institute of Medicine – Crossing the Quality Chasm: A New Health System for the 21st Century (2001)

HRSA Health Disparities CollaborativesHRSA Health Disparities Collaboratives

Patient self-management supportPatient self-management support Delivery system designed for patient supportDelivery system designed for patient support Evidence-based decision supportEvidence-based decision support Clinical information system to monitor Clinical information system to monitor

outcomesoutcomes Organization of health care for qualityOrganization of health care for quality Community partnershipsCommunity partnerships

The Planned Care Model includes six essential elements for improving the care of people (organized for more team function and increased 21st-century electronic information exchange and entire team access to information):

Collaborative EngineCollaborative Engine

Infrastructure Support

Web site E-mail Visits Phone Assessments Web-ex

Infrastructure Support

Web site E-mail Visits Phone Assessments Web-ex

Topic and

Process Experts

Planning Group

HC

Team Participants

PreworkP

S

A D

LS 3

Harvesting

Identify Change

ConceptsLearning Sessions

LS 2LS 1 LS 4

P

S

A D

GOAL 1:GOAL 1: Improve access to health care Improve access to health care

GOAL 2:GOAL 2: Improve health outcomes Improve health outcomes

GOAL 3:GOAL 3: Improve the quality of health care Improve the quality of health care

GOAL 4:GOAL 4: Eliminate health disparities Eliminate health disparities

GOAL 5:GOAL 5: Improve the public health and health Improve the public health and health care systemscare systems

GOAL 6:GOAL 6: Enhance the ability of the health care Enhance the ability of the health care system to respond to public health system to respond to public health emergenciesemergencies

GOAL 7:GOAL 7: Achieve excellence in management Achieve excellence in management practicespractices

The HDC Program is Consistent with The HDC Program is Consistent with All All

HRSA Strategic Goals (2005–2010)HRSA Strategic Goals (2005–2010)

2004:2004: Redesign into PHC strategy Redesign into PHC strategy

2005:2005: Make pilots and demos of integration Make pilots and demos of integration

2006:2006: Integrate high-leverage pilots/demos Integrate high-leverage pilots/demos

2007:2007: Complete all health centers Complete all health centers

2008:2008: 16 million patients in the registry 16 million patients in the registry

2009:2009: Collect data on PHC outcomes Collect data on PHC outcomes

2010:2010: Be ready to report as a system on health Be ready to report as a system on health outcomes measures of all 16 million outcomes measures of all 16 million patients anticipated to be under our patients anticipated to be under our mutual responsibility by thenmutual responsibility by then

Overall Strategic Timeline of the Overall Strategic Timeline of the HRSA Health Disparities HRSA Health Disparities

CollaborativesCollaboratives

Institutionalize quality into the HC program Institutionalize quality into the HC program expectations and into the supporting expectations and into the supporting infrastructure, both as defined in the IOM infrastructure, both as defined in the IOM report and as applied operationally via the report and as applied operationally via the systems change management approach. systems change management approach.

In order to eliminate health disparities in the In order to eliminate health disparities in the country, exceed all HP2010 Measures with all country, exceed all HP2010 Measures with all 16 million HC patients, as a system of HCs, 16 million HC patients, as a system of HCs, and have the data to prove it.and have the data to prove it.

Reference: Healthy People 2010Reference: Healthy People 2010

Overall Strategic Goals of the Overall Strategic Goals of the HRSA Health Disparities HRSA Health Disparities CollaborativesCollaboratives

Goal: Improve Quality of Care Goal: Improve Quality of Care –– Low BirthweightLow Birthweight

Sources: Uniform Data System, 1999–2003 National Center for Health Statistics (NCHS) – Health U.S., 2003

7.60 7.60

7.70

7.807.90

7.057.007.107.10

7.40

6.8

7

7.2

7.4

7.6

7.8

8

1999 2000 2001 2002 2003

Year

Ra

te U.S.Health Centers

For More Information For More Information

Ahmed Calvo, M.D., M.P.H., FAAFPAhmed Calvo, M.D., M.P.H., FAAFPChief, Clinical Quality ImprovementChief, Clinical Quality ImprovementDivision of Clinical QualityDivision of Clinical QualityBureau of Primary Health CareBureau of Primary Health CareHealth Resources and Services AdministrationHealth Resources and Services AdministrationU.S. Department of Health and Human ServicesU.S. Department of Health and Human ServicesPhone: 301-594-0818Phone: 301-594-0818E-mail: E-mail: ahmed.calvo@hrsa.hhs.govahmed.calvo@hrsa.hhs.gov

Health Disparities Collaboratives Health Disparities Collaboratives Web site: Web site: http://www.healthdisparities.nethttp://www.healthdisparities.net