“Bridging the Gap between Personal and Population Health”

1. “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 Ahmed Calvo

2. HRSA’s Mission MissionHRSA provides national leadership, program resources and services needed to improve access to culturally competent, quality health care. GoalsAs the Nation’s 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 Ahmed Calvo

3. HDC Vision: Changing Practices…Changing 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 ). Ahmed Calvo

4. 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 Ahmed Calvo

5. Lesson Learned re Medical Home: Composite Measures: HDC cancer screening quality measure using a relay-race analogy: good health care needs coordinated hand-offs • Relay team gets no credit if the baton is dropped; no matter how excellent the first runner is. • 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. Ahmed Calvo

6. Care South Carolina Equity Composite Measures Source: CareSouth Carolina (used with permission) Ahmed Calvo

7. Disease Collaboratives: Diabetes, Cardiovascular, Depression, Asthma, HIV/AIDS, Oral Health Types of HRSA Collaboratives 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 Ahmed Calvo

8. Practice Working in a vacuum 20% Compliance with guidelines 45% Internet traffic is patients seeking self management info Less than 18% use IT for patient care 40% waste & inefficiency The Prevalent Delivery of Care 3:1 Staffing Ratio Ahmed Calvo Delays & Waits for access 1-12 weeks

9. Public Health Practice is critical and not just Office Practice Decision support has to involve more than just the Org - Community surrounds practice A wider sense of self-mgmt activities deserve careful research & consideration Registries, EHR, PMS, CDMPs,& HIEs are critical Prepared Proactive Organization is just as critical 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 patient’s time Ahmed Calvo Communities of Practice are critical

10. The Original Institute for Healthcare Improvement (IHI) Learning Model“Breakthrough 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 Ahmed Calvo

11. 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 Ahmed Calvo

12. “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 x Ahmed Calvo

13. The Health Disparities Collaboratives have reached • over 85% of all of the health centers nationally. HDC Summary Status 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. Ahmed Calvo

14. 1) HRSA has begun a new national Collaborative: The Patient Safety and Clinical Pharmacy Services Collab (PSPC). The Next Generation of the HRSA Collaboratives 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. Ahmed Calvo

15. 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 Ahmed Calvo

16. 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@hrsa.hhs.gov www.healthdisparities.net www.hrsa.gov/patientsafety www.hrsa.gov/healthliteracy/training Ahmed Calvo