Slide 1 HRSA Health Disparities Collaborative 2006 Ahmed Calvo, MD, MPH, FAAFP US Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care Division of Clinical Quality Slide 2 Care South Carolina Community Health Center On a line graph labeled Equity by Disease, the X-axis lists months from June 2004 to December 2006, although all the lines stop at November 2005. The Y-axis is labeled Disparity. The line marked Equity Diabetes stays mainly with the range of 0 to 1, with a high of about 2.5 in October 2004. The line marked Equity Cardiovascular is almost always highest in disparity, with a low of about 6.5 in September 2004 and a high of about 12 in February and April 2005. Only in August 2004 is it not above the rest, when the line marked Equity Depression tops it. The Equity Depression line is the most jagged, with a high of about 11.5 in August 2004 and a low of about negative 5 in March 2005. After a relatively stable period, it is at about 1 in November 2005. The line marked Equity Asthma is mostly in the negative zone, with a high of about 7.5 in October 2004 and a low of about negative 2.5 in August 2004. Slide 3 Most Frequent Diagnoses in Health Center Encounters, 1998 to 2004 Alcohol and drug abuse, along with other mental health disorders, take over as most prevalent encounter diagnoses On a stacked bar graph, the X-axis lists selected years and the Y-axis gives the number of encounters in millions. The bars marked Hypertension show 1.9 million in 1998, 2.3 million in 2001, and 3.0 million in 2004. The bars marked Diabetes show 1.4 million in 1998, 1.7 million in 2001, and 2.5 million in 2004. The bars marked Hypertension show 1.5 million in 1998, 2.3 million in 2001, and 3.5 million in 2004. National Data, HRSA UDS Slide 4 Quality Improvement: Quick History of Health Centers, HC’s, in the HRSA HDC Program 1998 5 HC’s Excellent Outcomes Institute for Health Care Improvement Don Berwick, MD, Boston 2006 About 850 HC’s nationally More than 90 percent of HC’s in HDC 1,100 teams to date Slide 5 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. Slide 6 Why Is the Collaborative Designed in This Manner? Science of system; change designed to: Define, document, and disseminate ideas Accelerate improvement and achieve results Build clinical leaders and systems of change Based on the Institute of Medicine, IOM, definition of quality of care involving six distinct dimensions Slide 7 Six Aims of HDC Quality Improvement: STEEEP Climb to Higher 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 Slide 8 HRSA Health Disparities Collaboratives 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: Patient self-management support Delivery system designed for patient support Evidence-based decision support Clinical information system to monitor outcomes Organization of health care for quality Community partnerships Slide 9 Collaborative Engine At the upper left of the slide are the words Topic and Process Experts. An arrow points down from them to the words Planning Group, which has a rightward arrow marked Identify Change Concepts pointing to a box labeled LS 1. At the upper center of the slide are the words HC Team Participants. An arrow points down from them to the word Prework, which has a downward arrow pointing to the LS 1 box. A rightward arrow points from the LS 1 box to a box marked LS 2. Above this arrow is a circle of arrows from P to D to S and back to P. The LS 2 box has a rightward arrow pointing to a box marked LS 3. Above this arrow is a circle of arrows from A to D and back to A. Beneath the LS 1, LS 2, and LS 3 boxes are the words Learning Sessions. The LS 3 box has a rightward arrow pointing to a box marked LS 4. Beneath the LS 4 box is the word Harvesting. Infrastructure Support Web site E-mail Visits Phone Assessments Web-ex Slide 10 The HDC Program Is Consistent with All HRSA Strategic Goals; 2005 to 2010 Goal 1: Improve access to health care Goal 2: Improve health outcomes Goal 3: Improve the quality of health care Goal 4: Eliminate health disparities Goal 5: Improve the public health and health care systems Goal 6: Enhance the ability of the health care system to respond to public health emergencies Goal 7: Achieve excellence in management practices Slide 11 Overall Strategic Timeline of the HRSA Health Disparities Collaboratives 2004: Redesign into PHC strategy 2005: Make pilots and demos of integration 2006: Integrate high-leverage pilots slash demos 2007: Complete all health centers 2008: 16 million patients in the registry 2009: Collect data on PHC outcomes 2010: Be ready to report as a system on health outcomes measures of all 16 million patients anticipated to be under our mutual responsibility by then Slide 12 Overall Strategic Goals of the HRSA Health Disparities Collaboratives Institutionalize quality into the HC program expectations and into the supporting infrastructure, both as defined in the IOM report and as applied operationally via the systems change management approach. In order to eliminate health disparities in the country, exceed all HP 2010 Measures with all 16 million HC patients, as a system of HC’s, and have the data to prove it. Reference: Healthy People 2010 Slide 13 Goal: Improve Quality of Care; Low Birth Weight On a line graph, the X-axis lists years from 1999 to 2003 and the Y-axis gives rates. The line marked US proceeds thus: 7.60, 7.60, 7.70, 7.80, and 7.90. The line marked Health Centers proceeds thus: 7.40, 7.10, 7.10, 7.00, and 7.05. Sources: Uniform Data System, 1999 to 2003; National Center for Health Statistics, NCHS, Health US, 2003 Slide 14 For More Information Ahmed Calvo, MD, MPH, FAAFP Chief, Clinical Quality Improvement Division of Clinical Quality Bureau of Primary Health Care Health Resources and Services Administration US Department of Health and Human Services Phone: 3 0 1, 5 9 4, 0 8 1 8 E-mail: ahmed.calvo@hrsa.hhs.gov Health Disparities Collaboratives Web site: http://www.healthdisparities.net