April 2021

WCHQ’s work on identifying disparities was recently featured in a paper published in the Wisconsin Medical Journal. The March 2021 special issue focused on how the health of the people in Wisconsin is affected by race and racism. The editorial staff, with the support of the WMJ Publishing Board and its member institutions, chose to highlight stark racial disparities among populations in Wisconsin and provide a forum for scholars in Wisconsin to share their work.

The special issue featured a report, submitted by a team comprised of UW School of Medicine and Public Health and Health Innovation Program researchers and Matt Gigot, MPH and Abbey Harburn, MPH from WCHQ, based on their work to identify racial and ethnic disparities in health outcome and care measures in Wisconsin.

Using electronic health record data from 25 health systems submitted to WCHQ, the team identified disparities in measures including vaccinations, screenings, risk factors for chronic disease and chronic disease management. Disparities were categorized by race/ethnicity, geography and payer. The results showed that American Indian/Alaska Native and Black populations experienced substantial disparities across multiple measures. Asian/Pacific Islander, Hispanic/Latino and White populations experienced substantial disparities for two measures each. The full report is available on WCHQ’s website.

WCHQ is committed to incorporating disparities in all its initiatives, including improvement, measurement and education programs.

The stress of the pandemic intensified the already high demand for behavioral health services in Wisconsin, which providers have met in a variety of ways. On April 30, WCHQ’s Assembly showcased several new approaches to increasing access to services. A summary of the meeting follows. The recording of the event will be available to WCHQ members the week of May 3 in Online Community. If you would like to request the link, contact Mary Kay Fahey.

Zero Suicide Initiative

The Zero Suicide Initiative was created in 2012 and is a quality improvement model within health and behavioral health systems that transforms suicide prevention and care to save lives. Jim Salasek, a leader in the Zero Suicide initiative in Wisconsin, explained the model and what is takes for a health system to make a system-wide, organization commitment to safer suicide care.

Peer Run Respite Care and Warmline Services offer a relatively new, but positive opportunity to avert a crisis and avoid hospitalization. Joann Stephens from the Wisconsin Department of Health (DHS), Bureau of Prevention, Treatment and Recovery, joined four colleagues who are involved in running peer-run respites in Wisconsin. DHS currently funds four, peer-run respites; a fifth respite for veterans is not funded by DHS. The following people representing peer-run respites participated in a panel discussion during the webinar:

• Iris Place – Appleton, represented by Paula Verrett
• Solstice House – Madison, represented by Tori Krohn
• Monarch House – Menomonie, represented by Samantha Jasper
• R&R House (Veterans Only) – Pewaukee, represented by Victor Kilpatrick

Peer-run respites are for people living with mental health or substance-abuse-use concerns. They offer a supportive, home-like environment during times of increased stress or symptoms. Peers with personal experience connect with those seeking services. Most guests stay no longer than one week. The coordinators explained the benefits to health systems and how it helps avoid ER visits and hospitalizations. Peer-run respite staff also provide support over the phone, called a warm-line, at no cost for those who need to talk to someone. (It is intentionally not called a hotline because it is not for extreme crises.)

Stigma and Bias in the Care and Treatment of Obesity

Are patients who are seeking care for obesity tentative to do so because they face stigma and experience bias in the medical community? Uzoma Okeagu, medical science liaison at Novo Nordisk, provided a perspective on how implicit and explicit weight bias may deter patients from seeking care for obesity. WCHQ is partnering with Novo Nordisk on a statewide project aimed at improving care for those who are obese. Contact Jen Koberstein for information.

Working to Recovery: A Holistic Approach to Recovery from Psychosis

Psychosis is closely linked to trauma; a fact of which Assembly Speaker Karen Taylor is well aware. Taylor’s organization, “Working to Recovery,” is an internationally respected organization that takes a holistic approach to recovering from psychosis. Taylor, who is based in the United Kingdom, explained how those who are experiencing psychosis are helped when they can connect their current condition with what has happened to them in the past.

WCHQ’s Behavioral Health Improvement team helped develop the Assembly agenda. Their work in 2021 is focused on issues related to integrating behavioral health with primary care and meeting the demand for services because of the pandemic. Contact Jen Koberstein to join this group.

Dr. Melanie Smith from Advocate Aurora Health presented an obesity care model framework developed by the American Medical Group Association (AMGA) at the April 21 meeting of the WCHQ Obesity Advisory Group, which was formed earlier this year. The obesity care model framework was developed during a three-year collaborative effort by providers and health care systems across the country. They shared best practices for treating obesity and submitted data during the process. AMGA created an Obesity Care Model Playbook that provides users with knowledge and insights on treating patients with obesity.

The Advisory Group also discussed upcoming obesity educational events hosted by WCHQ and opportunities for future events. The group meets monthly to advise WCHQ on its obesity initiative, a three-year project aimed at improving the care of those who are obese. If you are interested in participating, contact Jen Koberstein.‍

Chronic Disease

Planning is underway for updating the format of the WCHQ Chronic Disease Learning Collaborative. Members have expressed interest in creating focused workgroups for diabetes, hypertension, and team-based care. The three workgroups will have overarching themes of reducing disparities. Separately, the workgroups will convene quarterly between July 2021 and June 2022 to discuss diabetes, hypertension, and team-based care improvement strategies. The larger Chronic Disease Learning Collaborative will convene at least twice in that timeframe to discuss general chronic disease resources, education, and update the chronic disease toolkit. Members may choose to participate in any or all workgroups.  If you are interested in participating in the workgroups please contact Jen Koberstein.

Adolescent and Child Health

The Adolescent and Child Health Improvement Team met on April 19 and began an evaluation of the measures included in the 2021 Medicaid and Children’s Health Insurance Program (CHIP) Core Set of Children’s Health Quality Measures (Child Core Set). The Adolescent and Child Health Improvement Team set a goal in 2021 to select at least one additional pediatric quality measure to program and report internally from the Child Core Set. These measures were selected by CMS and represent the continuum of care received by pediatric patients, including measures of primary care access, perinatal health, care of chronic conditions, behavioral health, and dental services. Currently, the Adolescent and Child Health team internally reports two measures from this suite of metrics: Adolescent Well Care Visits and Developmental Screening in the First Three Years of Life. Additionally, there are a number of publicly reported WCHQ measures that align with this reporting effort, including Childhood Immunization Status, Adolescent Immunization Status, and Human Papillomavirus Vaccine.

The Child Core Set of quality measures will become required state reporting for Medicaid and CHIP in 2024. By beginning to collect data related to these measures now, WCHQ members will be better prepared to assist in data collection for state reporting efforts in the future. The Improvement Team reviewed the entire suite of Core Measures to identify measures with the potential of a large impact, ease of reporting and data collection, and strong clinical evidence. The Team will continue this review in May and plans to begin data collection in the second half of the year. For more information about the Adolescent and Child Health Improvement Team, contact Abbey Harburn.

Oral Health Collaborative

The WCHQ Oral Health Collaborative has developed a measure to indicate the percentage of patients with diabetes who received a comprehensive or periodic oral evaluation during the year. According to the American Dental Association, dentists should regularly examine patients who suffer from diabetes for oral manifestations of inadequately controlled diabetes. Those symptoms can include xerostomia, burning sensation in the mouth, impaired healing, increased infections, increased severity of infections, gingivitis, and periodontitis. Mayo Health System outlines the oral health issues that can be exacerbated by uncontrolled blood sugar levels including tooth decay, early gum disease, advanced gum disease, thrush and dry mouth (xerostomia).

Developing a baseline for this population is the first step in ensuring that dental providers are taking an active role in treating the overall health of people with diabetes. This measure will allow dental providers and medical providers to evaluate the oral health care currently accessed by people with diabetes and to identify interventions to improve rates of oral evaluation for these patients. In the future, the Oral Health Collaborative plans to complete more detailed analyses of oral health care for people with diabetes and to develop additional cross-cutting measures for this patient population. By gathering more data about care for people with diabetes in the oral health setting, the members of the Oral Health Collaborative will continue to lead in oral health quality measurement. For more information about the Oral Health Collaborative, contact Jen Koberstein.‍