The CKD Advisory Group met to continue planning a full-day event that will be held at the Heidel House in Green Lake on September 26. The event will feature both in-person and virtual attendance options. The group began planning the event with a focus on a patient’s experience living with CKD, an overview of the CKD guidelines, and presentations by dietitians, social workers, and pharmacists.

George L. Bakris, MD, F.A.H.A., F.A.S.N., will be presenting at the conference. Dr. Bakris is a Nephrologist/Certified Hypertension Specialist trained at the Mayo Clinic and the University of Chicago Medicine. He is a professor of Medicine and Director of the American Heart Association Comprehensive Hypertension Center at the University of Chicago Medicine. He has published over 900 peer-reviewed articles and book chapters in the areas of diabetic kidney disease, hypertension, and nephropathy progression.

For more information about the work WCHQ is doing on chronic kidney disease, contact Jen Koberstein at jkoberstein@wchq.org.

‍

April 24–30 is National Infant Immunization Week and our spotlight for April. The health of the children of Wisconsin is a top priority for WCHQ and its member organizations.

As illustrated by the graph below, we have made collective strides toward protecting children from vaccine preventable diseases. But in early 2020, COVID-19 caused many disruptions in family life which prevented or delayed children from receiving routine care and vaccinations. Wisconsin felt the effects, as evidenced by the 2%-3% drop in vaccination rates across our membership.

‍

While the world has largely returned to normal, WCHQ’s work continues to focus on childhood immunization. WCHQ and our members have formed a workgroup to further collaborate on ways to improve care, and immunization rates, for Wisconsin’s youngest population. One of the ways we are looking to further care for kids is to widen the immunizations we measure. Currently, we are looking at a Combo 7 immunization schedule. In the coming months, we would like to begin testing a measure that examines a Combo 9 immunization schedule. This work will use the data to identify barriers and opportunities to ensure children have access to immunizations. 

In addition to changing the Childhood Immunization measure, the work group is also looking to update the Adolescent Immunization measure. Dr. Margaret Hennessey, from Ascension, had this to say about the changes to the Childhood Immunization Measure and the Adolescent Immunization measure: “Adding rotavirus vaccine and hepatitis A vaccine to the childhood vaccine series will cause a potential decrease in overall rates for all clinicians. Hepatitis A vaccines and rotavirus vaccines have been on the routine schedule for several years but rotavirus vaccine does have a maximum age indication. As a result, infants who miss the cut off age, are not able to start or complete the series. As for adding HPV vaccine to the adolescent series, this will also potentially decrease the overall rates for all clinicians. The uptake of HPV vaccine has been slower in the clinics. However, it does make sense to stop treating HPV as a special vaccine. It should be treated as a routine vaccine because it is. I would expect that this change will help clinicians to treat it as routine as well.” 

If you are interested in participating in this work, please contact Quality Improvement Specialist Lori Bue.

WCHQ partnered with the Medical College of Wisconsin on a project funded by Advancing a Healthier Wisconsin to increase access to behavioral health services for patients with Medicaid. As part of this project, patients tell the stories of their experience receiving services. WCHQ will feature these stories in upcoming newsletters.  

These contemporary portraits of people living with mental illness provide brief glimpses into the experience of navigating the US health system as Medicaid recipients. They share their stories of seeking care, engagement with clinicians, therapeutic treatment, peer support, and recovery. The 3-minute personal vignettes point to the impact of social-cultural and institutional determinants on health, and the resilience it takes to access care and get better.  

‍Abbie
“The Undiagnosed”
‍Rural access and what we need

In this video portrait, Abbie talks about her experience living in the rural Midwest and the challenges of growing up with undiagnosed mental illness. She speaks frankly about the need for mental health screening in primary care and the lack of access in small towns.

Possible topics for discussion: rural access, the right to health care, health literacy and the power of diagnosis.

‍

Sign-up now to join the 2023 UW-UNC HPV Vaccine Project to improve adolescent vaccination in your health system.

In collaboration with WCHQ, the UW-UNC project team will work with health systems to deliver a brief, evidence-based HPV vaccination communication workshop, known as Announcement Approach Training. Content includes traditional approaches, such as using presumptive announcements, as well as newer ones, such as how to start discussions about HPV vaccine with parents whose child is age 9 or older. WCHQ data will be used to track improvements.

Health systems will receive a 1-hour CME/CNE communication workshop for providers and clinical staff in primary care clinics, as well as additional training for one or more Vaccine Champions. Champions will deliver the HPV vaccine communication workshops to half of the health system’s participating clinics and experts from the project team will deliver workshops to the remaining clinics. If applicable, small stipends are available to support system participation.

This workshop has been shown to increase HPV vaccination by five percentage points (Brewer et al, Pediatrics, 2017) and save physician time during clinic visits (Malo et al., Implementation Science, 2018). It will also help clinical staff build relationships with families and defuse conflict.

The project team will provide all training and materials needed. While this project currently focuses on HPV vaccination, health systems may adapt these materials for sustainable quality improvement as they wish after the project is over.

This project is funded by the National Cancer Institute. Project leads are Elizabeth Cox, MD, PhD, a pediatrician and health services researcher, and Meghan Brennan, MD, MS, an infectious disease physician and health services researcher, both at the University of Wisconsin; along with Melissa Gilkey, PhD, a behavioral scientist at the University of North Carolina.

Training will begin shortly with workshops delivered to participating clinics in Spring 2023.

Thank you to the health systems currently working with us! We look forward to hearing from other interested health systems. Contact Jen Koberstein or the UW-UNC project team at prokids@pediatrics.wisc.edu or 608-263-1202. The team will set up a brief meeting to discuss the project and answer questions.

Antibiotic Stewardship

Reducing Unnecessary Antibiotic Prescriptions for Patients

The Antibiotic Stewardship Improvement Team, which meets every other month, met in March welcoming Froedtert to the team. Three measures that have been developed as part of this project - acute sinusitis, acute bronchitis and upper respiratory infection - are nearing completion. The data from these measures will be reviewed at upcoming improvement team meetings to better understand the prescribing patterns of the health systems involved in the outpatient setting.   

The meeting began with a presentation by Ascension’s Diane Erdman, PharmD, Ambulatory Care Pharmacy Manager, who described the work at Ascension to address antibiotic stewardship. Their work includes:

• alerts in the electronic health record based on visit symptoms
• education for providers with special attention to coding opportunities
• patient education
• developing a dashboard to provide feedback to providers  

Improvement team members discussed obstacles faced by health systems, including:

• the burdens on primary care
• COVID-19
• focus on inpatient prescribing
• sustainability

Tristan O’Driscoll, PharmD, MPH, BCIDP, System Antimicrobial Stewardship Coordinator with Aspirus Health, stated, “I’m glad that we are initiating this project, as it will raise awareness and engagement among our system leaders and stakeholders with respect to one of the largest areas of antibiotic misuse that we see. The data will not only help to identify areas for improvement, but also provide external benchmarking and a competitive drive to do better.” 

He continued, “By taking our previous work on antibiotic avoidance for acute bronchitis in our Emergency Departments and partnering with WCHQ and other health systems across Wisconsin to expand our focus to upper respiratory tract infections (URIs) in all ambulatory sites, we hope to apply data and evidence-based best practices to continue to improve the care of our patients by avoiding antibiotic use when it is unnecessary.”  

Please contact Lori Bue, Quality Improvement Specialist, at lbue@wchq.org if you would like to learn more about this project or join the improvement team.

‍

Asthma

Helping Patients Control Asthma Through Patient Screening Tools and Care Planning

The Asthma Improvement Team met in March to begin looking at regional asthma control measure results. This was the first step in setting benchmarks for the new WCHQ asthma control screening measure. The improvement team is currently capturing utilization to determine rates of screening for children and adults with the goal of increasing screening as a first step towards improvement.  

Karen Pletta, MD, a pediatrician and UW Health General Pediatric Quality Improvement Director, spoke to the team regarding the quality initiative UW Health embarked on in 2015. This initiative standardized the approach and documentation of the Asthma Control Test (ACT) and Asthma Action Plan (AAP) across all pediatric clinics. Dr. Pletta shared clinic workflows that were established, the roles each person on the care team had in gathering the questionnaire, accessibility of scores in Epic, and practitioner use of the tool during appointment. Dr.Pletta finished the presentation stating, “The Asthma Improvement Project will be very helpful for patients as it encourages use of the validated ACT towards improving assessment and asthma control for children through adults. Overall, the WCHQ quality metrics are very valuable for patient quality care! They validate the importance of the quality areas and provide focus for improving patient care across Wisconsin.” 

This improvement team is looking for health systems to participate. If interested, please reach out to Lori Bue, Quality Improvement Specialist at lbue@wchq.org.

‍

Maternal Health

Healthy Mom and Baby at Time of Delivery

WCHQ’s Maternal Health Improvement Team is seeking involvement from midwives or doulas who have interest in sharing their expertise on maternal morbidity and mortality. This team meets on the first Friday of each month from 12 – 1pm. The intent of this team is to look at chronic disease measures such as hypertension, diabetes, depression screening and obesity and apply them to the pregnant population. The data will then be stratified by age, race, payor, ethnicity, and location, to further identify the disparities amongst this population. This data will then be used to drive quality improvement activities within the health systems to decrease maternal mortality. If interested in participation in this group, please contact Lori Bue at lbue@wchq.org.

‍

Chronic Disease

Member Success Story: Gundersen Health System’s Diabetes Team-Based Care 

The Chronic Disease Learning Collaborative met on January 30, 2023, to share their improvement goals and outcomes in a poster presentation format. Aspirus, Associated Physicians, Gundersen, Marshfield Clinic (3), Prevea and Primary Care Associates of Appleton shared their improvement goals and the work they are doing in their health systems. One year ago, each team member set a chronic disease improvement goal unique to their health system.  

Diabetes remains very costly. According to the American Diabetes Association, every one in seven health care dollars is being used to treat complications of diabetes. We also know that managing and controlling diabetes can decrease risk for additional chronic diseases and improve outcomes for patients.  

Gundersen Health System highlighted a project with a “different approach of looking at our diabetes management and treatment of patients,” said Chelsea Schroeder, RN. In September 2022, Gundersen started a diabetes education pilot within two primary care clinics to help patients improve diabetes outcomes. The diabetes education staff moved from a specialty endocrinology clinic into the primary care clinics to reach the patients identified in their plan. Patients are now able to receive diabetes education in the primary care clinics instead of going into the endocrinology clinic. The patient is offered a warm hand off and brief intervention in conjunction with the referral to diabetes education. Nurses and primary care staff are collaborating with the diabetes education staff, reinforcing the diabetes educator’s treatment plan.

Gundersen is tracking the number of referrals to diabetes education and to pharmacy, as pharmacy can be involved in patient care as well. Highlighting improvement for one patient, six months ago the patient came into the clinics with a A1C of 14.7. After six months with this team-based approach, their A1C was down to 8.4.

Schroeder says, “We know we have increased provider satisfaction,” and Gundersen is working to assess the right workflows for the diabetic education staff. “Still a lot of work to do, but we are proud of the work and advancements we’ve made in diabetes management.”