The influenza (flu) season is fast approaching and WCHQ members are exploring how they will manage both the flu and COVID-19 among their patients. In Wisconsin, a total of 17,210 flu cases were reported during the 2018-2019 flu season. Infectious disease experts expect that we may see fewer influenza cases this year due to best practices related to COVID-19, such as social distancing and wearing masks; however, influenza immunizations are the best strategy to control the virus.

The CDC recently released updates regarding the flu vaccine, including the 2020-2021 flu vaccine viral compositions, newly licensed vaccines for patients 65 and older, availability of egg-free vaccines, the effects of the flu during the pandemic, guidelines for talking to patients and planning for vaccination clinics. Access CDC’s informational presentation for an overview or visit the Morbidity and Mortality Weekly Report regarding the flu vaccine.

WCHQ has been collating and sharing best practices of influenza vaccination among members at various improvement meetings. Health systems will need to be more creative this year in how they implement clinics, WCHQ members are exploring various options, including leasing local business property, renting trailers, or sending out mobile units throughout the community.

Communication with patients is a critical strategy during any flu season and that is now complicated by the existence of a pandemic. WCHQ members are using educational pamphlets, patient portal messages, text messaging, and offering self-scheduling online. Registering health system vaccination services through Vaccine Finder is another effective method to increase vaccination rates. To help with such planning and communication, the CDC has issued a revised Guidance for Planning Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations.

August is National Immunization Awareness Month, and the CDC has updated additional immunization toolkits for reaching healthcare professions and patients and adult vaccination recommendations and resources for healthcare professionals. For more local state-level information, visit the Wisconsin Department of Health Services’ flu web page.

According to the Wisconsin Asthma Plan, asthma is a chronic lung condition that affects 15 percent of adults and 10 percent of children in Wisconsin. The burden of asthma in Wisconsin is not equally shared. Certain minority groups, age groups and geographic regions are disproportionately affected. Too many people with asthma in Wisconsin struggle to thrive at work or school and are subject to reduced quality of life because their asthma remains poorly controlled. Taking a comprehensive approach to asthma management is one way your health care system can begin to make a difference with your patients with asthma.

Dr. Nicholas Antos from Children’s Wisconsin shared asthma management tools and implementation strategies with WCHQ members at an August 17 webinar, “Acting on the “ACT” Score: What an Asthma Control Test Can Do for You.” A screening tool, such as the Asthma Control Test (ACT), is a validated way to screen for and document asthma control. An asthma management plan is an important part of implementing an overall management strategy. WCHQ is working on developing a new asthma measure that will look at use of asthma assessments among patients with asthma. To join in WCHQ’s quality improvement work, contact us.

Dr. Antos shared an additional educational opportunity, School-Based Asthma Management Program (SAMPRO) usage. This webinar is approved for Part 4 MOC.

The August 17 webinar is available to members in Online Community.

For some, the home is not a safe place. For those experiencing intimate partner violence (IPV), the home has become even more dangerous during the pandemic.

A WCHQ-sponsored webinar August 6, “Addressing Intimate Partner Violence During the COVID-19 Pandemic,” focused on the tools and strategies clinicians can use to address IPV in their practices. Stacy Ogbeide, Psyd, MS, is a Board-certified clinical health psychologist at UT Health San Antonio, where she serves as director of behavioral health education. During the pandemic, Dr. Ogbeide said rates of Intimate Partner Violence (IPV) have increased dramatically in some communities. She encouraged primary care practices to screen and provide follow-up care for patients who are experiencing IPV, and she shared several tools she uses in her practice.

The prevalence of IPV among women in primary care clinic panels, according to Dr. Ogbeide, is between 5.5-22 percent. However, the screening rate in primary care clinics is very low, at only 1.5-12 percent. Telehealth can be useful in improving the screening rate, but patient safety and the patient’s ability to access care safely must be a consideration. It is imperative to remember that those who are being abused are often being closely watched by their abuser.  “A person’s ability to participate on a telehealth call related to domestic violence from a clinic can be compromised if the person they fear has access to their phone or even their call history,” she cautioned.

Members can access Dr. Ogbeide’s webinar presentation, including her slides, in WCHQ's Online Community.

Representatives from End Domestic Abuse Wisconsin were also available during Dr. Ogbeide’s presentation to offer state-specific input. Resources were provided and can be found here or you can visit their website at endabuseWI.org.

Adolescent and Child Health

WCHQ members have seen a dramatic increase in human papilloma virus (HPV) vaccinations rates, with nearly two thirds of eligible adolescents getting at least two doses (63%) compared to 48% in 2017. The Adolescent and Child Health Steering Team supports this work and has accelerated this improvement by sharing best practices among members.

The U.S. Department of Health and Human Services is prioritizing vaccines with a new campaign called “Catch-Up to Get Ahead.” They’ve created a toolkit for providers and health systems to utilize in efforts to increase the number of vaccines among their patients. The confluence of seasonal influenza and COVID-19 is prompting HHS to also push out messaging on the importance of getting a flu vaccination. Across the state, health systems and medical clinics are collaborating to ensure their communities are protected. For example, here is a news conference clip from the Madison health systems and public health department at a press conference August 24.

WCHQ will continue to facilitate conversations among our members to share best practices related to vaccinations for all ages and issues related to adolescent and child health. Contact Sarah (Wright) Sky to join this group.

Behavioral Health

Healthy People 2030 was released in August, which includes a new goal for depression to “increase the proportion of adults with major depressive episodes (MDEs) who receive treatment” to 69.5%. WCHQ’s members are already focusing on this topic and have seen a sizeable rate increase of screening by more than 37 percentage points in three years. As of 2019, WCHQ members have screened 77% of patients annually for depression and we expect further improvement in the future.

Depression screening is an essential first step in diagnosing and treating depression, and WCHQ’s next publicly reported behavioral health measures will focus on improving treatment outcomes such as depression remission and response. WCHQ’s Behavioral Health Quality Improvement Team meets monthly and focuses discussions on depression as well as the integration of behavioral health into primary care. Contact Sarah (Wright) Sky to join this team.

Oral Health

WCHQ is planning to publicly report three quality measures of oral health in September. These measures include an adult measure addressing periodontitis and two measures addressing children’s oral health. Consistent with WCHQ’s mission of publicly reporting to improve the quality and affordability of healthcare in Wisconsin, these measures will be among the first public measures of oral health quality at the dental practice level in the nation. The Oral Health Collaborative is also planning the development of a measure that crosses both the oral and medical health fields. Next month’s newsletter will feature an in-depth description of this novel project.

Oral Health Collaborative members continue to meet regularly to share best practices related to safely reopening practices during the COVID-19 pandemic. Currently, a major focus is providing support to the dental care team to ensure they remain safe while providing the best care possible to their patients.

For more information or to join the Oral Health Collaborative team meetings, contact Jen Koberstein.