Recently we’ve all been hearing various athletic analogies of the COVID pandemic- reminding us to remain strong with some version of “it is not a sprint, it is a marathon.” Personally, my favorite running method was neither the marathon or the sprint but speed play, a form of training popularized in Sweden and characterized by periods of fast running intermixed with a slower pace. Over the past year WCHQ, similar to health care in general, has had periods of intense speed and effort followed by periods of planning and anticipation. Even when things have slowed down, we have had to be ready at a moment’s notice to speed up quickly.
Like on the track, being able to accelerate quickly has allowed health care providers to implement immediate improvements to our care of patients even when the pandemic isn’t over. Nationally, this is demonstrated by the rapid development of effective vaccines. In Wisconsin we’ve seen medical providers identify strategies to remain open and provide preventive care even while treating (largely unvaccinated) COVID patients.
This month’s newsletter is filled with examples of improvement work that has become even more important due to avoided or delayed health care. In addition to continuing our sprints on essential care, such as immunizations for children, WCHQ members have undertaken some incredible new projects that will undoubtedly require marathon-level effort. Of particular note is the focus on reducing health care disparities with partners from across the state and efforts to reduce obesity with partners from both the provider and payer perspectives. Today we have record-level participation in this work by WCHQ members; if you or a member of your organization wants to participate, please reach out.
As evidence of a recent sprint, WCHQ has had to recently convert in-person meetings back to virtual. We are confident that the quality of the meetings will be unchanged as we have perfected our ability to engage participants and provide high-quality facilitation. We are, of course, looking forward to in-person meetings again soon and when we do, I am proud to report that 100 percent of WCHQ staff are fully vaccinated against COVID-19.
“Everyone needs to reinforce the importance of screening and getting our colorectal cancer screening rate back on track to take advantage of the momentum we gained in all the previous years,” according to Durado Brooks, MD, MPH, medical director of the screening business unit at Exact Sciences, speaking at the WCHQ - Exact Sciences webinar, "Addressing the Impact of the Pandemic on Colorectal Cancer Screening Rates" held July 30, 2021.
The pandemic created a huge backlog of colorectal cancer screenings that were missed from February through July 2020 as clinics stopped in-person visits. Brooks encouraged health systems to take an organized approach to find the people who need to be screened and after screening, prioritize those who are at high risk for a colonoscopy.
For those who are still concerned about coming into a clinic, Dr. Brooks suggested telehealth and then taking advantage of home testing.
What works? Dr. Brooks said a mailer to those who should be screened was the best approach, followed closely by a clinic visit-based FIT distribution. The annual flu shot visit also presents an opportunity to discuss screening or to send a test home with a patient. It requires planning, but it is effective in getting people tested.
Jennifer Strong, MD, regional medical director with the Marshfield Clinic Health System Institute for Quality, Innovation and Patient Safety said their approach to getting people screened is to have all practitioners within the health system remind the patient to be screened for colorectal cancer.
“I know we are successful when my patients say, even my podiatrist reminded me that I need to be screened,” said Dr. Strong.
Jennifer Weiss, MD, MS, director of the UW Health Gastroenterology Genetics Clinic, works closely with WCHQ on topics related to colorectal cancer. She described a project she is leading that is aimed at improving the quality of colorectal cancer screening across Wisconsin by learning from high-performing rural and urban clinics. By doing this, her team hopes to understand local variation in CRC screening rates and then apply multi-level interventions to increase screenings.
You can’t screen people you can’t find. That’s why Ellen Bateman and her team at Exact Sciences built an IT solution that helps health systems identify opportunities and optimizations in their EHRs to address colorectal cancer screening gaps in care. Bateman explained how their technology can be deployed to not only increase screening rates but to also decrease disparities.
The third annual WCHQ Oral Health Collaborative Summit brought the members of the one-of-its kind group together July 29 to network on topics ranging from evidenced-based dentistry to how data can be collected and used to improve patient outcomes.
If patient problems are similar, keynote presenter Mike John, PhD, MPH, believes that collaborating with other dental practices to collect data will help determine whether a treatment works. Patient-reported outcomes are an important data point to include, others are cost and resource use (waste avoidance).
The American Dental Association (ADA) created a repository for dental data, which presenter Diptee Ojha, PhD, MBA, described in detail. The ADA is building a dental data base that dentists can upload information into to run a report against quality measures to create a benchmark.
The ADA has created a core measure repository that captures Epic, Dentrix and open dental electronic dental records. The warehouse is designed to capture data that will allow dentists to compare their quality metrics to other dental practice.
Wisconsin Dental Association President Paula Crum, DDS, MS, reported on the WDA legislative agenda. During the last legislative session, WDA successfully advocated for an increase in Medicaid dental rates, the first significant increase in the history of the program. WDA also lobbied on teledentistry to virtually deliver diagnostic and screening services for those patients who cannot make an office visit. The bill requires the provider of these services be licensed in Wisconsin.
Equity in care should be available to all people, according to Jack Dillenberg, DDS, Dean Emeritus of the A.T. Still University of Arizona School of Dentistry and Oral Health. Dr. Dillenberg pointed out that more than 40 million people have disabilities in our country and have many unmet health care needs.
“Whatever role you play contributes to the health and wellness of our citizens,” according to Dr. Dillenberg. “We want to deliver that care respectfully and in a cost-effective manner without sacrificing quality.”
Dr. Dillenberg encouraged collaboration among dentists and physicians to help avoid episodic and fragmented care that results when a patient presents with tooth pain in the emergency department. By working together to solve this issue, he believes the patient will have better, coordinated care. Dentists should be meeting and collaborating. Episodic and fragmented – that is where we are at – patients go to the ER with tooth pain (but we could be doing better!) we need to have discussions with payers to allow providers to do what they need to do.
Gundersen Health has been using WCHQ data to benchmark their performance to other health systems across the state. Dawn Thorsen, director of quality at Gundersen Health System, explained how data is used to set improvement goals and then to measure progress. Matt Gigot, WCHQ director of performance measurement and analysis, described WCHQ’s data assets and the current dental measures that are being publicly reported at WCHQ.org.
The WCHQ Oral Health Collaborative meets regularly to discuss issues of common interest, develop dental measures and collaborate on improvement work and publicly report results. To learn more contact Jen Koberstein, program manager.
The WCHQ Oral Health Collaborative appreciates the support of GSK, Delta Dental of Wisconsin, and ForwardDental.
WCHQ is in the process of deploying an asthma control test measure in its Data Voyager platform for use by members who are interested in this area of care. This measure will identify patients ages 5-50, with asthma, who had an asthma assessment during the 12-month reporting period. The draft specification in its entirety is ready for review by any health system interested in reporting this measure. At this time, results of this measure are for internal use only.
The measure description follows:
The percentage of patients age 5 to 50 who have an active diagnosis of Asthma that have had an age-appropriate standardized asthma assessment in the 12-month measurement period. Examples of recognized assessments are as follows:
• Childhood Asthma Control Test (C-ACT)
• Asthma Control Test (ACT)
• Asthma Control Questionnaire (ACQ)
• Asthma Therapy Assessment Questionnaire (ATAQ)
If your health system is interested in reporting this measure or if you’d like the full measure specification, contact Jen Koberstein.
Closing the Gaps in COVID-19 Vaccination Rates
WCHQ’s 2019 Wisconsin Health Disparities Report highlighted the racial and ethnic disparities in vaccination rates for childhood and adolescent vaccines, HPV, and pneumococcal vaccination. The Wisconsin Department of Health Services (DHS) regularly provides current COVID-19 vaccination rates broken down by demographic data including race and ethnicity. The racial and ethnic disparities found in COVID-19 vaccination mimic those found in WCHQ’s vaccination measures, with 30.6 percent of Black Wisconsinites having completed at least one dose of the COVID-19 vaccination compared with 49.6 percent of white Wisconsinites. Additionally, 37.4 percent of Native American Wisconsin residents and 42.0 percent of Hispanic residents have completed at least one dose of the COVID-19 vaccine. DHS data also indicates that Wisconsin’s communities of color have been disproportionately affected by COVID-19 due to barriers caused by social determinants of health.
The disparities in COVID-19 impact vaccination rates highlight the need for increased statewide efforts to address inequities in health care access and outcomes. WCHQ is forming a Disparities Improvement Team to bring health care stakeholders throughout the state together to identify and share best practices to close disparities gaps. If you are interested in participating on this team, contact Abbey Harburn.
Integrating Behavioral Health into Primary Care Clinics
The Collaborative Family Healthcare Association joined the WCHQ Behavioral Health Improvement Team in July to talk about overcoming barriers in implementing integrated behavioral health (IBH) in primary care clinics. Culture change, billing, business goals and measurement were discussed. In addition, the group shared how to examine cost savings of implementing IBH services including decreased emergency department visits and hospital readmission for patients being treated in an integrated model. They also highlighted the importance of looking at quality of life measures for patients engaged in this model of care.
WCHQ members will continue to work on increasing integrated behavioral health in primary care settings as work begins on the Advancing a Healthier Wisconsin (AHW) project, in collaboration with the Medical College of Wisconsin. If you are interested in joining the Behavioral Health Improvement Team or would like to learn more about the AHW funded project, contact Jen Koberstein.
Improving Access to Obesity Services
WCHQ members on the Obesity Advisory Group recently met with a small group of payers to discuss coverage and payment issues associated with treating patients who are obese. Provers and payers are interested in increasing access to obesity services that will help all patients in this population, but especially those who have or are at risk of developing chronic conditions.
The treatment of obesity, whether it is through nutritional counseling, medication or surgical means is especially important in a state where more than 32 percent of the population is living with obesity. Many of these patients are already impacted by chronic health conditions associated with their obesity.
Priorities for the advisory group include developing measures that will allow health systems to identify best practices, improving quality of life, identifying areas for improvement, working with payers to increase access to services, and helping health system administrators better understand the challenges in treating this population.
If you are interested in participating on the Obesity Advisory Group, contact Jen Koberstein.
RSV on the Increase
Like much of the nation, Wisconsin is seeing an off-season increase in respiratory syncytial virus (RSV) this summer. RSV is a respiratory infection that usually rises in frequency during the fall. Pre-term infants are especially vulnerable to hospitalization due to RSV infection. Wisconsin did not see many cases of RSV last fall due to the COVID-19 precautions, leading to more cases earlier this year. As of July 31, the Wisconsin Department of Health Services reported an 8.8 percent positive rate compared with less than 1 percent in 2020.
This early RSV season also coincides with a surge of COVID-19 among children in Wisconsin. This combination of respiratory illnesses increases the burden on pediatric practices throughout the state. In August, the Adolescent and Child Health Improvement Team reinstated monthly COVID-19 Huddle discussions as part of the standing team meeting agenda. This Huddle allows Improvement Team members to share current strategies, best practices, and struggles related to managing the COVID-19 pandemic in their patient populations. During the August meeting, members discussed issues related to staffing and capacity. In September, the team will focus on staff and personal well-being during the COVID-19 pandemic. To participate in the Adolescent and Child Health Improvement Team, contact Abbey Harburn.
Chronic Disease Learning Collaborative, Hypertension Workgroup
The second workgroup series from the Chronic Disease Learning Collaborative (CDLC), met virtually August 23 with a focus on hypertension. A determined group-- it didn’t take long to recognize this team’s commitment to improving quality and sharing best practices.
The health systems and partners participating in the workgroup began with introductions that highlighted current hypertension initiatives and barriers. Members shared a variety of methods used to support hypertension management and accurate readings regardless of the care setting (e.g. cardiology verses primary care). Additionally, the group took note of the complexities related to identifying affordable and compatible equipment to support self-measured blood pressure readings.
The hypertension workgroup members are each tasked with establishing goal(s) that support hypertension care management. Similar to other improvement teams, this group has an opportunity to select a goal focused on disparities by means of screening for social determinants of health or connecting patients to community-based services.
Over the next few weeks, individuals from this workgroup will be establishing SMART goals to work on over the next twelve months. Once goals are established, the group will review them at the November meeting.
Important work- still time to join: the next meeting is November 22, 2021.
Contact Sheryl Pierce if you are interested in joining the Chronic Disease Learning Collaborative (CDLC) or workgroups (diabetes, hypertension, team-based care).