The WCHQ Obesity Advisory Group invites you to participate in a full day hybrid educational event at the Sheraton in Madison on September 13, 2023. Attendance for WCHQ members is free. Non-members may also attend for a registration fee of $80.

We have an exciting day planned with presentations that will address:

• Combination therapy for optimal obesity care
• Using WCHQ data to drive improvement and decrease disparities
• Childhood obesity and the impact across the lifespan
• A presentation from a patient on her personal weight loss journey
• Obesity case presentations from a variety of professionals
• How to create a lifestyle medicine program
• A presentation from a psychologist working in obesity treatment

Please sign up for the event on the WCHQ website.

For more information on obesity efforts at WCHQ contact Jen Koberstein.‍

‍Navigating health disparities, racism, and stigma to get mental health access

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 newsletter.

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.  
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Abbie – “Problem Patient”
‍Even the little things are harmful
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In this video portrait, Abbie addresses the lack of empathy and dignity that people living with addiction experience in the healthcare system. She details the impact that subtle negative clinical interactions had on her self-worth, help seeking, and recovery.

Possible topics for discussion: mental health stigma, addiction stereotypes, medication assisted treatment, implicit and explicit bias.

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The Wisconsin Association for Healthcare Quality (WAHQ) conference is coming up September 8 at Chula Vista Resort in Wisconsin Dells. The theme is “Thinking Upstream: Proactive Empowerment Resources for Quality Professionals.” Credits are available through the CPHQ CE Approval Program.

Visit the WAHQ website for more program and registration information.

Asthma

Enhancing Asthma Management: Leveraging the Asthma Control Testing in Primary Care

Asthma affects millions of individuals worldwide, leading to significant healthcare burdens and impairments in quality of life. While asthma management has improved over the years, many patients still struggle to achieve optimal control of their symptoms. In primary care settings, where the majority of asthma patients are initially evaluated and managed, the Asthma Control Test (ACT) has emerged as a valuable tool for assessing disease control and guiding treatment decisions.  

Advantages of using the ACT in primary care include:

• Early detection and intervention
• Personalized treatment plans
• Patient education
• Long-term monitoring
• Research and quality improvement

The WCHQ measure for extracting asthma screening data from member organizations has been built and validated. The Asthma Improvement Team reviewed the data of the participating organizations and will continue to review the data to explore how to increase utilization of the ACT in primary care offices to enhance asthma management outcomes.

We encourage other organizations who have an interest in improving asthma screening in their populations to join this improvement team. If interested please contact Lori Bue, Quality Improvement Specialist.

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Behavioral Health

‍USPSTF Endorses Anxiety Screening

This month, The United States Preventative Services Task Force (USPSTF) recommended anxiety screening for all patients under the age of 65. The WCHQ Behavioral Health Improvement Team reviewed this recommendation and discussed how each participating health system approaches anxiety screening. Many health systems that utilize the Patient Health Questionnaire (PHQ)-9 for depression screening also utilize the Generalized Anxiety Disorder (GAD)-7 for anxiety screening. If health systems utilize the PHQ-2 and the patient screens positive for depression symptoms, the follow up is to screen with both the PHQ-9 and GAD-7. Some health systems are sending these screening tools out electronically before appointments, and some screen for depression and anxiety at every visit, while others screen annually. The announcement on the USPSTF website can be found here.

While screening for mental health disorders is incredibly important, ensuring there is a warm handoff is also a part of this process. Many health systems are in different stages of implementing Integrated Behavioral Health (IBH) in primary care clinics. IBH is an efficient strategy to support patients when they screen positively on behavioral health screeners and provide brief interventions, sometimes the same day the patient is in the clinic.

WCHQ is hosting a behavioral health seminar focused on recovery and IBH on October 5, 2023, 9 am -11:45 am. Please join us to learn more about IBH, how to continue to implement IBH, improve disparities in mental health screening and treatment and to learn more about both the Primary Care Behavioral Health (PCBH) and Collaborative Care Model (CoCM).  Register here.

 For more information about the behavioral health initiative contact Renee Sutkay.

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Chronic Disease

Chronic Disease Learning Collaborative Member Success Story:  
Marshfield Clinic

The Chronic Disease Learning Collaborative met on January 30, to share their improvement goals and outcomes in a poster presentation format. Aspirus Health Care, Associated Physicians, Gundersen Health System, Marshfield Clinic Health System (3), Prevea Health 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.

Marshfield Clinic presented their project aimed at improving the consistency of the warm handoff in a team-based care model and increasing colorectal, breast and cervical cancer screenings. Kassandra Justman, RN, BSN reports, “We know the benefits of the warm handoff based on previous work and we really wanted to focus on consistency even through staff turnover.”

Barriers to effective handoffs included staff turnover and the learning curve with the new electronic health record. The team focused on coaching and training for staff, specifically in the Rice Lake Primary Care Clinic, with the adult population. The project leads, Mary Sundby, MSN, RN and Angela Miller, LPN, worked to train staff on the warm handoff best practice and the impact of the warm handoff, specifically around completing important preventive cancer screening.

The following were results from this quality improvement project:

The warm handoff provides education to the patient, which ultimately allows the patient to feel like an engaged member of the treatment team. The warm handoff supports long term engagement into healthcare, empowers shared decision-making, and improves health literacy. The increase of these important preventative cancer screenings highlights the effectiveness of the efforts. Since January, Marshfield Clinic has added the warm handoff to adult primary care standard rooming process and continues to train staff on the importance of the warm handoff in the team-based care model.

For more information on the work WCHQ is doing on chronic disease prevention and treatment contact Renee Sutkay.

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Colorectal Cancer

Helping Patients and Providers Understand Colonoscopy Coverage

The Colorectal Cancer Screening Advisory Group met in July to continue to discuss barriers to colorectal cancer screening in rural Wisconsin residents. After a stool-based colorectal cancer screening test is positive, it is recommended that a follow up diagnostic colonoscopy is completed. There have been significant barriers to insurance covering the recommended follow up colonoscopy. The advisory group reviewed the insurance coverage availability to better understand if diagnostic colonoscopies were covered. 

The colonoscopy procedure is covered, but depending on the insurance carrier, there can be an additional step a patient or provider must take, including paperwork and the approval process. From a rural patient perspective, the biggest barrier to scheduling the colonoscopy is procrastination according to the National Colorectal Cancer Roundtable¹. Any extra step for a patient can be detrimental in getting that follow up screening, even if insurance does cover the procedure.  

The group then discussed ways that healthcare systems can proactively help people complete colorectal cancer screenings. These included making phone calls to average risk patients who are on the colonoscopy waiting list to offer them a stool-based screening for colorectal cancer and increasing consultations with gastroenterologists before scheduling a diagnostic colonoscopy, specifically for young people. The group discussed the importance of building trust with populations of color, not only to complete the recommended screening tests but also to build relationships for ongoing care and establishing a primary care medical home.  

Participating health systems are working together to identify barriers that affect the rural communities they serve and are working to understand disparities data by rural zip codes. In the coming weeks, WCHQ and participating health systems will work together to develop interventions and goals to target screening for rural populations as we work toward a goal of 80% of eligible patients screened in every community. 

If you are interested in joining the advisory team, please reach out to Renee Sutkay.
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^{1. National Colorectal Cancer Roundtable. 2019 Colorectal Cancer Screening Messaging Guidebook: Recommended Messages to Reach the Unscreened. 2019}

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Disparities

WCHQ Disparities Event Focuses on Community and Health System Collaboration

WCHQ hosted its third annual Health Disparities event in Madison on Thursday, July 27. The event brought together health systems and community partners from across the state to learn, collaborate and network on opportunities for reduction in healthcare disparities.

The event kicked off with a presentation by Shiva Bidar-Sielaff, MA, CDM,Vice President and Chief Diversity Officer at UW Health and Associate Dean for Diversity and Equity Transformation at the University of Wisconsin Madison. Shiva gave an overview of UW Health’s vision and strategic plan aimed at dismantling racism by enhancement and proactive recruitment of staff at UW Health. She also discussed ensuring patients are supported through staff education and accountability. “We felt it was really important to lead with dismantling racism. We know when racism is named, we are also impacting other areas of discrimination and marginalization as we address racism.”

Travelle Ellis, MD, PhD, Director of Health Equity Education, Strategic Partnerships and Medical Integration at Exact Sciences, shared staggering statistics around colorectal cancer screenings for people experiencing healthcare disparities. Colorectal cancer incidence and morbidity are highest in Wisconsin for Non-Hispanic Black populations. For example, 49 people per 100,000 non-Hispanic Black individuals will be diagnosed with colon cancer compared to 34.1 per 100,000 of all races¹ while 1 in 21 Wisconsinites have a lifetime risk of being diagnoses with colorectal cancer². She reminded us that, “Without the data, we can’t measure our progress.” Dr. Ellis also gave us a strong call to action to increase patient engagement and trust, to ensure patients are part of the process. “We have to break down our barriers not only as systems, but us as people.” Dr. Ellis also pointed out that we need to move away from “awareness bombing” and focus on the interventions we can provide, such as localized and individualized outreach, small media or using trusted community members to deliver health messages.

Fort HealthCare is supporting communities with its innovative school nursing program. Fort HealthCare contracts with local school districts to provide schools nurses to those districts. Not only does this support the school nurses with health system resources, but also provides families a connection to the health system and increases the connection of a health home for families versus crisis care. The school nurses are integral in providing health literacy for a myriad of topics including diabetes, immunizations, occupational, speech, and physical therapy, exercise, medication adherence, and healthy eating. Jennifer Kawleski, RN, BSN, LSN, NCSN, the program’s coordinator, reminded the audience, “We need to meet people where they are with the tools they need to build the bridge to better health.” 

The Wisconsin Hospital Association and Unite Us focused their presentations on utilizing data and dashboards to connect patients to resources. The goal of Unite Us is to bring communities together by creating a robust referral network where social determinants of health needs can be met. Unite Us uses their software platform to connect an ecosystem of partners and resources to that patient. Each service provider or agency understands where other referrals can be made and this encourages collaboration. The Wisconsin Hospital Association reframed the Community Needs Assessment from a requirement to a tool for health equity that can strengthen hospital and community relationships. Both presentations remind us of the importance of data and collaboration to support patients and families in real time. 

Healthy Metric, a partnership between WCHQ, UW Madison’s Health Innovation Program, Marshfield Clinic Research Institute, the Medical College of Wisconsin, and the Wisconsin Health Information Organization, funded by Wisconsin Partnership Program and Advancing a Healthier Wisconsin Endowment, has released two health disparities reports describing data on health disparities for mental health treatment and diabetes in rural communities. Joan Neuner, MD, MPH explained the goal of this work is to use data to inform disparities improvement, catalyze change through implementing interventions to reduce disparities, and build research partnerships. The mental health report shows visits for depression and anxiety increased by age and insurance type from 2019 to 2021, overall percentage of visits for depression and anxiety in 2019 were 8%, 2020 8.4% and 2022 8.9% respectively, showing us that more Wisconsinites are being seen for mental health treatment³.  “It doesn’t help if we just talk about it,” Dr. Neuner reminds us. These reports are essential for driving health system work in quality improvement interventions. 

Lindsey Purl, MPH, was the final speaker of the day and showcased the important and evidence-based work of Community Health Workers utilizing the Pathways Community HUB model to reduce healthcare disparities and increase health outcomes for patients. The HUB model connects funding (health plans and grants), referral partners and care coordination agencies together to provide services that improve health outcomes, reduce costs, increase value, and ultimately improve health equity. Lindsey explained the key to trust building with patients is CHWs’ lived experience and the culturally appropriate health education, system navigation and care coordination that community health workers provide. Lindsey reminded us that care coordination leads to efficient care across service providers. “When we are not all communicating, there can be a lot that is lost in translation and duplicate efforts provided; the point of this work is to eliminate that,” she said. This model also recognizes the importance of the family system and focusses on the health of everyone in the household. Lindsey reminds us that when social determinants of health needs are met, positive health outcomes are followed.  

WCHQ was honored to engage with twenty-four health systems and many community partners throughout the day. Our event sponsors also included Advancing a Healthier Wisconsin Endowment, Wisconsin Partnership Program, Exact Sciences, Genentech, GSK, Janssen, Myriad and Otsuka.  

We are excited to continue this work of putting data into actionable interventions as we work together to drive improvement efforts. As Jenny Pritchett, RN, BSN, MPH, MBA, CIC, Clinical Quality Improvement Manager at Wisconsin Hospital Association reminds us, “The best results come through collaboration.”

If you are interested in this work, please reach out to Renee Sutkay, Quality Improvement Specialist. 

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<sup>1. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023 [published online ahead of print, 2023 Mar 1]. CA Cancer J Clin. 2023;10.3322/caac.21772. doi:10.3322/caac.21772
2. American Cancer Society. Cancer Facts & Figures 2023.  Atlanta: American Cancer Society; 2023. 2. Wisconsin Behavior Risk Factor Surveillance System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2020.
3. Healthy Metric. Disparities in Mental Health Care and Outcomes: A Healthy Metric 2023 Report for Wisconsin. Published June 2023</sup>

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Oral Health

Oral Health Measures are Publicly Reported for the First Time Post-Pandemic

The Oral Health Collaborative members met in July to review publicly reported data for the first time since the pandemic. Many oral health providers closed for several months during the first wave of the pandemic in 2020, which caused significant disruptions for providers and patients from 2020-2022. WCHQ oral health members have been focusing on getting all patients back to the clinics for cleanings and routine care, as well as more comprehensive care. 

In July, WCHQ’s Oral Health Collaborative members kicked off a regular public reporting cadence that will see this group reporting on oral health quality measures twice per year. These updates will occur in July and January each year. 

As part of our review, WCHQ completed an analysis of the changes seen in these measures since the last time this group publicly reported back in July of 2019. There were two groups – Children's Hospital of Wisconsin and Health Partners – who participated in reporting measures in both periods. Below is a summary of the aggregate results that saw a statistically significant shift: 

This high-level analysis provides an interesting look at the pre- and post-Covid impacts on oral health. While both of these rates saw a statistically significant improvement from the 2019 baseline, both also saw a large decline in the number of patients in the denominator. This would seem to indicate that the participating oral health providers are providing higher quality care for their patients on these measures, and that significant opportunity exists for patients who fell out of the measures entirely.  

A third measure – On-going Care for Adults with Periodontitis – saw rates decline, but not by a statistically significant amount. The same trend in lower n-values was also observed in this measure.

The WCHQ Oral Health Collaborative continues to meet monthly to work on value-based care, disparities in oral health, and quality improvement. If you are interested in learning more about the work WCHQ members are doing to advance the integration of oral and physical health, contact Jen Koberstein.

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