With representation from nearly every health system in Wisconsin in attendance, the WCHQ Disparities Summit on November 10 was successful in bringing health systems and stakeholders together who have a common mission to decrease health disparities in Wisconsin.

Two health systems shared how they are adopting new internal policies related to hiring practices with a goal of being more inclusive to and reflective of the people who live in their communities. Tammy Simon, RN, Vice President for the institute for Quality, Innovation & Patient Safety at Marshfield Clinic said people living in rural areas have fewer resources and are less able to access care. Increasing the availability of preventive care, tailoring the outreach to the population and helping people who need transportation are important.

“We must work with the fabric and foundation of the communities we serve,” according to Simon. “2020 was a clear call to roll up our sleeves and address our systemic inequities, and intolerance.”

Mark Lodes, MD and Andres Gonzalez from Froedtert and the Medical College of Wisconsin shared how their health system has made policy changes “from top to bottom” in its hiring criteria and even in their vendor mix to ensure it is creating equity and fairness as a business partner in the region.

“We need to ask ourselves what we are doing organizationally, individually and as teams to elevate and improve the quality of life across the region as it pertains to all the determinants of health,” Dr. Lodes said.

Gonzalez emphasized the importance of having executive support for the change that is necessary to eradicate racism. Reducing disparities, he said, is a long-term strategy for which there are no quick fixes.

Data is critically important in anticipating and planning for emergency responses, according to Ben Weston, MD, with the Department of Emergency Medicine at the Medical College of Wisconsin. As the Director of Medical Services in the Milwaukee County Office of Emergency Management, Dr. Weston understands the importance of sharing data publicly. Milwaukee was one of the first areas of the country to publicly report COVID-19 data. And the findings, that it was disproportionately impacting people of color, was a call to action.

“If we hide behind it (data), nothing will change,” according to Weston. “However, if we put it out there, we can use data to improve disparities in the community.”

Once the data was available, resources were shifted in Milwaukee County to the most vulnerable. Aziz Abdullah, co-found of INPOWER, played a key role in gaining the trust of disenfranchised neighborhoods in Milwaukee to help them understand the importance of getting a COVID vaccination.

“We chose to lead with empathy. Our model was based on helping people make informed choices,” according to Abdullah.

Abdullah explained that one of the silver linings of the pandemic was finding and using data in was that decreased inequities and promoted health. Some people who had not been vaccinated for more than two decades agreed to be immunized against flu and COVID-19.”  

Debra Nevels, MSHCM, program manager of community outreach and engagement at the Medical College of Wisconsin Cancer Center shared the importance of being able to link communities to resources, such as food banks, as work is being done to create a more sustainable system.  

Lyn Ranta, MD and Greg Stadter with the Milwaukee Health Care Partnership, said the approach in Milwaukee was to increase all immunizations, including COVID 19. What the groups working on increasing immunizations learned was most families were very interested in having their children vaccinated and many did not realize their children were not up to date.

“We knew we could not do this alone. A large part of our efforts was to build bridges with our community because that was the best way to amplify our impact,” according to Dr. Ranta.  

Immunize Milwaukee originated within the Milwaukee health department and incorporated wide-ranging representation from clinical and community organizations. It is focused on vulnerable populations, including the uninsured and racial and ethnic groups with lower rates.

Joan Neuner, MD, MPH from the Medical College of Wisconsin, described the WCHQ statewide disparities project, which is funded through the Advancing a Healthier Wisconsin Endowment and the Wisconsin Partnership Program foundations through Wisconsin’s two medical schools. She credited the health systems for giving it their full support and said the project represents a first-of-its kind in the country effort to catalyze a statewide effort to reduce health disparities in collaboration with health systems.

WCHQ Analytics Manager Abbey Harburn introduced the last presenters who presented best practices related to decreasing disparities within their communities and internal to their health systems.

Renita Robinson, EdD, VP Diversity and Inclusion at Prevea Health, said the first realization they had when they started working on equity issues was, they did not have the data they needed to do the work.

“We needed to increase awareness across the system about health disparities so we collaborated with others and we started with educating our internal network first,” she said.

At Bellin Health, Maggie Koch, RN suggested leveraging artificial intelligence and digital to connect with people in new ways.

“We must do things differently than we have before,” Koch concluded.

In response to this statewide priority to increase access to child and adolescent behavioral health services, the Wisconsin Collaborative for Healthcare Quality (WCHQ) entered a partnership with the Medical College of Wisconsin in a project funded by the Advancing a Healthier Wisconsin Endowment to increase integrated behavioral health in primary care clinics in Wisconsin. You can learn more about the project on the AHW blog.

Reminder: Evidence-based Resources Available to Increase HPV Vaccination Rates

Sign-up now to join the UW-UNC HPV Vaccine Project to improve adolescent vaccination in your health system while spots are still open. Thank you to systems currently working with us!

In collaboration with WCHQ, 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, associate professor of health behavior at the University of North Carolina, are seeking Wisconsin health systems as partners for a project to improve HPV vaccination rates. 

The UW-UNC project team will work with partnering health systems to deliver a brief, evidence-based 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 HPV vaccine discussions at age 9. This workshop has been shown to increase HPV vaccination by five percentage points, save time during clinic visits, reduce conflict with vaccine hesitant parents, and prevent burnout. Joining the project will also build on your health system’s strengths by providing training and support to your vaccine champions to increase capacity and sustainability for HPV vaccine quality improvement.

The workshops will be delivered in Spring 2023. Participating health systems will receive: (1) the 1-hour CME communication workshop for providers and clinical staff in six or more primary care clinics and (2) additional training and support for one or more health system vaccine champions. Champions can be providers or clinical staff. The project team will provide training to champions, who will then deliver the HPV vaccine communication workshops to half of the health system’s participating clinics. Trained experts from the project team will deliver workshops to the remaining clinics. 

Other incentives include 1 hour of CME/CE, a $200 honorarium and travel reimbursement per workshop, and a $100 Amazon gift card for completing an exit interview for champions (as allowable by system policy). Providers and clinic staff who attend the workshops will receive 1 hour of CME/CE and a $25 Amazon gift card for completing three brief surveys. 

No data collection from patients or families is necessary. Vaccination data to support the project’s evaluation will come from WCHQ. This project is funded by the National Cancer Institute. 

Interested in participating or have questions?

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. Please share this information with others who may be interested.

Chronic Kidney Disease

Identify CKD and Slow the Progression – A Review of 2022

Early stages of kidney disease often go unrecognized as many people do not present with symptoms. With nearly 40 percent of patients with diabetes showing evidence of kidney disease and 90 percent of these patients not aware of their kidney disease, WCHQ members are putting an additional effort into creating awareness to stop or slow the progression of CKD.

Wisconsin health systems with support from Bayer, formed the Chronic Kidney Disease Advisory Group in 2022 to support early detection and treatment of chronic kidney disease. The CKD Advisory Group convened in March 2022 and created a detailed charter outlining the specific direction and goals for the work over the next few years.

Understanding the importance of data, the CKD Advisory group developed two quality measures that will become foundational components of future work – one addressing early detection of chronic kidney disease and the other supporting an evidence-based treatment option. The WCHQ data team continues to work with health system teams to capture and validate components of this data in an effort to guide improvement efforts in 2023.

Looking ahead to 2023, the CKD Advisory Group will focus on improvement efforts, engaging health plans and various stakeholders, developing a toolkit and providing education. To learn more, consider registering for the upcoming CKD webinar January 12, 2023, under the Member Education Events section. Contact Sheryl Pierce if you would to learn more about the CKD Advisory Group.

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Obesity

WCHQ Obesity Efforts in 2022 Builds Disease Awareness, Measures

The WCHQ health systems were successful in creating an increased awareness of obesity as a disease and the treatments available to patients who have this condition. In 2022, health system providers and clinicians met regularly with payers to address payment issues and to answer questions related to treatment options. In June, WCHQ partnered with The Alliance to deliver employer-focused content on obesity to more than 200 businesses in Wisconsin. The agenda included information delivered by physician and clinical leaders in Wisconsin as well as an industry leader in Texas. They emphasized that treating obesity early can lead to better outcomes, fewer employees advancing to more serious, and higher cost, conditions, and improved health for both the employee and their family.

The WCHQ Obesity Advisory Group developed two obesity measures that were deployed and are in the process of being tested by a small group of health systems. The measures include the prevalence of obesity in the population and obesity prediabetes and diabetes Hba1c control. The group plans to meet with the WCHQ Measurement Advisory Committee in December to revise the denominator in the Hba1c control measure. The plan in 2023 is to develop two additional obesity measures.

The members developed an agenda for a full-day of learning at a Summit, sponsored by Novo Nordisk, on October 13 in Fond du Lac. More that 150 people attended the event, which included presentations on diet, treatment and physical activity.  

The group is now finalizing an online obesity toolkit that will be helpful to primary care providers treating patients with obesity.  

For more information about WCHQ’s work on obesity contact Jen Koberstein.

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‍Disparities

WCHQ Seeks Members to Join Teams Focused on Disparities Related to Maternal Health, Immunization

WCHQ is now recruiting participants to two newly created improvement teams that will focus on reducing disparities associated with maternal health and immunizations. This work is made possible through a grant from the Wisconsin Department of Health Services (DHS.)

WCHQ received two grants from DHS. The first will address disparities in maternal morbidity and mortality, by improving upstream factors that impact maternal health outcomes. The second grant will improve disparities in childhood and adolescent immunization rates, which were exacerbated by the COVID-19 pandemic. This project will convene stakeholders to address inequitable distribution of vaccines in childhood and adolescence

Both projects will bring stakeholders together to determine the best ways to address social and economic conditions that can impact maternal and child health. These issues include how to increase access to health care in a way that ensures continuity of care by addressing issues associated with education, poverty, and racism, which are essential to changing the trajectory of health disparities.

Both projects will launch January 1, 2023. To join a team or to learn more about the projects, contact Lori Bue.

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Antibiotic Stewardship

Attacking Antimicrobial Resistance in the Ambulatory Setting

Antimicrobial resistance is an ongoing public health concern driven by antibiotic overuse across the care continuum, according to the Centers for Disease Control. It has been estimated that 80 to 90 percent of all antibiotic use in humans occurs in the ambulatory setting. The overuse of antibiotics has been attributed as a primary cause of resistance and can lead to adverse events, such as secondary Clostridioides difficile infections. Ambulatory stewardship encourages the appropriate use of antibiotics, preserves antibiotic effectiveness and reduces the risk of developing antibiotic resistant bacteria. 

Earlier this year, WCHQ partnered with the Wisconsin Department of Health Services (DHS), to develop three ambulatory antibiotic stewardship measures focused on appropriate prescribing for patients three months and older diagnosed with acute sinusitis, upper respiratory infections, and bronchitis. The measures will help WCHQ members track prescribing patterns for these three conditions at the organizational level.

WCHQ has created an antibiotic stewardship improvement team, which will launch in January 2023. If you are interested in participating, or if you have questions, reach out to Lori Bue, WCHQ Quality Improvement Specialist.

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Asthma

WCHQ Forms New Asthma Improvement Team

Asthma affects more than 400,000 adults and over 100,000 children in Wisconsin. It is a public health priority to ensure people with asthma can properly manage and control their disease.

The Asthma Control Test (ACT) an efficient, reliable and valid way to measure asthma control. This screening tool can be used in primary care practice and pulmonary and allergy clinics to improve the management of patients with asthma and to determine asthma management goals. WCHQ, along with the Wisconsin comprehensive Asthma Control Program, Department of Wisconsin Health Services (DHS) and a pilot group of WCHQ members, have been developing a new measurement focusing on patients ages 5-50, with active asthma diagnosis, who had an appropriate asthma assessment in a 12-month period.

Reporting ACT measure data will support quality improvement activities at WCHQ member health systems by providing baseline and trending data over time. The asthma workgroup will facilitate focused training for health care providers and will also encourage the use of effective, evidence-based best practices for quality improvement by bringing health systems together to share knowledge, workflows and quality improvement strategies related to asthma control. 

A new team is now forming focused on improving care for those with asthma. If you are interested in learning more about the work of joining the team, contact Lori Bue.

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Behavioral Health

Behavioral Health Improvement Team Reviews Disparities Data

The Behavioral Health Improvement Team reviewed health disparities found in the WCHQ behavioral health measures at their November meeting. Abbey Harburn, WCHQ Analytics Manager, joined the meeting to present data on depression screening, PHQ-9 utilization, and depression remission and response. The measure results were stratified to identify disparities gaps by race/ethnicity, payer type, and geographic groupings. One major point of discussion within the Improvement Team was the geographic divide in depression screening performance. Overall, rural areas had significantly lower rates of depression screening than urban areas. The team spent time discussing the barriers to screening in rural clinics, including stigma of mental illness and provider bandwidth.

Data from these measures will be included in an upcoming report that will be published in early 2023 in collaboration with the Healthy Metric project. For more information on WCHQ’s disparities reports, contact Abbey Harburn. To join the Behavioral Health Improvement Team or for more information, contact Jen Koberstein.

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Oral Health

WCHQ Oral Health Collaborative Anticipates Ambitious Projects in 2023

The WCHQ Oral Health Collaborative members met regularly in 2023 to explore and advance work on topics such as value-based oral healthcare, patient reported outcome tools, health equity and oral health measurement.  

The members decided to begin collecting data on a new measure aimed at ensuring periodontal treatment is being provided to patients with diabetes. The data from the new measure should be available in early 2023.

One member of the group agreed to pilot a patient report outcome tool, with WCHQ’s technical support. They expect to launch the pilot in 2023.

WCHQ members met for the Summit in La Crosse in October 2022 and discussed how to advance oral health equity and value-based care. Conversations continue to evolve about how the group can work on both issues in the coming year.  

If you are interested in learning more about the work WCHQ is doing on oral health, contact Jen Koberstein.

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Chronic Disease Learning Collaborative (CDLC)

2022 in Review: Members Collaborate to Improve Care

In 2022, more than 15 health systems in Wisconsin were actively engaged in WCHQ efforts dedicated to improving chronic conditions. The WCHQ Chronic Disease Learning Collaborative (CDLC) workgroup advanced improvement efforts by meeting monthly to engage in topics specific to individual health system and statewide quality initiatives supporting patients with diabetes and hypertension.

Early on, CDLC participants committed to a SMART goal framework to guide this important work. Throughout 2022, this group shared evidence-based approaches, solutions to overcome barriers and supported their peers with relevant topics further supporting goals. The CDLC welcomed presentations from members and partners with topics related to disparities, obesity, sociodemographic profile reporting, team-based care and self-measured blood pressure.

Committed to quality, the CDLC participants will showcase quality improvement efforts at the upcoming January CDLC workgroup meeting, which will feature poster presentations.

For more information, contact Sheryl Pierce.‍