Launch Webinar Scheduled for Feb. 27, 2024

The WCHQ Chronic Kidney Disease (CKD) Improvement Team launched a toolkit to help primary care providers screen for and treat kidney disease. The toolkit helps primary care practices to adhere to standards of care in screening for CKD, understand diagnosis of CKD, manage and treat CKD in their practice, and refer to nephrology when necessary. 

Brett Pasiuk, MD, a Nephrologist at SSM Health, will present a webinar on how to use the toolkit in primary care practices. The webinar will be held on February 27, 2024 from noon – 1 PM. You can find the link here to register for the event.  

There are limited nephrology resources within some health systems and treating people in primary care settings can increase the health care capacity, slow disease progression, and improve outcomes. The toolkit is a practical, usable tool for quick referencing and following standards of care.

Providers can find information about:

• causes, prevalence, and costs of CKD
• the connection between diabetes and kidney disease
• connections between hypertension and kidney disease
• guidance on screening and treatment illustrated on the KDIGO Heat Map

The new toolkit is available here.  

If you are interested in joining the work members are doing on chronic kidney disease, contact Jen Koberstein.

Under the direction of WCHQ’s Measure Advisory Committee, comprised of clinicians, measurement and quality experts, the new composite measure summarizes member performance across all measures and benchmarks participants into percentile rankings based on performance.

This year-long effort gives members a tool to discuss their results across all 27 publicly-reported WCHQ measures by providing enhanced benchmarking capabilities.

"In the sphere of ambulatory quality measurement, integrating all of WCHQ's measures into a composite framework elevates the way we can talk about quality performance," shares Chris Elfner, VP of Bellin Health’s Clinically Integrated Network and Measurement Advisory Committee chairman. "It allows us to move the discussion beyond individual measure performance and better understand health system performance. Many members have been doing something like this on their own, so it makes sense to have the Collaborative provide a standard model."

The new composite ranking is currently available to WCHQ members only and was included in WCHQ’s recent release of the latest public reporting results.

Primary Care Associates of Appleton Uses Self-Measured Blood Pressure Monitoring to Increase Blood Pressure Control

Self-measured blood pressure monitoring (SMBP) with clinical support is a proven strategy to lower blood pressure and increase medication adherence (Community Preventive Services Task Force, 2017). Primary Care Associates of Appleton (PCAA) has successfully incorporated SMBP into patient care and the electronic health record (EHR), resulting in significant improvements in blood pressure control.

PCAA plans to increase the number of patients using SMBP and overall blood pressure control. PCAA shares their best practices:

• Ensure sufficient primary care teams are supporting patients using SMBP so that every patient interested in doing SMBP has a team to support them. Since launching the SMBP program in 2021, PCAA increased the number of provider teams utilizing SMPB from 4 teams to 24 teams.
• Coordinate with health plans that offer SMBP benefits to make SMBP easy for patients. PCAA worked closely with Network Health through a pilot, to offer free home blood pressure monitors and training for their enrollees that completed the PCA training. Network Health identified eligible patients and ensured they took advantage of this benefit.
• Make the SMBP service affordable and accessible. PCAA currently uses a no-copay code to ensure patients are not charged. The two codes used for SMBP are 99473 and 99474.
• Utilize an automated SMBP registry. PCAA received support from the Wisconsin Community Health Empowerment Fund (WCHEF) in 2023 to change from a manual process to an automated registry through the electronic health record. Health care registries improve the quality and safety of services and provide a mechanism for recording the SMBP in the EHR.

Program statistics include:

• 433 patients trained prior to 2023. Eighty-nine percent of those returned “first home results” to their provider as indicator of compliance. Patients that go through training, but do not send in their first round of results, or “first home results,” despite outreach reminders, are counted as not completed with the program.
• 313 patients added since the beginning of 2023.
• 23/31 teams are utilizing SMBP which is a participation rate of 74%.
• 2 staff are offering one day a month for SMBP training and device accuracy tests that any team can schedule with. 

“Not only is this an evidence-based program that has proven to bring patients to BP control, in a more timely and efficient way than prior methods, it’s a big win for the patients, too! Once trained, patients no longer need to come into the clinic for nurse visit BP checks. We are very proud of the continued growth of this program. This is both a patient and staff satisfier,” reports Ann Taake, PCAA Quality Improvement Specialist.

At this year’s educational events, knowledgeable presenters inspired and challenged our WCHQ member representatives with actionable strategies in a variety of healthcare specialties. For example:

• At the Statewide Quality Improvement Event and Diabetes Summit in June, Mallory Baerenwald and Maria Boeck of Bellin Health shared their Diabetes Prevention Program. Mallory and Maria reported overall improvement in HgA1c over a five-year period with plans to expand the program.
• Joan Nuener, MD, MPH, represented the quality health collaborative Healthy Metric, of which WCHQ is a partner, at our Healthcare Disparities event in July. She shared findings from their recently published report, Disparities in Mental Health Care and Outcomes: A HealthyMetric 2023 Report for Wisconsin. The report showed 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 that more Wisconsinites are being seen for mental health treatment. “It doesn’t help if we just talk about it,” Dr. Neuner had said, noting these reports are essential for driving health system work in quality improvement interventions.
• A panel of five physicians shared case studies with the audience at WCHQ’s Obesity Summit in September. Each of the case studies highlighted treatment that a primary care physician could also implement in their clinic to help someone with obesity. The panel included Samantha Pabich, MD, MPH, UW Health; Chris Weber, MD, Ascension; Sachin Jogal, MD, SSM Health; Melanie Smith, DO, Advocate Health and Compton Kurtz, MD, UW Health. Conference attendees asked numerous questions and were really engaged with “real-life” examples of patients living with obesity.
• At our first event highlighting chronic kidney disease (CKD), also in September, we were joined by Dr. George Bakris from the University of Chicago. He reminded the group of employing the following best practices to diagnosis CKD as early as possible, such as screening high risk patients due to diabetes or hypertension and referring patients for additional services, such a dietitian.

Feedback from our events has been informative as we plan for 2024. When we hear comments like, “Tons of ideas to implement in primary care,” and “I will be sharing this information with other primary care providers at my organization,” we know we are on the right educational path for our members.

In addition to the four in-person events, WCHQ hosted nine webinars, with varying topics from CKD and heart failure disparities, increasing immunization rates, antibiotic stewardship and more.  

Our 2024 events are on our website now, mark your calendar and plan to join us. You won’t want to miss out on the chance to hear from both fellow WCHQ members and industry experts on information and strategies that will make a difference to your patients.

In 2023, three WCHQ member systems participated in a project to improve HPV vaccination rates, including almost 300 clinical staff across Wisconsin and the Upper Peninsula of Michigan. We are now enrolling WCHQ member systems for 2024! Will your health system join?

HPV vaccine improvement project by the numbers in 2023:

WCHQ invites member systems to receive a 1-hour CME/CNE evidence-based communication workshop. Workshops will be held in the spring and early summer of 2024. The workshop, called The Announcement Approach Training, has been shown to increase HPV vaccination rates by five percentage points. It also helps reduce conflicts with patients by giving staff the tools to communicate with them differently and supports sustainable improvements by training internal staff to become trainers.

The Announcement Approach Training workshop is for all clinical staff who have a role in adolescent vaccination. Additional training for one or more vaccine champions in your health system is provided. Champions deliver the workshop to half of your system’s participating clinics, facilitating project sustainability. Experts from the project team deliver workshops to the remaining clinics. WCHQ data will be used to track improvements. 

To learn how your health system and clinics can get involved, contact Jen Koberstein at Jkoberstein@wchq.org or the UW-UNC project team at prokids@pediatrics.wisc.edu or 608-263-1202.

The project is led by Elizabeth Cox, MD, PhD, a pediatrician and health services researcher and Meghan Brennan MD, MS, an infectious disease physician and health services researcher, from the University of Wisconsin, and Melissa Gilkey, PhD, a behavioral scientist specializing in adolescent health at the University of North Carolina. The project is funded by the University of Wisconsin-Madison.

Antiobiotic Stewardship

Members Implement Antibiotic Stewardship in Outpatient Care

Overprescribing antibiotics can lead to antimicrobial resistance and result in difficulty treating serious and life-threatening conditions. The majority of antibiotics are prescribed in outpatient settings and, of these, at least 30% are unnecessary. Ambulatory Antibiotic Stewardship encourages appropriate use of antibiotics in order to preserve antibiotic effectiveness and reduce the risk for the development of antibiotic resistant bacteria.  

WCHQ partnered with the Wisconsin Department of Health Services (DHS) to develop three measures that focus on appropriate prescribing of antibiotics. The measures are for patients three months and older diagnosed with acute sinusitis, upper respiratory infections, and bronchitis. Currently, the measures are not part of WCHQ’s public portfolio but are available to interested members as part of the Antibiotic Stewardship Team.  

In September, initial data was reviewed from the measures. The improvement team continues to identify ways to review the data, such as by visit type, pediatrics vs. adult populations and class of prescription by diagnosis and WCHQ will present the data stratified this way in 2024 meetings.  

Workgroup participant results 7/1/22-6/30/23:

Participants in the Antibiotic Stewardship Team receive education and tools to improve antibiotic usage. Recent examples include education on the Collaboration to Harmonize Antimicrobial Registry Measures CHARM. CHARM provides a collaborative effort to utilize data from partner institutions electronic medical records to quantify and assess local antimicrobial prescribing practices. Partners then understand their current prescribing practices, antimicrobial stewardship opportunities can be targeted, and the impact of initiatives can be measured. CHARM allows participating entities to benchmark their usage patterns against other systems.

If you are interested in joining this work, please contact Lori Bue.

Asthma  

Controlling Asthma Through Patient Screening and Care Planning: The Year in Review

This year, the Asthma Improvement Team developed a measure for health systems to determine if patients with an active asthma diagnosis are receiving an appropriate asthma screening annually. The team reviewed data from the participating health systems to better understand what quality improvement projects could increase the use of asthma screenings. The team noted that 24% of patients with asthma were receiving these screenings annually. The provider can then use the patient’s screening responses about use of rescue inhaler, wheezing, coughing, shortness of breath and activity to aid in preparing the patient’s treatment plan.  

Also in the last year:

• Member health systems shared how they implemented a standardized process for Asthma Control Testing (ACT) across their pediatric clinics.
• Dr. Nicholas Antos, Director, Cystic Fibrosis Center, Children’s Wisconsin, Medical College of Wisconsin, spoke to the group about the importance of the patient screenings.
• The team heard from the American Lung Association about The Enhancing Asthma Control Program that is available to organizations in Wisconsin.   

The next year will bring continued review of the measurement data and education that the group can share with the WCHQ membership. This improvement team is continuing to look for health systems to participate, if interested please reach out to Lori Bue, Quality Improvement Specialist at lbue@wchq.org. 

Disparities

WCHQ Members Continue to Prioritize Interventions to Improve Healthcare Disparities

Over the last year, Disparities Improvement Team members have shared processes and strategies that have improved healthcare outcomes for populations experiencing disparities.  

Ascension recently shared they have used zip code-level data to identify clinics in communities with the highest needs and identified areas with high prevalence of patients on Medicaid. By understanding the population, Ascension is planning targeted improvement strategies to increase the number of patients receiving preventative cancer screenings, diabetes testing and control, and hypertension control specifically at the four clinics identified.  

“The primary care directors are committed to understanding patient barriers and understanding communities where people live in order to make an impact on their healthcare and lives,” says Amrinder Singh, MD, Primary Care Director for Ascension’s Franklin, St. Francis, and Racine Region. The group is looking to develop priority interventions to improve outcomes for this population and is using data to look for trends over time. 

The Disparities Improvement Team has expanded to include Community Health Workers (CHWs). CHWs bring significant value to the patient by being on their healthcare team:

• CHWs can take complicated healthcare information and instruction from the patient’s provider and help them understand step-by-step the next steps in following the provider’s advice.
• The CHW often has experience similar to the patient (i.e.: has diabetes and has had the experience of uncontrolled blood sugar) and can offer unique support to the patient as they navigate their healthcare needs.  
• CHWs often provide services to patients right in their homes which decrease barriers to travel and extra time for the patient to get into the clinic.

The team is excited to share they are working on a Disparities Toolkit. The toolkit will be a resource that provides information about how to understand healthcare disparities data, define language about healthcare disparities, share resources, and disseminate best practices from the Disparities Improvement Team. Be on the lookout in early 2024 for information on the toolkit going live!

Interested in learning more about this work? Contact Renee Sutkay, Quality Improvement Specialist, at rsutkay@wchq.org.

Immunizations 

Improvement Team Works to Improve Vaccination Rates

During WCHQ’s last two public reporting periods, WCHQ members have seen a decrease in childhood immunization rates. In response to this trend, in 2023, WCHQ kicked off a new improvement team that included representatives from ten health systems and six community partners with a focus on increasing childhood and adolescent immunization rates and reducing disparities.

The improvement team will continue this work in 2024 with the following initiatives:

• An immunization toolkit to provide resources to help medical staff speak to patients and parents about the importance of vaccinations.
• Educational sessions and mini documentaries featuring Community Health Workers (CHWs). The CHWs will provide insight into populations known to have greater disparities in immunizations and potential causes that might be preventing patients and parents from getting their children vaccinated.
• Testing the addition of Hepatitis A and Rotavirus vaccines to WCHQ’s childhood series and adjusting the HPV vaccine to examine completion of the series by age 13, as well as include it in the adolescent series. Once this is completed, the team plans to further break down the data by geographic area, race/ethnicity, and payer to be able to identify the different disparities across the state.  

If you are interested in joining the work WCHQ is doing on childhood and adolescent immunizations, please contact Lori Bue.

Obesity 

Obesity Continues to be a Priority for Health Systems in Wisconsin

2023 was a year of accomplishments for member health systems involved in obesity work at WCHQ. Members endorsed two new obesity measures this year:

• The Blood Pressure Control. This measure looks at patients 18-85 years old who have a BMI equal to or greater than 30 and have blood pressure controlled at less than 140/90. Preliminary results were shared with the advisory group members in November with requests to look at the data by disparities at the next meeting.
• Obesity Diagnosis on the problem list. This measure looks at patients 18-85 years old who have a BMI equal to or greater than 30 and a diagnosis of obesity on their problem list. This is an important measure because if providers are not diagnosing obesity, it is unlikely they are treating it and talking to their patients about it. The results on this measure are forthcoming and will be shared with the advisory group at the meeting in December.

Also in 2023,

• Dr. Samantha Pabich from the University of Wisconsin Health, hosted a webinar to introduce the Obesity Toolkit. The toolkit is located on the WCHQ website at and is a quick resource for primary care providers.
• Members worked on an additional obesity toolkit that will help employers evaluate how they support employees and their families who have obesity. This toolkit will be launched in early 2024 on the WCHQ website.
• Dr. Gabrielle Rude, President and CEO of WCHQ, and Dr. Sachin Jogal, MD, Pediatrician at SSM Fond du Lac and Obesity Advisory Group member, presented to the Speaker’s Task Force on Childhood Obesity in September. They presented the task force with data and information about the disease and continue to be a resource as the task force is launched.

The Obesity Advisory Group plans to continue monitoring and updating measures, providing education, and working on quality improvement activities in 2024. If you are interested in joining the work WCHQ is doing on obesity, contact Jen Koberstein.