February 2021

President's Column

Gabrielle Rude, PhD

One of WCHQ’s founding members was fond of explaining the importance of public reporting as being analogous to answering the phone when another physician asks for patient care advice. WCHQ’s public reporting simultaneously answers an exponential number of such questions. WCHQ members should be commended for recognizing the criticality of publicly reporting clinical outcomes, particularly during a pandemic.

WCHQ will soon release its first quality measurement report since the COVID-19 pandemic struck. Early national reports on clinical care focused on the impact of avoided and delayed care; indeed, during certain months of the pandemic primary preventive care was nearly nonexistent. We know that Wisconsin medical providers quickly rallied to assure patients that preventive care was safe and remind them of its necessity (i.e. life-saving childhood immunizations). Thanks to our members’ commitment to their communities, there was a dramatic ramp up of primary care as the pandemic dragged on.

WCHQ’s measure results reflect 12 months of clinical data. In a typical year, this accounts for the fact that patient care occurs at multiple touchpoints. This purposeful strategy has the effect of smoothing out the dramatic swings in patient volume our members’ may see on a monthly basis, providing longer-term results on many of WCHQ’s clinical measures. We expect to see significant impacts on measures that require care at specific intervals (i.e. diabetes A1c tests that should occur every six months) and we should begin to see the influence on measures with longer timelines (i.e. colon cancer screening).

WCHQ’s goal is to shine a light on successes and identify strategies for improvement during and through the pandemic. Right now, everyone’s goal is to vaccinate more patients; if you haven’t already, a reminder to request your neighborhood report on COVID-vaccination risk to inform your vaccination strategy. Looking forward, WCHQ will begin estimating the impact of these delays based on patient outcomes and long-term costs. We will also look to identify patient populations that were particularly impacted due to delays in care.

WCHQ is committed to helping our members recover from the pandemic by offering tools, such as customized reports on measure results and ZIP code reports from the Neighborhood Health Reports, to name just two. This year will be one of transition and growth for our members, and for WCHQ. We are well prepared, and together, we will be even more effective.

- Gabrielle Rude

Novo Nordisk, WCHQ Partner to Improve Care, Reduce Obesity

Rene
Renee’ Rawls,
Novo Nordisk Patient Ambassador

The project will promote public, clinical education to deliver better care

The Wisconsin Collaborative for Healthcare Quality (WCHQ) and Novo Nordisk announced a multi-year partnership aimed at increasing public awareness of and improving clinical care for patients with obesity.

At an online member event held February 24, representatives from the two organizations presented an overview of the project, which is focused on obesity education, measurement and improvement. The webinar opened with a thought-provoking video that illustrates the lack of understanding of obesity as a disease and sometimes absence of compassion for those who struggle with it.

Guest speaker, Renee’ Rawls, a Novo Nordisk Patient Ambassador, shared her personal experience with her weight during the webinar. She encouraged those who are seeking help to find a physician who understands their issues

“Talk to your physician. Keep going until you find the right physician for you,” Rawls urged. “I had to change how I lived, what I ate. I had to choose life, for the rest of my life.”

WCHQ President and CEO Gabrielle explained that the WCHQ-Novo Nordisk partnership combines the strengths of both organizations to create a better system of support, care and treatment for those who are obese. The first year of the project will focus on clinical and patient education. In years two and three, it is anticipated WCHQ will develop and build a set of metrics, with member input, that will assess different aspects of the treatment of people living with obesity. It is expected the data will then be used to guide improvement projects in Wisconsin medical clinics and health systems.

Dr. Rude, said the project will have a far-reaching impact on how people with obesity are treated clinically and viewed by society.

“Nearly all communities have identified obesity as a top health concern. It is a difficult to address because people are reluctant to ask for help because of the stigma and, sometimes, they just give up,” according to Dr. Rude. “Our health systems are highly integrated, which means they can bring not only medical, but also behavioral health services together for our patients. This improves their chances of having a favorable outcome.”

Christopher Weber, MD, is the Bariatric Medical Director for Ascension Wisconsin and a Diplomate of the American Board of Obesity Medicine. Dr. Weber directs Ascension's Comprehensive Bariatric programs at Ascension Columbia St. Mary's Hospital Milwaukee, Ascension Columbia St. Mary's Hospital Ozaukee, and Ascension SE Wisconsin Hospital - Elmbrook campus. These clinics are multidisciplinary programs consisting of surgical and medical providers, dieticians, nurses, physical therapists and psychologists.

“Obesity is a complex disease that is not always well understood in the medical community. It can be caused by factors outside of a person’s control, such as genetics and certain medications. It also increases a patient’s risk of heart disease, diabetes, high blood pressure and other diseases,” according to Dr. Weber. “As practitioners, we are on the front lines as patients struggle with their weight, and we want to help them. This project has the potential to expand our knowledge not just in treating this as a medical condition, but also looking beyond to the behavioral health implications of obesity.”

For nearly two decades, WCHQ has focused on using data and scientific evidence to help its member health systems and medical clinics improve health care quality. Novo Nordisk is a global health care company that has clinical capabilities and educational resources that help people live longer, healthier lives. Their commitment to designing new care management tools and helping clinicians better understand disease will accelerate improvement and lead to longer-term changes in patient care delivery.


Education: Acting on the “ACT” Score: What an Asthma Control Test Can Do for You

March 24, 2021
12 PM – 1 PM CST

FLYER
REGISTER

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.

WCHQ and the Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health are hosting a series of webinars to help clinicians measure and improve care for their patients with asthma.

The second webinar, March 24, 2021, noon – 1 PM, will feature Nicholas J. Antos, a pediatric pulmonologist at Children’s Wisconsin. Dr. Antos will present a reprise of the last webinar discussion on multiple asthma control tests, including usage, differences and clinical relevance. Additionally, he will discuss how providers can help support asthma in the schools, by using Asthma Action Plans. He will also include information on a free MOC IV opportunity for those interested. This work is now supported by a new SAMPRO bill.

Topics that will be covered in this webinar include:

  1. Self-reported measures of asthma control, such as the Asthma Control Test
  2. The role of health systems/primary care practices as it relates to the school
  3. Clinical benefits of asthma plans for those in school

Dr. Antos is the Director of the Cystic Fibrosis Center at Children’s Wisconsin and the Medical College of Wisconsin and the medical director of the Southeastern Wisconsin School-based Asthma Management Program (SAMPRO). He is on the faculty at the Medical College of Wisconsin and Children’s Wisconsin and is an Assistant Professor of Pediatrics. Aside from clinical practice, Dr. Antos’ research has focused on using quality improvement methods to improve the care of children with chronic respiratory diseases and specifically cystic fibrosis and asthma. Projects have focused on CF pulmonary exacerbation care, implementing asthma management plans and improving school-based asthma care, funded by the Cystic Fibrosis Foundation and CDC through the Wisconsin Asthma Coalition. In addition to leading local SAMPRO initiatives, Dr. Antos is part of the national AAAAI Office of School-based Management of Asthma and SAMPRO taskforce.

Save the Date
April 30 – WCHQ Behavioral Health Assembly (webinar), 9 AM – 12 PM
June 29 – WCHQ Statewide Quality Improvement Event and Diabetes Summit, Monona Terrace, 9 AM – 4 PM

WCHQ IAC Focus on Disparities in 2021

In 2021, the Improvement Advisory Committee (IAC) meetings will have an overarching focus on disparities. At the February IAC meeting, members explained what disparities they were focused on and how they were implementing change in their organizations. WCHQ members said they were identifying disparities by using care gap lists and comparing results based on payer, including Medicaid. Operational teams use the lists to reach out to patients on a monthly basis. At WCHQ, improvement teams emphasis is health care disparities as they relate to populations at risk for chronic disease.

Members also reported that their areas of focus align with WCHQ improvement priorities, which includes chronic disease, specifically diabetes A1c control and blood pressure control, along with cancer screening. Members said they are working on food insecurity and developing food programs to improve A1c rates and the health of their patients with diabetes. Most health systems are partnering with community organizations to reach patients who are food insecure.

COVID-19 and competing priorities remain challenges for members while they are attempting to refocus their efforts on quality improvement.

If you are a health care provider and would like to join the Improvement Advisory Committee, contact Cara Winsand.

WCHQ Improvement Teams

Behavioral Health

A recent article published by the NYU Grossman School of Medicine highlighted the increased risk of living with schizophrenia during the pandemic.

Researchers identified schizophrenia as being second, only to age, as the most significant risk factor for morbidity during the COVID-19 outbreak. According to the research, people with schizophrenia are 2.7 times more likely to die if they contract COVID-19. The lead study author, Katlyn Nemani, MD, went on to say that the increased risk is not related to co-morbid medical conditions of those with schizophrenia so at present time, the reason for the increased risk is unknown

What should health care providers do with this research? The WCHQ Behavioral Health Improvement Team discussed interventions such as providing better masks, increasing efforts to educate this population about social distancing and good hand hygiene, and promote efforts to educate people who suffer from schizophrenia about the importance of getting vaccinated. It is also important to prioritize outreach and medical care for people with schizophrenia who contract the virus.

The WCHQ Behavioral Health Improvement Team continues to work on the effects of COVID-19 on people suffering from behavioral health issues. The team meets monthly to discuss these issues, current research, and evidence-based practices. For more information or to join the improvement team contact Jen Koberstein.

Chronic Disease

The Chronic Disease Improvement Team continues to prioritize the improvement of hypertension and diabetes measures and the adoption of best practices despite the frenzied COVID-19 vaccination efforts. Even Wisconsin Lt. Governor Mandela Barnes has taken action to promote heart health. February is American Heart Month and here’s a video from him asking everyone to join in the efforts to improve the heart health of Wisconsinites.

WCHQ is an active partner in the chronic disease network in Wisconsin, which encompasses entities such as the WI Department of Health and Human Services, public health departments, other health-related associations, and community health organizations. The beginning of 2021 has brought a flurry of new resources and opportunities for participation in improvement activities from this partnership. Please review a summary of these below and if an opportunity interests you or if you’d like to join in the collaborative discussions or receive more chronic disease resources and information, please contact Sarah Sky.

  1. Diabetes Affinity Group through the online WI Heart Health Community of Practice
  2. With access to this community, sponsored by a Centers for Disease Control and Prevention (CDC) grant, you will be introduced to other diabetes providers and stakeholders committed to helping and serving people with diabetes by providing a set of skills and practices to enable them to manage their disease. This community will identify and zero in on education and teaching practices that work and benefit patients. The community will offer relevant articles, tools, ideas, polls, and opportunities for conversations with professionals working on diabetes initiatives.
  3. This group is free to join. Join here.
  4. WCHQ Chronic Disease Workgroups
  5. Beginning in July 2021, WCHQ will host three new workgroups for members focusing on hypertension, diabetes, and team-based care. Each health system joining a workgroup will work toward completing a quality goal by the end of the 12-month program. Workgroups will meet quarterly and be given resources, peer support, and best practice sharing to help them achieve their goals.

Adolescent and Child Health

As the COVID-19 pandemic continues, the mental health of children and adolescents must be brought to light, especially as their environments continue to change. Social distancing prevents children and adolescents from spending time with friends and family. Schools change their policies from virtual to in-person and back to virtual again. Children are thought to be resilient, but a closer look on the impact of this pandemic might reveal that to be a misconception.

A rapid system review of published articles on this subject revealed that the risk of depression and anxiety increases among children and adolescents during social isolation and loneliness. The depression and anxiety affects could also be seen up to nine years after the event. Surprisingly, the biggest factor in the degree of mental health systems is due to the duration of social isolation and loneliness and not necessarily their intensity. The article suggests that managing mental health symptoms and preventing loneliness among children and adolescents should be a current priority instead of waiting for a potential big wave of mental health needs to arise in the future.

The Adolescent and Child Health Improvement Team will continue to discuss the health and wellbeing of children and adolescents in 2021. The group is reviewing current goals for 2021, which include the following:

  • Percent of children, ages 9 months to 71 months, receiving a developmental screening using a parent-completed screening tool.
  • Percent of adolescents age 12-17 years who receive a well-care visit in the last year.
  • At least one additional measure selected from the CMS Child Core Set prioritized by current improvement team members.

If you’re interested in joining the discussion or have an opinion on which CMS Child Core Set measure the improvement team should select, contact Sarah Sky.

Oral Health Collaborative

The WCHQ Oral Health Collaborative continues to meet regularly to discuss issues related to medical-dental integration, dental measurement outcomes, cross-cutting medical and dental measures, and the recovery from the pandemic. Recent meetings have focused on planning the annual WCHQ Oral Health Summit. The Summit, which draws oral health providers statewide, will be held in La Crosse this July.

Since first publicly reporting oral health quality measures in October, WCHQ has learned of many groups throughout the nation that are working to further oral health outcomes. That has opened an opportunity for WCHQ to share its work broadly.

The collaborative members have determined that patient reported dental outcome measures are a priority for this group going forward. Mike John, PhD, DMD, MPH teaches the University of Minnesota School of Dentistry and was recently awarded a federal grant to develop patient reported dental outcomes for use in dental offices. Dr. John will discuss his work with the Collaborative members in July and use their feedback to inform his work.

To learn more about patient reported dental outcome measures, check out Dr. John’s new resource published in November 2020 by the Dental Quality Alliance.

For more information on the Oral Health Collaborative, contact Jen Koberstein.

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Madison, WI 53717