WCHQ quickly pivoted to meet members’ needs for collaboration and information sharing on COVID-19 related issues.
Members asked to meet more frequently as the situation unfolded and urgent issues arose related to telehealth, closing and reopening clinics, continuing care for patients with chronic illnesses, well childcare and immunizations and behavioral health issues.
WCHQ will continue to facilitate collaboration among members throughout the COVID response, including best practices for implementing vaccination clinics and administering the vaccine to staff, patients and in the community, as that information becomes available.
Here is a brief summary of the July improvement work, by clinical topic:
Adolescent and Child Health
This month members discussed best practices related to procedures during the pandemic, including scheduling well child visits through telehealth and in the clinic, best practices related to immunization clinics for this population and testing. WCHQ members reported a significantly higher demand for COVID-19 testing consistent with statewide trends. Wisconsin has worked toward expanding its capacity to complete and process testing. The number of labs performing testing went from 2 in March to 83 in July (WI DHS, 2020). The testing capacity of the state went up from 120 in March to 24, 156 in July (WI DHS, 2020).
Members shared information on methods to help meet the demand for testing, such as opening more testing sites and implementing drive-through testing. There remain concerns about the availability of testing kits and supplies as well as the delay in receiving testing results. To address delays, many members are utilizing in-house lab testing rather than depending solely on outsourced lab results. WCHQ is focused on supporting members to continuously adapt and modify clinical practice and testing workflows as the pandemic continues.
Related Resources:
Off-Site COVID-10 Testing Center Considerations Infographic
Wisconsin COVID-19 Summary Statistics: Cumulative Data
To join the conversation, please contact Sarah (Wright) Sky.
Chronic Disease
WCHQ members are continuing to reopen clinics and increasing face-to-face visits while taking necessary extra precautions to ensure patient and staff safety. As clinics catch up on the backlog of patients from the past few months, staff are working extra hours or extending clinics hours to see more patients in a day.
In July, WCHQ facilitated a presentation from researchers at the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR) Neighborhood Health Partnerships Program (NHP). Interested WCHQ members have the opportunity to design new health system and clinic-level diabetes reports for this program. The reports will provide local, timely and actionable data to support community health in Wisconsin. WCHQ members interested in joining in the co-design process for these reports should contact Lauren Bednarz.
WCHQ members are welcome to join the Chronic Disease meetings at any time. Contact Cara Winsand to learn more about this team.
Oral Health
Members of the WCHQ Oral Health Collaborative are meeting frequently to help dental practices continue to reopen safely. WCHQ facilitated sharing of best practices and discussion of strategies to address challenge. This month’s focus was on how to support staff who are struggling with the “new normal.”
Both Delta Dental of Wisconsin and the Health Policy Institute (HPI) at the American Dental Association (ADA) have been tracking re-opening statistics. According to claims data and practice reported data from Wisconsin, general dental practitioners have recovered to a level very near pre-COVID, close to last year’s levels of production. Preventive services are at or above last year’s level and the number of insured visits per provider are a bit higher than last year or pre-COVID 2020. The levels of recovery, however, appear very different by dental specialty. Pediatric dentists have experienced a robust recovery at or even above last year’s trends. Endodontists have also experienced a near complete recovery with visits per week only slightly below last year. Periodontist appear to be lagging last year’s production levels by about 25% despite an increase in maintenance services per visit, but a decrease in treatment services. Oral surgery has currently only recovered about 40% of last year’s production after experiencing early growth to nearly 75% of last year when dental offices first opened, followed by a second decline to the 40% level in the last several weeks.
Personal Protective Equipment (PPE) supplies remain a concern for oral health providers as they return to normal business. Providers have expressed the desire to be good stewards of PPE thereby ensuring medical providers have what they need. The American Dental Association reported in a recent survey that more than 75% of dental offices surveyed in Wisconsin have more than 14 days’ worth of PPE available and this issue seems to be resolving for dentists in Wisconsin.
Looking ahead, the Oral Health Collaborative is focused on the development of meaningful, publicly reported measures in the dental environment.
Behavioral Health
WCHQ’s Behavioral Health work has been focused on facilitating member discussions on best practices to adapt to the COVID-19 impacts on daily practice, including telehealth visits during COVID-19, and the integration of behavioral health and primary care.
WCHQ will begin publicly reporting several new behavioral health measures in the Fall of 2020 and 2021 including a PHQ-9 utilization measure, and measures of depression remission and response. These measures are challenging to achieve but essential parts of good clinical care. Soon, WCHQ will facilitate improvement meetings to share best practices to achieve success on these measures.
One avenue for success that WCHQ is already promoting through its Value Acceleration Initiative (VAI) is Integrated Behavioral Health (IBH). Using SAMHSA’s 6-Levels of Integrated Care, achieving higher levels of collaboration between primary care and behavioral health can improve patient health outcomes. The collaborative care model shown to better manage the many steps necessary during a patient’s depression treatment continuum (Pence, O’Donnell, & Gaynes, 2012). Having a team approach with an on-demand or in-clinic behavioral health consultant increases the capacity of a primary care practice to routinely screen patients for depression, clinically recognize depression, begin adequate and timely treatment, and track patients with treatment progress (Pence, O’Donnell, & Gaynes, 2012).
To join the conversation or to ask WCHQ for assistance while implementing integrated behavioral health, please contact Sarah (Wright) Sky.
Pence, B. W., O'Donnell, J. K., & Gaynes, B. N. (2012). The depression treatment cascade in primary care: a public health perspective. Current psychiatry reports, 14(4), 328–335. https://doi.org/10.1007/s11920-012-0274-y
