May 2023
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Wisconsin Health News Highlights the Disease of Obesity
WCHQ staff, members serve as guest panelists
Wisconsin Health News (WHN) convened a panel on April 27 to talk about the shifting culture of obesity. The panel included Abbey Harburn, Director of Analytics and Practice Transformation at WCHQ; Dr. Sam Pabich, UW Health; Andrea Werner, Chief Population Health Officer, Bellin and Gundersen Health System; Dr. Leslie Golden, Watertown Family Practice and Jean Harris, Senior Director of Market Access Midwest, Novo Nordisk. The virtual event was sponsored by WCHQ member Bellin and Gundersen Health System and moderated by Tim Stumm of Wisconsin Health News.
The panel discussion focused on the shift in health care from obesity being perceived as a lifestyle choice to the recognition that obesity is a disease in need of evidence-based treatment. The guests also spoke to biases that exist for patients living with obesity.
Abbey Harburn shared the work WCHQ has been doing for the past two years to address obesity, such as convening an advisory group made up of WCHQ member representatives, developing a toolkit for primary care, education events, and involving payers and employers in this work.
What a patient living with obesity faces
The group discussed the many implications to health that a person living with obesity faces. Dr. Golden said, “There are more than 200 medical conditions that are caused or worsened by obesity. If we put effort into treating obesity, we can treat at the root cause.” Dr. Pabich listed some of the more prevalent complications stemming from obesity, including heart disease, stroke, cancer and mood disorders. In addition, Dr. Pabich noted that obesity is now the leading contributing factor to the need for a liver transplant.
Jean Harris and Dr. Golden both shared the biases patients with obesity face, from community members, healthcare professionals and even their own internal biases. Dr. Golden said, “Patients think, ‘It’s a willpower issue, I’m not trying hard enough.’ But it’s not about willpower. It’s a hormonal imbalance that can cause people to eat more often. And even though obesity was recognized as a chronic illness in 2013, many clinicians still don’t subscribe to that. There are so many layers of bias throughout the system.”
All of the panelists agreed that biases toward people with obesity have improved, but there is still much work to be done.
Jean Harris talked about her personal experience with obesity. She explained it is important to educate about the stigma and bias related to obesity. She went on to say that it is so important to use people-first language. “There are so many people doing things from an unconscious place. For instance, chairs in an office that are made for people with a larger body size.”
How treatment of obesity is evolving
Dr. Golden said treatment of obesity has changed in several ways. “First, we are treating it, which was not done in the past,” she said. “It’s important to understand that when we treat weight successfully, it’s a comprehensive approach. Not just surgery or medication or lifestyle. It’s all of it. We also look at the severity of the disease. How much is it affecting the person’s life? If there are life threatening issues, that requires urgent treatment.”
Jean Harris commented that medications have evolved, and continue to do so. “Things are very different now,” she said. “Until the last few years, only 6-10% of patients achieved their goal weight loss. New meds are yielding more like 15-18% of patients. More meds are coming, we may even see higher percentages of weight loss.”
Dr. Pabich added that, while medications are evolving, many of them are not covered by Medicare or most insurance plans. She hopes that in years to come, coverage will be offered by more plans.
Abbey talked about the “myths that persist about obesity and how this causes lower quality care and poorer outcomes.” She also shared details about the WCHQ Obesity Advisory Group that launched in 2021. The advisory group focuses on education, best practices, toolkits, provider and payer communication, benefit design, and quality measurement. Abbey went on to say that she hopes “we will see a community benefit to treating obesity in the future that will impact the availably of treatment for all people.”
Obesity and how it impacts healthcare quality will be a topic at the WCHQ Statewide Quality Improvement Event and Diabetes Summit on June 22 in Madison. Click here to learn more or register for the event.
For more information about the work WCHQ is addressing with the Obesity Advisory Group, please contact Jen Koberstein at JKoberstein@wchq.org.
Improvement Team and Advisory Group Updates
ASTHMA
Asthmatic Patient Screening Tools: Differences, Processes and Benefits
About one in thirteen people in the United States is living with asthma, a long-term condition that affects breathing. Asthma impacts some communities more than others, but it can be managed with the right tools. May is National Asthma and Allergy Awareness Month and WCHQ’s Asthma Improvement Team met and had a presentation by Dr. Nicholas Antos, Director, Cystic Fibrosis Center, Children’s Wisconsin, Medical College of Wisconsin, about the importance of the patient screening questionnaires used to gain insight on how the patient’s asthma control is outside clinic visits.
Dr. Antos spoke to the team about different patient screening questionnaires that are commonly used before, during and between clinic visits. He also talked about the unique scoring attributes and clinical processes needed for optimal results. Dr. Antos said, “The reason why I think the asthma control test is important is that it turns the subjective symptoms into an objective measure.”
Although the questionnaires can come in different lengths, asking slightly different questions, scored differently, they are simple for the parent/patient to complete and are a validated screening and documentation tool for asthma control that can be used consistently. Dr. Antos went on to suggest how a health system can choose a screening tool that is sustainable and easy to score, while also considering cost, literacy level, and the cultural needs of the health system population.
Concluding, Dr. Antos said, “From a usage standpoint, it is variable how people actually use it and look at it. I use it a lot in discussions with the family. It is especially clinically useful when it doesn’t match what I think is going on.”
This improvement team is looking for health systems to participate in this work. If interested, please reach out to Lori Bue, Quality Improvement Specialist at lbue@wchq.org.
BIOMARKER TESTING
The Importance of Biomarker Testing in Non-small Cell Lung Cancer
On April 20, WCHQ hosted a webinar entitled, “Importance of Biomarker Testing in Treatment Optimization for Patients with Advanced Non-small Cell Lung Cancer.” Lung cancer is one of the most common cancers and is the leading cause of cancer deaths in the United States. One in sixteen men and women will be diagnosed with lung cancer in their lifetime according to the American Cancer Society. Lung cancer survival rates are low, in part because 77% of patients initially present in later stages of the disease. Some cancers have mutations, or genetic alterations. These mutations can indicate whether a patient will respond or not to specific treatments. Biomarker testing helps oncologists determine whether a patient’s cancer has such a mutation, which in turn dictates treatment selection and can lead to better patient outcomes.
Ward Kadel, Principal Biomarker Lead with Genentech U.S. Medical Affairs, provided the audience with information about biomarker testing and background about how biomarkers target therapy to more effectively treat a patient’s cancer. He shared guidelines from the National Comprehensive Cancer Network (NCCN) about biomarker testing and shared data on comprehensive testing rates.
Abbey Harburn, Director of Analytics and Practice Transformation with WCHQ, presented on the future of quality improvement and measurement for biomarker testing. She talked about how data collected from an upcoming survey of WCHQ members will be analyzed to better understand the current practices of biomarker testing across health systems. This data will identify educational needs and resources.
The goals of this project are:
- to understand the landscape of biomarker testing for lung cancer in Wisconsin
- identify best practices
- increase rates for biomarker testing
- improve outcomes for patients with lung cancer
We are looking for member health systems to work with us on the Biomarker Testing Advisory Group. Potential advisory group members include those who work in Oncology or Primary Care (all roles), Quality Improvement staff and health system leaders.
If you are interested in participating in this group, please reach out to Quality Improvement Specialist Lori Bue.
CHRONIC DISEASE
Member Success Story: Gundersen Health System’s Diabetes Team-Based Care
The Chronic Disease Learning Collaborative met on January 30, 2023, to share their improvement goals and outcomes in a poster presentation format. Aspirus, Associated Physicians, Gundersen, Marshfield Clinic (3), Prevea 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.
Diabetes is a costly chronic disease, making up $1 in every $7 healthcare dollars spent, not to mention increased patient risk for chronic kidney disease, heart disease, stroke, amputation and blindness, all decreasing patient quality of life and increasing societal costs of absenteeism and disability.
To work toward improving diabetes outcomes, Gundersen has piloted decentralizing diabetes education in the larger, endocrinology clinics and moved diabetes education to three primary care clinics. In this team-based care model, “diabetes educators are available for primary care to offer a warm hand off, brief intervention and the patient is able to receive care in a familiar primary care clinic,” reports Chelsea Schroeder, RN, Quality Improvement Specialist.
Gundersen worked to create a consistent, systems approach with common language and standard work to standardize diabetes education. Gundersen has seen an increase in patient engagement due to the warm hand off and the ability for diabetes educators are able to make a follow up appointment directly with the patient.
Gundersen has seen improved patient outcomes with diabetes in this work so far with this pilot project. One patient experienced a drop in A1C from 14.7 to 8.4 within six months of being engaged in this team-based care model. Pharmacists can also be involved in the care of patients with diabetes; Gundersen is tracking consults sent to diabetes education and to pharmacy for medication review.
COLORECTAL CANCER
New WCHQ Advisory Group to Address Colorectal Cancer Screening Disparities in Wisconsin
On April 11, WCHQ held a webinar focused on a deep dive into colorectal cancer screening disparities in rural communities. Dr. Jennifer Weiss, faculty member of the Division of Gastroenterology and Hepatology within the Department of Medicine at the University of Wisconsin-Madison, presented data from her most recent research project with the Wisconsin Partnership Program. This data has shed a light on the screening gaps for people of color in rural communities. As a result of years of research into the disparity gaps in Wisconsin’s colorectal screening rates, Dr. Weiss has coined a new term: “The double whammy of rurality and race/ethnicity.”
During the webinar, Dr. Weiss shared some important statistics about colorectal cancer from the American Cancer Society:
- Colorectal cancer is the second leading cause of cancer deaths in Wisconsin.
- In Wisconsin, there have been 24,000 new cases of colorectal cancer and 9,000 deaths in the last 10 years.
- One in four eligible Wisconsin adults are unscreened for colorectal cancer.
“I think that colorectal cancer is the most preventable, yet least prevented cancer, due to low uptake of screening,” said Dr. Weiss. “It’s very preventable, but yet it’s not being prevented as much as it should be because of variations in colorectal cancer screening rates.”
The National Colorectal Roundtable’s most recent colorectal cancer screening goal is 80% of eligible people in every community. In some communities in Wisconsin, screening rates are as low as 31%.
WCHQ is kicking off an advisory group sponsored by Exact Sciences. The first meeting is May 12. The group will examine the disparities in screening and the cultural factors leading to these disparities. Group members will then utilize quality improvement strategies to make changes within their health systems, analyze results, and share their learning. This process will assist in achieving the National Colorectal Roundtable’s goal. If you are interested in participating in this work, please reach out to Quality Improvement Specialist Renee Sutkay.
MATERNAL HEALTH
Better outcomes for pregnant patients and their infants
Preeclampsia is a hypertensive disease that occurs during pregnancy. This disease encompasses 2 to 8% of pregnancy-related complications, greater than 50,000 maternal deaths and over 500,000 fetal deaths worldwide as sited by National Institutes of Health.
Hypertension in the pregnant population is a measure that the WCHQ Maternal Mortality and Morbidity Improvement Team is developing to better understand, identify and work to close care gaps. Once the measure is complete, the team will stratify the data to identify any disparities by age, race, payer, ethnicity, and geography. Other chronic disease conditions, such as diabetes and obesity, will also be stratified to determine disparities.
Angela Rohan, PhD, Maternal and Child Health Epidemiologist with the Centers for Disease Control and Prevention, assigned to the Wisconsin Division of Public Health, will be presenting at WCHQ’s Statewide Quality Improvement Event, June 22, 2023 at the DoubleTree by Hilton Madison East in Madison. This presentation will provide an overview of maternal health outcomes and inequities in Wisconsin and describe current efforts and opportunities to improve maternal health in the clinic and in the community. Programs and resources highlighted will include the Wisconsin Maternal Mortality Review Program, the Wisconsin Perinatal Quality Collaborative, and CDC’s “Hear Her” Campaign.
If you are interested in participating in the WCHQ Maternal Mortality and Morbidity Improvement Team, please contact Lori Bue.
Click here to register for the WCHQ Statewide Quality Improvement Event on June 22 in Madison.
ORAL HEALTH
Oral Health Update
The COVID-19 pandemic has disrupted many aspects of our lives, including our oral health. The State of Wisconsin has experienced a significant decrease in routine dental appointments and oral health checkups. This disruption has raised concerns about the potential long-term effects on the population's oral health.
Since COVID-19 has decreased in confirmed cases, and vaccination rates have risen, it is time to address the issue of oral health and ensure we do our part to maintain good oral hygiene by resuming public reporting on oral health quality measures at WCHQ.
Public reporting on oral health involves collecting data on various oral health indicators, such as Caries Risk Assessment, Ongoing Care with Periodontitis, and Topical Fluoride Application. WCHQ then uses the data, in partnership with oral health members, to develop strategies to improve oral health outcomes.
Public reporting on oral healthcare is critical in the post-pandemic era. This will enable WCHQ to track the impact on oral health outcomes and develop appropriate responses to address the issues from the last two years. Additionally, public reporting can help to raise awareness about the importance of oral health and encourage people to prioritize their oral hygiene.
In conclusion, as we emerge from the pandemic, we must not forget the importance of oral health. Bringing back public reporting on oral health can help us to identify the scope of the oral health problem and develop effective strategies to address it. By prioritizing oral health, we can maintain healthy smiles and overall health and well-being.
If you, or your organization, are interested in oral health quality improvement or oral health data, please contact Jen Koberstein.
Health Wisconsin Families Grant Opportunity
We are pleased to share details of a new grant offered by the UW School of Medicine and Public Health and the Wisconsin Department of Health Services. Additional information can be found here.
This funding opportunity seeks to improve the health outcomes of mothers and their infants during the prenatal and postpartum period by strengthening relationships between non-profit health organizations and community partners.
Eligible organizations include Wisconsin-based non-profit hospital/health systems, Federally Qualified Health Centers, and other non-profit clinical care entities in partnership with one or more established community partners. Collaborations and consortium applications are encouraged by health delivery entities.
Awards of $1,150,000 max for up to two years. Proposals should address how applicants will establish better models of care for mothers and infants in Wisconsin during the critical window of time just before labor and delivery through the postpartum period. Applications are due Tuesday, May 30, 2023.
