For the first time since WCHQ members began collaborating to reduce health disparities we are seeing statistically significant and clinically relevant evidence of successful health disparity reductions. WCHQ members are sharing their best practices transparently as part of the WCHQ Disparities Improvement Team.  

Here we highlight the results and successful strategies of two WCHQ members that demonstrated marked improvement between 2021 and 2022.

One WCHQ Member identified a significant disparity of blood pressure control between black and non-black patients. They were able to reduce this disparity by 44% in one year by implementing the following:

• Frequent education for all staff on diversity, equity, and inclusion.
• The Community Engagement Manager is connecting with community partners who serve the African American Community to understand which interventions are decreasing disparities in the population they serve.
• Outreach to patients with uncontrolled hypertension and, if appropriate, referred to the clinical pharmacist team.
• Case management services provided for patients with complex situations; case management services assessed for needs and barriers.
• Travel vouchers provided for patients in need, as assessed by the case management team.

Another WCHQ Member identified a significant health disparity in breast cancer screening for the Asian and Pacific Islander community. For this member, many of these patients came from the Hmong community and the member therefore focused their efforts on providing culturally sensitive care for these patients. They implemented the following interventions:

• Partnered with a Hmong Community Center to offer mobile mammograph services during a Hmong Family Health even where the whole family was invited.
• Consulted with community leaders to develop culturally sensitive terminology to describe the need for mammography (choosing the term “breast health” instead of “breast cancer screening”).
• Staffed a mammography event with Hmong nurses the community members know and trust.

WCHQ has an active Disparities Improvement Team that is open to all members who want to work on reducing health disparities in their populations. For purposes of this article, we blinded the names of the involved members; the improvement team is transparent and open sharing of learnings and best practices. WCHQ members are encouraged to review the publicly available reports found here as well as make sure you have a copy of your own data showing your specific health disparity opportunities.  

If you are interested in learning more about the evidence-based interventions that health systems are using as they work toward specific goals, or to obtain your own data, please reach out to Renee Sutkay.‍

WCHQ Advisory Group Takes Aim at Leading Cause of Cancer Deaths

Lung cancer is the leading cause of cancer deaths in the United States, with one in sixteen people diagnosed with lung cancer in their lifetime (American Cancer Society) and more than 4,000 new cases in Wisconsin each year (Wisconsin Cancer Coalition).  

Lung cancer survival rates are low, in part, because the majority of patients are diagnosed late in the disease progression, only after symptoms have begun. Wisconsin ranks 27^th in lung cancer diagnoses in the United States with screening rates slightly higher than the national average (6% versus 10% based on 2022 data from the American Lung Association), yet a large majority of people at high risk for developing lung cancer remain unscreened.

The United States Prevention Services Task Force recently updated its recommendations for lung cancer screening to include a larger age range and more current and former smokers. The research behind this change indicated that increasing screening for those at high risk can reduce the lung cancer death rate by up to 20% by detecting tumors at early stages. (American Lung Association, 2022).  

Increased screening will lead to more patients being diagnosed with lung cancer at earlier stages. This gives treatment teams more opportunity to target treatment for the patient’s specific cancer characteristics. In response to the need and changing recommendations, WCHQ has formed an advisory group focusing on biomarker testing for non-small cell lung cancer in Wisconsin. The advisory group’s goal is to increase biomarker testing and improve health outcomes by using the right treatment for the right patient. Biomarker testing helps oncologists determine whether a patient’s cancer has a specific mutation, which in turn informs treatment selection and can lead to better patient outcomes. If you would like more information on this project or to join the advisory group please contact Lori Bue.‍

WCHQ’s recent event, “Addressing Maternal Mortality & Morbidity Through Education & Advocacy,” provided participants with actionable information and resources to care for at-risk patients. The event was created in partnership with participants in the WCHQ Maternal Health Improvement Team, who are focused on pre-hospitalization risk factors and effective interventions for maternal morbidity and mortality. The team has representation from ten members and several community partners with the focus of improving maternal health before the mother arrives at the hospital for birth.

MAMA LOVE (Morbidity And Mortality Assessment: Lifting Outcomes Via Education) is a free application that addresses the leading medical conditions contributing to maternal mortality, with a focus on mental health conditions and social determinants of health. Abby Britt, CNM, PhDc, MACHM from Emory Nell Hodgson Woodruf School of Nursing and MAMA LOVE co-founder, shared how the tool is used by patients and providers. It begins with a patient filling out a quick questionnaire regarding the symptoms they are encountering and provides them with recommendations based on the algorithm built into the application.

The Periscope Project is a free perinatal psychiatric access program available to providers and professionals who are caring for pregnant and postpartum women struggling with behavioral health disorders. Lizzie Hovis, MD and Shelby Kuehn, BA, provided an overview of the project which currently has 1,536 health care providers and professionals enrolled and has completed 3,105 provider to perinatal psychiatrist teleconsultations. One hundred percent of those responding to the follow up survey were satisfied with the service, helped them to more effectively manage their patients care and indicated they will incorporate the information they learned into future care of patients.

If you are interested in joining our Maternal Health Improving Team or learning more about this work, contact Lori Bue.‍

WCHQ member Ascension describes positive experience and improved HPV vaccination after 2023 participation

WCHQ invites member health systems to participate in a 1-hour workshop to improve human papillomavirus (HPV) vaccinations in primary care clinics. The workshop, called The Announcement Approach Training, has been shown to increase HPV vaccination by five percent (Brewer et al, Pediatrics, 2017). WCHQ members currently have an overall HPV immunization rate of 69% while the Wisconsin Cancer Collaborative goal is 80%. We are enrolling systems now for spring 2024 workshops. Participants will receive continuing medical education credits. 

Margaret Hennessy, MD, Pediatrician and Medical Director of Pediatrics at Ascension, shared this about Ascension’s participation in the project, “HPV vaccination was one of our quality metrics so this fit into our program beautifully. We are already seeing improvement in HPV vaccination in our clinics. The project staff were great, and I heard that the clinicians were very appreciative of the training. We plan to expand this into other clinics in the near future.”  

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Twenty primary care clinics from three systems participated in spring 2023. Preliminary results from workshop participant surveys show high satisfaction with the training. Almost all (>90%) participants agreed the training improves HPV vaccine communication and workshop facilitators were effective. Two months after the training, most participants (>90%) reported the approach taught in the workshop fit easily in their clinic workflow.  

The workshop is for all clinical staff who have a role in adolescent vaccination. Content includes traditional and new approaches, such as how to start discussions about HPV vaccination with families starting at age 9. It also helps clinical staff build relationships with families and defuse conflict. 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. 

The project is led by Elizabeth Cox, MD, PhD, a pediatrician and health services researcher, 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.  

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.

‍Navigating health disparities, racism, and stigma to get mental health access

WCHQ has partnered with the Medical College of Wisconsin to increase access to behavioral health services for patients with Medicaid.  As part of this project, patients tell the stories of their experience receiving services.

These contemporary portraits of people living with mental illness provide brief glimpses into the experience of navigating the US health system as Medicaid recipients. They share their stories of seeking care, engagement with clinicians, therapeutic treatment, peer support, and recovery. The 3-minute personal vignettes point to the impact of social-cultural and institutional determinants on health, and the resilience it takes to access care and get better.  
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Richard – “Teach me”
So I don’t have to stay stuck

In this video portrait Richard talks about his experience with medication treatment. He asks that clinicians “work with” patients and ‘trust that patients know their bodies” well enough to know what they might need. Richard advocates for patient empowerment through health education and collaboration.

‍Possible topics for discussion: Health literacy, social disparities, mental health access and insurance.

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