A Life Saving Priority

Over the last three years, following more than 15 years of improvement, WCHQ members have been seeing a decline in colorectal screening rates. In addition, Wisconsin continues to see significant disparities in colorectal cancer screening rates with rural areas lagging significantly behind. This trend was identified as part of WCHQ’s 2020 Disparities report, and remains true today.  

WCHQ members currently exceed the national average of colorectal cancer screening rates, yet since the pandemic, the number of patients screened has decreased. This means we saw nearly 30,000 patients fall out of compliance with colorectal cancer screening compared to pre-pandemic rates.

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Younger Patients Need Screening

WCHQ is in the process of adjusting our measurement approach to align with current recommendations from the U.S. Preventative Services Task Force, which recommend initiating colorectal cancer screening at the age of 45, instead of 50. This change will result in an estimated 226,000 patients eligible for screening next year across the WCHQ members. 

“Many members have made this transition within their health systems and are already screening the younger population,” shared Brian Slattery, WCHQ Director of Performance Measurement and Analytics. “Because of this leadership, WCHQ members are well positioned to meet the influx of eligible patients and continue to show strong results on these important screenings.” 

Improvement Support

Building upon this momentum, WCHQ members have established a dedicated improvement team focused on improving colorectal cancer screening rates for all patients. 

“We understand that every patient matters when it comes to lifesaving screenings, and we are committed to closing these gaps,” shared Renee Sutkay, Clinical Transformation Specialist and lead facilitator of the Colorectal Cancer improvement team.  

The team, with 11 health systems represented (Ascension, Bellin Health, Gundersen Health System, MercyHealth, Prevea Health, Reedsburg Area Medical Center, ThedaCare, UW Health, and Watertown Regional Medical Center), is particularly focused on increasing colorectal cancer screening for the rural population. Rural communities in Wisconsin experience significant disparities in colorectal cancer screening and significant travel burden to receive colonoscopies. The team is working to identify evidenced-based solutions to barriers within their current workflows. The team has heard from health systems who have improved rural screening rates and have connected with Wisconsin resources on farm/rural culture and The Wisconsin Cancer Collaborative to further think about the rural population.  

For more information about the workgroup or WCHQ’s Colorectal Cancer Screening measure, 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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On October 26, WCHQ hosted a kickoff meeting for the Mental Health Action Partnership (MHAP), a coalition under the National Alliance on Mental Illness (NAMI), Wisconsin Chapter. The newly formed MHAP aims to ensure mental health services across Wisconsin are equitable, trauma-informed and highlight the voice of the patient. The work brings peers, families, providers, advocates, law enforcement, advocacy, and clinicians together.

WCHQ welcomed over 40 stakeholders from across the state, including partners at Wisconsin Primary HealthCare Association, Wisconsin Hospital Association, Rogers Behavioral Health, Advocate Aurora, Children’s Wisconsin, Wisconsin Nurses Association, Wisconsin Psychiatric Association, Wisconsin County Human Services Association, and numerous other local, non-profit services agencies.

The group came together to make sustainable change to mental healthcare across the state. Sita Diehl, MSSW, Public Policy and Advocacy Director at NAMI WI said, “When we all gathered in the room, there was a palpable sense of optimism that we can work together over the long haul for the benefit of the people we serve throughout Wisconsin.”

Next steps of the coalition are to identify the shared problems within the mental health system across the state and move toward a plan to improve some of these problems. The group would like to prioritize understanding ineffective, outdated and harmful care. The next meeting in January will focus on strategies to effect change in Wisconsin’s mental health system of care.

WCHQ’s work to improve the integration of behavioral in primary care and to improve the quality of mental healthcare in Wisconsin is integral to the goals of the MHAP. If you are interested in learning more about WCHQ’s behavioral health work, including this project, contact Renee Sutkay.