September 2023
SPOTLIGHT: Members Partner to Reduce Maternal Mortality and Morbidity
WCHQ health system members have joined with community partners to address the work of reducing maternal morbidity in Wisconsin through the WCHQ Maternal Mortality and Morbidity Improvement Team. In Wisconsin, at least 1 out of every 100 delivery hospitalizations resulted in at least one severe maternal morbidity. Wisconsin severe maternal morbidities rates are highest for women younger than 20 years of age, women 35 years of age and older, and non-Hispanic Black women. Based on the most recent data, there were 80 pregnancy-associated deaths in Wisconsin per year. (Department of Health and Human Services).
Participating WCHQ members include:
- Advocate Aurora Health
- Ascension
- Associated Physicians
- Bellin Health System
- Gundersen Health System
- Marshfield Clinic
- Froedtert/Medical College of Wisconsin
- Prevea Health Care
- SSM Health
- UW Health
Partnering organizations include participants from Department of Health Services Maternal and Child Health, Wisconsin’s Maternal Mortality Review Team, University of Wisconsin Madison Health Innovation program, Healthy Metrics Disparities through Medical College of Wisconsin and UW Milwaukee College of Nursing.
“As perinatal healthcare professionals, the continued review and improvement guidelines to reduce maternal morbidity and mortality is vital to the care of women and newborns in our community,” shared Janet Letter, MSN, RNC-OB, C-EFM, Team Leader and Kirstin Hopson, RN, BSN, Nurse Practice Specialist, from Bellin Health.
Participants are using WCHQ data to identify at risk populations and then design effective interventions, with a focus on the upstream factors that impact morbidity and mortality. The data identified certain populations are at higher risk including Black, Hispanic, Asian/Pacific Islander, American Indian, underserved, rural disadvantaged and urban disadvantaged. The improvement team is focused on interventions that occur before the patient is in the hospital, such as control of hypertension, diabetes and obesity, screening and treatment of substance abuse disorders, early identification of clinical depression, and depression remission and response.
The team will be conducting patient interviews to gain patient perspective on the identified issues.
If you would like to represent your WCHQ member health system on the Maternal Health Improvement Team, contact Lori Bue at lbue@wchq.org.
This work is supported by the Wisconsin Maternal and Child Program and the Maternal and Infant Mortality Prevention Program.
September is Suicide Prevention Month
WCHQ Focuses on Depression Care
During Suicide Prevention Awareness Month we are encouraging appropriate screening for clinical depression, one of the most effective strategies in suicide prevention.
WCHQ began publicly reporting rates of screening for clinical depression back in 2016. Wisconsin health systems chose to report because, while overall screening was at only about 40% of eligible patients, there were some members were at over 80% who could share their best practices. Over the next four years, through improvement activity and collaboration, Wisconsin health systems were able to dramatically improve on this measure, with more than 80% of all patients screened annually.
“Wisconsin’s Screening for Clinical Depression is a real success story for Wisconsin health systems,” shared Brian Slattery, Director of Performance Measurement and Analytics at WCHQ. “Even after the pandemic, when services at our health systems were significantly altered, performance on this measure improved. This is a testament to the improvement work and processes put in place by WCHQ members.”
Following the success of the Screening for Clinical Depression measure, WCHQ is implementing a new behavioral health outcome measure, Depression Remission and Response. This measure tracks how depression symptoms change over a 4-8 month period. “This is a very natural evolution of WCHQ’s measure, health systems begin by working on improving the screening process, then focus on improving the outcomes”, shared Mr. Slattery.
Depression Remission results will be available to WCHQ members for preview in the Fall 2023 reporting period and will be publicly reported in the Spring 2024 period.
WCHQ Hosts Third Obesity Summit
State and nationally-known medical professionals who treat obesity shared insightful information at the recent WCHQ obesity summit, “Comprehensive Approaches to Treating Obesity.” More than 150 participants learned more about caring for their patients living with obesity.
WCHQ dedicated a full day to this critical health problem that affects at least a third of Wisconsinites and is complex to treat. Obesity is a long-term health problem that impacts overall health and is associated with medical conditions such as heart disease, hypertension, high cholesterol, and diabetes. Societal attitudes toward people living with obesity increase stigma and deter people from seeking help. Insurance coverage for obesity treatment varies making it difficult for people to engage in treatment.
Opening remarks were made by Dr. Samantha Pabich, an endocrinologist at UW Health. Dr. Pabich encouraged the audience to think of obesity as a chronic disease. She emphasized the need to eliminate comments about obesity treatment “taking away from” other treatment.
Dr. Angela Fitch, the current President of the Obesity Medicine Association presented about the future of obesity medicine. She defined the quintuple aim: outcome, quality, cost, resiliency, and equity. She shared Dr. Pabich’s sentiment that obesity should be addressed as a chronic disease with comprehensive care. Dr. Fitch shared data on current and future medications and other forms of treatment and ended her presentation reminding the audience that we need to find the right treatment for the right people with other therapies.
Abbey Harburn, MPH, presented the WCHQ obesity data in Wisconsin. She presented data on the disparities in screening and treatment for people with obesity. Abbey shared that there are substantial disparities in the prevalence of obesity with the highest rates seen in the African American population and substantial disparities in rural and urban underserved populations in Wisconsin. She also shared that the lowest rates of A1c control for people with obesity are Hispanic/Latino. Abbey encouraged people to join the work of WCHQ on obesity by joining our Obesity Advisory Group.
Dr. Sachin Jogal, a pediatrician at SSM Health, presented on the impact of childhood obesity across the lifespan. Dr. Jogal shared that 16% of children ages 10-17 in Wisconsin are overweight and another 15% are obese. He went on to talk about how the pandemic accelerated weight gain in children and the impact of high ACE scores on obesity. Dr. Jogal went on to say that per the World Health Organization, high ACE scores increase the obesity rate by almost 50%. Dr. Jogal and others in the room were pleased that Wisconsin has formed the Speaker’s Task Force on Childhood Obesity and the Chair, Representative Karen Hurd, joined WCHQ members for the morning.
Renee Rawls, a patient ambassador, kicked off the afternoon by sharing her personal journey with weight loss. Ms. Rawls talked about her experience of being over 500 pounds and having the choice between life and death. She talked about what choosing life meant for her and how health care providers can join a person in that journey.
A panel of five physicians shared case studies with the audience. Each of the case studies highlighted treatment that a primary care physician can also implement in their clinic to help someone with obesity. The panel included Samantha Pabich, MD, MPH, UW Health; Chris Weber, MD, Ascension; Sachin Jogal, MD, SSM Health; Melanie Smith, DO, Advocate Health and Compton Kurtz, MD, UW Health.
Maggie Koch, RN and Stephanie Becken, APNP from Bellin Health System joined us to share information about Bellin Health’s Lifestyle Medicine Program. Lifestyle Medicine is the use of a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease. They also answered questions about how health systems can start their own program.
We ended the day with a presentation by Dr. Courtney Barry, a licensed clinical psychologist and assistant professor in the Department of Psychiatry and Behavioral Medicine from Medical College of Wisconsin. She addressed how mental health and trauma contribute to obesity, and the impact of social determinants of health on obesity. She impressed upon the audience the importance of asking “why” with their patients. Understanding “why” helps to understand how we can help.
If you are interested in learning more about how WCHQ is partnering with its members to better serve patients living with obesity, please contact Jen Koberstein.
WCHQ Member Access Community Health Center Receives WPHCA Performance Excellence Award
The Wisconsin Primary Care Association (WPHCA), the statewide association for Community Health Centers, recently honored Access Community Health Center with the 2023 WPHCA Performance Excellence Award. Each year, WPHCA recognizes a team of Community Health Center staff who are working towards achieving the quadruple aim: improving the health of patients, patient experience, cost effectiveness, and/or staff satisfaction.
Access’s interdisciplinary team collaborated to support substance use disorder (SUD) treatment as a routine part of primary care, achieving multiple outcomes including:
- 35 medical providers across three clinic locations now prescribe buprenorphine for SUD treatment, increasing from three providers in 2018
- Increase in the number of patients served who received SUD treatment by over 80% between 2019 and 2023
- Implementation of an annual universal wellness screener for all patients as a part of Access’ “We Ask Everyone” campaign to support reducing stigma associated with mental health and SUD treatment.
Congratulations, Access, on your achievement!
Improvement Teams
Behavioral Health Recovery Stories:
Navigating health disparities, racism, and stigma to get mental health access
WCHQ is partnering with the Medical College of Wisconsin to increase access to behavioral health services for patients with Medicaid by featuring real patients telling their own stories of receiving health services.
These contemporary portraits of people living with mental illness provide brief insights 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.
Rene – “Born to be Real”
Listening to the voices of lived experience
Rene talks vulnerably about how she recovered from her internalized stigma and self-loathing around having a mental illness. She describes how she learned to accept her illness and identify what was essentially the “system’s fault”. This portrait elucidates the power of peer support in recovery.
Possible topics for discussion: racism, gendered diagnosis, trauma informed care, peer support, stigma.
This project is funded by Advancing a Healthier Wisconsin.
Chronic Disease
Member Success Story: Prevea Health Care
Prevea Health, a member of WCHQ’s Chronic Disease Learning Collaborative, shared their improvement work towards their goal to decrease in-basket work and increase call standardization for primary care teams. This goal ensures the “right staff to do the right work,” says Julie Chaloupka, RN, BSN, Primary Care Manager for Prevea Health Care. The project improved care for patients as their return calls and messages were answered more quickly and providers’ workload was more efficient and organized, therefore reducing burn out.
The primary care team identified over distinct 300 reasons for patients calling their clinic! Previously, the reception staff was sending the call to the triage nurse who would then assign a call back or follow up for that patient. The team grouped the call reasons into 25 categories and included these in the electronic health record. This change made it easier for the reception staff to know the appropriate team member for follow-up. The triage nurse was consulted when there was a need for triage, rather than being the person to assign every call.
Key to the project’s success was the inclusion of the entire team in the improvement process. Everyone worked together to understand each team member’s workflow and worked to improve it. The team piloted the project at two primary care sites. It was successful in reducing workload and increasing efficiencies in the workflow and quickly rolled out to the entire clinic and to some specialty sites.
When patients call for advice, staff found they needed to add a secondary reason to ensure priority for the patient’s call. “This helps the triage nurses manage their pool.” Chaloupka said. This work not only supports clinical staff workflow, but also simplifies the reception staff workflow.
This project has led to more projects and ideas focused on staff efficiencies. Future steps include reviewing in basket work for MyChart messages. Chaloupka notes, “We want to ensure patients are being seen in the clinic if they need to be seen.”
Colorectal Cancer
WCHQ Rural Health Members Address Colorectal Cancer Screening for Farmers
The Colorectal Cancer Screening Advisory Group focuses on improving colorectal cancer screening rates in rural communities.
Karen Endres, Farmer Wellness Program Coordinator with the Wisconsin Department of Agriculture, Trade, and Consumer Protection, met with the Advisory Group to discuss specific cultural considerations when working with farmers. Endres explained the many roles that farmers play in their daily lives: mechanic, scientist, nutritionist, market analyst, agronomist, and geneticist to name a few, all while taking care of their daily duties of feeding and caring for the land and animals. They do this work oftentimes in isolation or with a few trusted partners and employees. In farming culture, people are used to taking care of things themselves, building trust with this community is important to the process.
Having extra time to connect with a farmer coming into the clinic when they have been otherwise isolated can be a great tool in trust building, Endres reminds us, “You may be the only person that farmer has seen today.” Farmers also have a lot on their plates that depend on the weather. When a farmer has to choose between harvesting their crops on the best weather day of the week and a healthcare appointment, they will likely prioritize their crops.
“When working with farmers, having that flexibility is important when they call to cancel last minute,” Karen said.
Allison Antoine, MPH, CHES, Outreach Program Manager at the Wisconsin Cancer Collaborative presented on the Wisconsin Cancer Collaborative’s recent report, “The Availability of Colorectal Cancer Screening with Colonoscopy in Wisconsin.” The report detailed a breakdown of the availability of colonoscopy by Wisconsin county and by payer type. The report can be viewed here and is layered by population, payer, and geography.
These resources were helpful for the group to determine how to think about interventions to improve colorectal cancer screening within the rural populations they serve. WCHQ is meeting individually with health systems to support the implementation of new interventions for improvement.
Current Colorectal Cancer Advisory Group members include:
- Fort HealthCare
- Mercy Health
- Gundersen Health System
- Reedsburg Area Medical Center
- Prevea Health Care
- Watertown Regional Medical Center
- Bellin Health
- UW Health
If you are interested in participating in or learning more about this work, please contract Renee Sutkay.
Disparities
WCHQ Members Reduce Colorectal Cancer Screening Disparities
Several WCHQ health systems reduced disparities in colorectal cancer screening, contrary to the national trend that shows COVID-19 had an inequitable impact on marginalized populations. The WCHQ Disparities Improvement Team recently analyzed colorectal cancer disparities data, comparing performance in 2022 to 2019 and noted that some health systems are narrowing gaps in care for marginalized patient populations.
Improvement Team participants shared strategies to improve equitable screening for colorectal cancer:
- Dr. Amrinder Singh, Family Medicine, Ascension Wisconsin highlighted a partnership with a community health center to increase awareness of screening recommendations and options. Ascension Wisconsin is also increasing colorectal cancer screening by completing fecal immunochemical tests (FITs) in-office during physical exams.
- Maggie Koch, BSN, BS, RN, Director of Care Beyond Walls for Bellin Health shared that Bellin Health has robust information on colorectal cancer screening available in Spanish, a primary language spoken by their patient population. Bellin is working to create comprehensive and culturally appropriate educational information in both Hmong and Somali, as they have identified spoken language as a barrier to completing colonoscopies.
- Brenda Rooney, PhD, MPH, an epidemiologist with Gundersen Health, highlighted the importance of taking a population health approach to colorectal cancer screening, particularly in light of backlogs and during pandemic shutdowns. Gundersen was able to screen low risk patients through a proactive FIT campaign, sending testing kits to qualifying patients.
These interventions show the innovative solutions that health systems are taking to address health disparities. For more information or to join the Disparities Improvement Team, please contact Renee Sutkay.
Immunizations
HPV Vaccine Improvement Project Recruiting Health Systems for Spring 2024
Contact the project team to learn how your health system can join.
WCHQ is continuing its partnership with the University of Wisconsin and the University of North Carolina to deliver an evidence-based HPV vaccine communication workshop to member systems. The workshop has been shown to increase HPV vaccination by five percentage points (Brewer et al, Pediatrics, 2017) and save physician time during clinic visits (Malo et al., Implementation Science, 2018). WCHQ members currently have an HPV immunization rate of 69% and the goal in Wisconsin set by the Cancer Collaborative is 80%. The project is now enrolling systems to receive workshops in the spring of 2024.
The communication workshop, called The Announcement Approach, 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 will also help clinical staff build relationships with families and defuse conflict.
Health systems receive a 1-hour CME/CNE communication workshop for providers and clinical staff in primary care clinics, as well as additional training for one or more Vaccine Champions. Champions will deliver the HPV vaccine communication workshops to half of the health system’s participating clinics and experts from the project team will deliver workshops to the remaining clinics. WCHQ data will be used to track improvements.
Twenty primary care clinics from three systems have already participated in 2023. Jill Spejcher, MSN, RN, Primary Care Clinical Operations Team Leader at Bellin Health, had this to say about Bellin’s experience:
“The project was a really great success within Bellin. We had great staff engagement, and the communication approach taught in the training was very easy for our staff to use. It didn’t slow down the rooming process and fit in with the workflow. Since the trainings, we’ve been seeing improvements in HPV vaccination rates that add up to an additional 250-350 vaccines per month.”
The project is led by Elizabeth Cox, MD, PhD, a pediatrician and health services researcher and 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 can get involved, contact Jen Koberstein or the UW-UNC project team at prokids@pediatrics.wisc.edu or 608-263-1202.
