A Federal Government Web site managed by the Agency for Healthcare Research and Quality
Priorities in Action features some of our nation's most promising and transformative quality improvement programs, and describes their alignment to the NQS' six priorities. Updated monthly, these programs represent private sector, Federal, State, and local efforts.
We want to hear from you! If your program aligns with the priorities, email NQStrategy@ahrq.hhs.gov with details.
Inclusion in the Priorities in Action program listing does not constitute endorsement by the U.S. Department of Health and Human Services.
To expand/collapse the full description of any program below, please select the link labeled (more...).
Homeless individuals and families face unique challenges in accessing a health care system built to serve a housed population.1 As a group, chronically homeless individuals suffer disproportionately high rates of mental illness, substance abuse disorders, and chronic conditions that are exacerbated and in some cases caused by living on the streets. People who are homeless are three to four times more likely to die prematurely than their housed counterparts. Nationally, homeless individuals experience average life expectancy as low as 41 years.2
In many States, Medicaid expansion programs will extend insurance coverage to millions of Americans, many of whom who have long-unmet needs for primary and specialty care. Finding providers who understand the distinct physical, psychological, and social needs of the homeless will be a challenge for many States as they seek to improve the health of this population while controlling spending. High-quality care for people who are homeless offers promise to improve disparities, offset costs elsewhere (e.g., fewer emergency room visits, hospitalizations), and contribute to the reduction of homelessness, the underlying cause and consequence of many of the illnesses affecting this population.
For 30 years, the Colorado Coalition for the Homeless has been working to integrate health care and housing services for the homeless based on the principle that safe housing is required to effectively manage the related mental illnesses, substance abuse disorders, and multiple chronic medical conditions. The Coalition takes a multidisciplinary approach to delivering care that combines patient-centered physical care delivery—medical, dental, vision, and pharmacy—with behavioral health care—mental health care and substance treatment services—and supportive housing.
In 2013, the Coalition provided health care services to more than 13,000 homeless individuals and families. Many of the patients the Coalition treats are afflicted with multiple chronic conditions common to those without housing, such as hypertension, diabetes, and asthma. The nonprofit oversaw the development of 1,600 housing units for homeless individuals and families largely in the Denver metropolitan area. Of those units, a significant portion are developed specifically for men and women in frail health whose recovery is hindered by lack of consistent access to nutritious food, clean water, and a safe place to rest.
The Coalition's integrated delivery model responds to specialized needs unique to homeless individuals and families. The Coalition's integrated supportive housing developments are transformational for the residents served. Participants in the Coalition's programs gain the resources necessary to achieve and maintain long-term recovery, stable housing, employment, and overall self-sufficiency.
Recently, the Coalition opened the Stout Street Health Center and Renaissance Stout Street Lofts in Denver's Curtis Park neighborhood. This is the 18th affordable housing development constructed and operated by the Coalition. The Coalition designed the Health Center from the ground up to be targeted to the needs of people who are or have been homeless. Within the 53,000-square-foot Federally Qualified Health Center, the Coalition operates a unique model of care that fully integrates patient-centered care with an emphasis on providing housing and other social services to address the full spectrum of the determinants of health. These facilities provide essential medical care services for up to 18,000 homeless Coloradans each year and provide supportive housing for 78 formerly homeless households. Residency in the Lofts is targeted toward highly vulnerable families who have ongoing health and mental health needs that can be best addressed through onsite social services.
The Health Center introduces a unique model of integrated health care targeted to the needs of homeless patients. It fully integrates patient-centered, trauma-informed medical and mental health care3, substance treatment services, dental and vision care, social services, and supportive housing to more fully address the spectrum of problems homeless adults and children bring to their medical providers.
The Health Center is made possible by the expansion of Medicaid eligibility in Colorado under the Affordable Care Act. Prior to the Affordable Care Act, only 15 percent of homeless individuals served by the Coalition were eligible for Medicaid. Today, nearly 70 percent of the Coalition's patients have been enrolled in Medicaid. The increased payments through Medicaid helped fund the new facility as well as expanded the number of health care providers to serve the unmet need in the community.
Results from the Coalition's new Health Center will be available at the end of 2015. However, the effectiveness of similar work undertaken by the Coalition shows promise that the new Health Center will see improvements in health outcomes for the people it serves and reductions in the cost of caring for them. The Coalition's efforts, which employed a "Housing First" approach, demonstrated marked improvements in health and substantial cost savings in comparing the health and utilization of participants 2 years prior to entering the program and 2 years after. Participants in the program demonstrated a significant housing stability: during the period studied, 77 percent of participants continued to be housed. The Coalition also found that 50 percent of studied participants showed improvements in their health status: 43 percent showed improvements in their mental health status and 15 percent decreased their substance abuse4
Coupled with these improvements in outcomes was a significant decline in the cost of care for the studied participants. Utilization of health services was found to have uniformly declined, with an average cost savings of $31,545 per participant over 2 years when comparing the 2 years prior to entering the program with the 2 years after.5 Even when considering the cost of each patient's housing and support services, which average $13,400 per person per year, the average cost savings was still $4,745 per person over the 2 years.6 In addition to those direct savings, the project is currently estimated to reduce State and local costs for emergency care, detoxification services, and fire and safety services by up to 29 percent annually based on randomized control trials in other settings.7 The results demonstrated by the Colorado Coalition for the Homeless hold promise that access to high-quality health and health care services can demonstrably improve outcomes for persons who are homeless while reducing treatment costs.
These efforts promote person- and family-centered care, effective communication and care coordination, and make quality care more affordable through the lever of Innovation and Diffusion.
The Colorado Coalition for the Homeless is a 501(c)(3) nonprofit organization that provides housing and integrated health care to individuals and families who are homeless in Colorado. The Coalition operates a Federally Qualified Health Center designated as a Healthcare for the Homeless Program. The Coalition operates more than 40 programs at 18 locations that offer a range of services beyond traditional health care services. To learn about the entire scope of the Coalition's work, please visit www.coloradocoalition.org.
1. Gelberg L, Linn LS. Assessing the physical health of homeless adults. JAMA. 1989; 262:1973–1979.
2. O'Connell, James. (2005, December). Premature Mortality in Homeless Populations: A Review of the Literature. Available at http://santabarbarastreetmedicine.org/wordpress/wp-content/uploads/2011/04/PrematureMortalityFinal.pdf.
3.According to the Substance Abuse and Mental Health Services Administration's (SAMHSA's) concept of a trauma-informed approach, “A program, organization, or system that is trauma-informed: realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; responds by fully integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively resist re-traumatization.” More information is available at: http://www.samhsa.gov/nctic/trauma-interventions.
4. Commonwealth Fund. “Colorado Coalition for the Homeless: A Model of Supportive Housing.” Quality Matters. Available at: http://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/october-november/case-study.
5. Perlman, J. and Parvensky, J. (2006). Cost Benefit Analysis and Program Outcomes Report, Denver Housing First Collaborative. Available at http://www.coloradocoalition.org/!userfiles/Housing/Executive_Summary_DHFC_study.pdf.
6. Commonwealth Fund. "Colorado Coalition for the Homeless: A Model of Supportive Housing." Quality Matters. Available at: http://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/october-november/case-study.
7. Sadowski, L.S. (2009). Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults. JAMA. Available at http://jama.ama-assn.org/content/301/17/1771.full.pdf.
Building a Healthier Chicago (BHC) launched in 2008, when a group of 20 individuals involved in health and health care in Chicago convened a consortium to address the health of Chicagoans. In just over a year, the group grew to several hundred "stakeholders" focused on this effort. Today, BHC's vision is to make Chicago the healthiest place to live in America. To increase its impact, BHC became a 501(c)(3) nonprofit organization in 2014. It continues its rich heritage as a stakeholder organization and works to create a culture of healthy living in major social settings throughout the city including worksites, faith communities, schools, and restaurants.
The organization's efforts all work toward the BHC's goals of improving Chicago's health by understanding social settings, building trust, fostering innovation, and collaborating with well-positioned partners to promote healthy lifestyle behaviors with an emphasis on nutrition and physical activity. BHC has four priority initiatives:
Together, BHC's efforts are laying the foundation for a healthier Chicago by improving the accessibility of healthy food and, perhaps more importantly, a more knowledgeable and empowered population armed with the tools necessary to make meaningful long-term lifestyle and policy changes.
Building a Healthier Chicago's initiatives promote the wide use of best practices to enable healthy living in major social settings through the levers of Learning and Technical Assistance; Certification, Accreditation and Regulation; Incentives and Benefit Design; and Innovation and Diffusion.
The Connecticut Association of School Based Health Centers is an advocacy and networking organization committed to increasing access to quality health care for all children and adolescents in Connecticut schools. Connecticut's school based health centers (SBHCs) have delivered comprehensive health care in schools—where students spend 25 percent of their day—for 27 years.
The Connecticut Department of Public Health funds 88 SBHCs, and that number continues to grow each year. SBHCs provide physical, mental, and oral health services to more than 44,000 students in 22 Connecticut communities each year and have become a key part of Connecticut's comprehensive coordinated care system for children and adolescents.
Connecticut SBHCs work cooperatively with schools to implement quality standards through person- and family-centered care. Students who use their SBHC have access to a routine source of care, a personal nurse practitioner and behavioral health clinician, referrals for specialty care, and coordinated health care. In a 2012 Connecticut Student Satisfaction Survey report, more than two-thirds of students confirmed that they learned new health habits through their visits to the SBHC.1 An even higher percentage of students reported that visits to the SBHC taught them how to better manage their personal health issues.
Connecticut SBHCs also deliver important preventive health monitoring services that provide students with a solid foundation for a healthy future. Locations throughout the State offer dietary and exercise counseling services to help identify and monitor the obesity rate in young children and adolescents. By monitoring the obesity rate, SBHCs work to reduce the incidence of adult health conditions that may require costly treatment. A recent study estimated that a 1-percentage point reduction in obesity among 12-year-olds would save $260.4 million in lifetime medical expenditures.2
SBHCs also provide a cost-effective means of delivering care. Studies have shown SBHCs reduce Medicaid costs associated with emergency room use and hospitalization. In the case of children and adolescents insured by Medicaid, each visit to an SBHC saves an estimated $35.00 in Medicaid costs per child per year.3
The Connecticut Association of School-Based Health Centers' efforts promote the delivery of person- and family-centered care in schools with the most effective prevention and treatment practices for obesity. The SBHCs work with communities to promote wide use of best practices to enable healthy living and make quality care affordable. This is accomplished through the levers of Learning and Technical Assistance, Measurement and Feedback, and Innovation and Diffusion.
The Connecticut Association of School Based Health Centers is a 501(c)(3) private nonprofit organization. Membership consists of SBHC sponsoring organizations, affiliate organizations, and individual members. Learn more at http://www.ctschoolhealth.org/.
1 Connecticut Association of School Based Health Centers (CASBHC), Student Satisfaction Survey. http://www.ctschoolhealth.org/images/2012_FINAL.pdf.
2 Trasande L. "How Much Should We Invest In Preventing Childhood Obesity?" Health Affairs, March 2010, 29:3372-378; doi:10.1377/hlthaff.2009.0691.
3 Guo J., et al. "School-Based Health Centers: Cost–Benefit Analysis and Impact on Health Care Disparities." American Journal of Public Health (2010), 100, 1617–1623.
In Minnesota and nationally, the two largest causes of chronic disease and premature death are (1) obesity caused by poor nutrition and insufficient physical activity and (2) commercial tobacco use. The Statewide Health Improvement Program addresses this issue by preventing disease before it starts by helping create healthier communities that support individuals seeking to make healthy choices in their daily lives.
The Minnesota Statewide Health Improvement Program addresses the leading causes of premature death and disability through improved nutrition, increased physical activity, and decreased exposure to commercial tobacco products. Working with local governments, communities, schools, businesses, and medical providers across Minnesota, the program builds sustainable, community-level changes and supports local public health and tribal health agencies through grants, gathering together science-based best practices in a menu of strategies, and offering technical assistance and evaluation.
The program's most recent year's results demonstrate how each community intervention improved the health and health care of Minnesotans: roughly 14,000 workers benefited from worksite wellness programs; more than 60 communities increased biking and walking in their communities by making safer crosswalks, sidewalks, and bike paths; and 98 property management companies adopted smoke-free policies across the State. The program worked with farmers across the State to add 11 additional farmers markets to the existing 77 throughout the State. There were 429 schools that incorporated changes into their food policies by supporting school gardens, and 160 schools adopted the "Safe Routes to School" program to make walking and biking to school easier and safer for more than 68,000 students. In addition, 232 schools implemented "Active Classroom" programs to incorporate more physical activity into the school day, affecting 118,000 students.1
Efforts such as these promote health and well-being of communities through the levers of Learning and Technical Assistance and Innovation and Diffusion.
The Minnesota Statewide Health Improvement Program is run by the Minnesota Department of Health. Learn more at http://www.health.state.mn.us/ship/.
1Original Source: SHIP Progress Brief Year 3: Legislative Report July 2011-June 2013 http://www.health.state.mn.us/divs/oshii/ship/docs/SHIP3report.pdf.
Note: The numbers in this report differ as the updated numbers were provided directly from the Communications Coordinator, William Burleson, in the Office of Statewide Health Improvement Initiatives at the Minnesota Department of Health.
The California Quality Collaborative (CQC) is a health care improvement organization comprising approximately 300 purchasers, providers, health plans, and patient advocacy organizations dedicated to improving health care delivery for 7 million Californians. CQC offers a host of health care improvement programs, ranging from quality improvement training for physicians and hospitals to topical collaboratives centered on disseminating best practices in chronic care and readmissions.
CQC is improving transitions of care through two separate collaboratives. Through the Avoid Readmissions through Collaboration (ARC) program, hospitals implement processes known to reduce readmissions, such as providing patients with self-management skills post-charge and deploying a discharge advocate to coordinate discharge with the care team and the patient. Hospitals participating in ARC have realized an 8 percent reduction in 30-day all-cause readmission rate across 18 hospitals, preventing more than 6,300 readmissions and resulting in over $60 million in estimated savings. The Take Accountability through Ambulatory Care Transitions (TAACT) program enables medical groups, independent practice associations, hospitals, and health plans to develop team-based post-discharge care strategies to address the outpatient medical and social issues which lead to readmissions, including poor care coordination and noncompliant patient behavior. The TAACT Collaborative spreads best practices in managing the handoff from inpatient to ambulatory systems through virtual care teams and learning networks. Communication between providers is facilitated through information exchanges between the hospital, clinics, and care transition teams, who follow patients from the hospital to the home.
In addition, a Centers for Medicare & Medicaid Services Innovation Award led to the launch of the Intensive Outpatient Care Program, which engages 27,000 high-risk Medicare patients throughout California and Arizona in a new care delivery model focused on intensive care management in partnership with the patients' delivery systems, health plans, and purchasers. This program embeds care managers in primary care settings to develop close relationships with patients and helps tailor care to each patient's needs while reducing costs by reducing emergency room visits, avoidable hospitalizations, and complications through intensive care management. By 2015, the Collaborative anticipates improving patient experience by 2 to 4 percent; improving patient clinical outcomes, blood pressure, cholesterol, and blood sugar control by 2 percent; and reducing cost by 5 percent through lower hospital utilization rates and fewer emergency department visits.
Efforts such as these promote effective communication and care coordination and make quality care more affordable through the levers of Learning and Technical Assistance and Innovation and Diffusion.
CQC is a subsidiary of the Pacific Business Group on Health. The CQC Steering Committee comprises leaders from physician groups, health plans, purchasers, and public health entities and their partners. Learn more at http://www.calquality.org/index.php.
Established in 2000, the Oregon Healthcare Quality Corporation is an independent nonprofit organization dedicated to improving the quality and affordability of health care in Oregon by leading community collaborations and producing unbiased public reporting information. The Oregon Health Care Quality Corporation works with the members of the community—including consumers, providers, employers, policymakers, and health insurers—to improve the health of all Oregonians and finds solutions to Oregon's health care challenges, such as reducing unnecessary emergency department visits.
In 2007, the Oregon Health Care Quality Corporation became one of the 16 Robert Wood Johnson Aligning Forces for Quality Programs tasked with developing what is now Oregon's most comprehensive claims database system. The Oregon Health Care Quality Corporation collects primary care provider performance data for a number of quality indicators and provides results with local and national benchmarks over a secure portal. The data collected, only visible to providers, allow for the identification of gaps in care and places where followup needs to occur. Providers can use these tools to identify patients who are not receiving the care they need, allowing them to more effectively manage the health of their populations. The Oregon Health Care Quality Corporation's database currently includes more than 2.6 million, or 75 percent, of publicly and privately insured Oregonians. This allows the collaborative to have a statewide impact on the communication and coordination of care across Oregon.
As a result of its work, combined with the efforts of community members and stakeholders across the State, the Oregon Health Care Quality Corporation reported a decrease in potentially avoidable emergency department visits from the prior year. Avoidable emergency department visits, as a percentage of total emergency department visits, have dropped from 16.8 percent to 13.9 percent among children. In the same time period, the percentage of avoidable emergency department visits among adults also decreased from 11.0 percent to 10.1 percent.1
Efforts such as these promote effective communication and coordination of care using the levers of Public Reporting, Measurement and Feedback, and Health Information Technology.
The Oregon Health Care Quality Corporation Board of Directors includes 25 members representing health plans, physicians, hospitals, policymakers, consumers, and employers. Learn more at http://www.q-corp.org.
1Oregon Health Care Quality Corporation. Information for a Healthy Oregon: Statewide Report. August 2013. Accessed May 2014. http://www.q-corp.org/resources/browse/type/14/order/ASC.
In 2007, northeast Ohio health care systems, health plans, employer groups, and community organizations established Better Health Greater Cleveland to improve health and health care while reducing costs. The collaborative develops and disseminates evidence-based care transformation strategies focused on primary care for chronic conditions, including diabetes, high blood pressure, and heart failure. Across the region, the collaborative's programs have helped more than 700 primary care providers from 12 health care systems adopt patient-centered models of care, use electronic health records more effectively, and regularly measure care to identify opportunities to continuously improve.
Better Health offers numerous programs, including onsite coaching for quality improvement and building team-based care, to advance primary care practices' adoption of the patient-centered medical home (PCMH) model. The PCMH model emphasizes care coordination, stronger doctor-patient engagement, improved access to primary care services, and proactive management of chronic conditions. Since 2009, more than 52 practices achieved National Committee on Quality Assurance PCMH recognition with the collaborative's help to drive higher quality, patient-centered care at lower costs.
Primary care practices' transition to the PCMH model is enabled by effective measurement and actionable feedback on the care they provide. Providers who participate in Better Health agree to provide clinical quality measures every 6 months. All participating practices have adopted or are in the process of adopting electronic health record systems from which clinical data are provided to Better Health's Data Center. The collaborative uses these timely data to provide system- and community-level benchmarks on accepted measures of quality that practices can act on and to deliver timely reports to the community on provider-level quality and regional trends. Further, Better Health mines the data to identify positive outliers, verifies that the results followed deliberate actions to improve, and invites the high-achieving practice to share its processes so others can replicate the success. Learning networks and events such as the biannual Learning Collaborative Summits convene providers from across northeast Ohio and provide an opportunity to spread best practices, showcase successes, and overcome common challenges.
Better Health's efforts to improve primary care for patients with common chronic conditions are reducing hospitalizations in northeast Ohio. Trends in hospitalization rates for these conditions were stable from 2003 to 2008 for Ohio's six most populous counties, including Cuyahoga, home to Cleveland, where Better Health primarily is engaged. But from 2009 through 2011, when the collaborative's activities were well under way, Cuyahoga County experienced lower hospitalization rates than the other counties in the State, avoiding an estimated 1,928 admissions and $13.5 million in associated costs. Across the region, Better Health's efforts have achieved a 60 percent reduction in emergency room visits, resulting in 25 percent lower costs than estimated by the Centers for Medicare & Medicaid Services and $50 million in savings.
Care transformation efforts such as these promote the most effective prevention and treatment practices and make quality care more affordable through the levers of Public Reporting, Learning and Technical Assistance, Measurement and Feedback, and Health Information Technology.
Better Health Greater Cleveland is a 501(c)(3) nonprofit organization, one of 14 alliances in the Robert Wood Johnson Foundation's signature Aligning Forces for Quality grant, and a member of the Network for Regional Healthcare Improvement. Learn more at www.betterhealthcleveland.org.
The Reginald S. Lourie Center for Infants and Young Children is a nationally recognized pioneer, incubator, and disseminator of evidence-based treatments and best practices in the field of early childhood development, prevention of emotional or behavioral disorders, and intervention. The Lourie Center seeks to improve the social and emotional health of young children and families through prevention, early intervention, education, research and training. The Lourie Center serves 4,000 children and families in the Washington, DC, metropolitan area. Approximately 80 percent of the families it serves are enrolled in Medicaid. The Center's programs are designed to strengthen families, help young children and parents/caregivers develop increasingly secure relationships, and support the social and emotional competencies needed for success in life.
The Lourie Center operates four core programs: an onsite Therapeutic Nursery serving preschool children ages 3–5 with emotional and behavioral difficulties; the Lourie Center School, a Special Education Elementary School serving children from kindergarten through fifth grade; the Parent-Child Clinical Services Program, a licensed outpatient mental health clinic that offers an attachment-centered approach to the early identification, treatment, and prevention of emotional and behavioral problems in young children and their families; and the Early Head Start Program, a federally funded initiative involving weekly home visits and parent-toddler activity groups, which fosters child development and promotes healthy parent-child relationships. The Center also partners with Montgomery County's Infants and Toddlers Program and Child Welfare Services to deliver high-quality services to those in need.
The Center spreads evidence-based practices through education, research, and training. Recent research in the Parent-Child Clinic has shown that within 6 to 9 months of a family's enrollment in the program, treatment significantly increased parental emotional availability and insightfulness into the child's emotional cues, improved child and parent relationships, and strengthened the foundation of lifelong healthy development.1 The Center provides technical training to government agencies, school systems, and national and international nonprofit organizations across the country and around the world. For example, after the 2010 earthquake in Haiti, the Lourie Center helped design and implement a community-based early intervention program for children and their teachers/caregivers suffering from the trauma of the earthquake. Every year, the Lourie Center partners with local and national colleges and universities to provide yearlong training programs, summer internships, and postdoctoral training.
These efforts promote person- and family-centered care and promote wide use of best practices to enable healthy living through the levers of Learning and Technical Assistance, Workforce Development, and Innovation and Diffusion.
The Reginald S. Lourie Center for Infants and Young Children is a private, nonprofit agency. In July 2006, the Center affiliated with Adventist HealthCare, Inc. Learn more at http://www.adventisthealthcare.com/LC/.
1 Ziv, Y., and Venza, J. “Changes in parental insightfulness and dyadic emotional availability after an attachment-based intervention program.” Poster presented at the Society for Research on Child Development Conference, Seattle, WA, April 2013.
The Wisconsin Collaborative for Healthcare Quality (WCHQ) is a voluntary, statewide consortium of physician groups, hospitals, health plans, and employers working together to improve health and the quality and affordability of health care in Wisconsin. WCHQ members publicly report an agreed-upon set of performance measures related to the services that they provide, enabling the collaborative to produce comparative reports on health care quality and patient experience. As a result, practices are able to identify areas for improvement within their own organization and build the capacity to do so through the forums convened and facilitated by the Collaborative to share successes and challenges with others.
Since 2004, at least 567 health care practice sites—including 65 percent of primary care providers in the State—participating in the Collaborative have reported on over 30 performance measures adopted by the WCHQ Board. The Collaborative then validates the underlying data used to generate the measures before posting the results to its Web site for use by health care providers, purchasers, consumers, and other stakeholders to compare member organization performance. Novel measures developed by WCHQ allow for tracking the practices' performance across all patients and all payers, a difficult task with traditional claims-based measures.
Using the reports provided by WCHQ, participating providers can identify opportunities for improvement, common challenges, or promising successes that can be shared across the Collaborative. WCHQ hosts regular learning events for health care providers, purchasers and payers to do just that. On more difficult issues requiring greater technical assistance, the WCHQ Online Community provides tools and resources for members to collaborate and serve as peer-to-peer coaches.
Wisconsin consumers benefit not just from being able to access information pertaining to the quality of their care, but also from the quality improvement resulting from the Collaborative's public reporting efforts. Evidence has shown that the voluntary public reporting undertaken by WCHQ members results in quality improvement across the reported measures over time. A Commonwealth Fund-supported study found that WCHQ member organizations saw significant improvement across diabetes and cardiovascular disease measures reported to WCHQ over a 5-year period, and outperformed non-member peers in Wisconsin, nearby States, and the rest of the United States.1
The public reporting and quality improvement initiatives undertaken by the Wisconsin Collaborative for Healthcare Quality contribute to the prevention and treatment of leading causes of mortality.
The Wisconsin Collaborative for Healthcare Quality is governed by a multi-stakeholder board of directors. The Collaborative receives its funding from member assessments as well as grants from the Agency for Healthcare Research and Quality (AHRQ) and national organizations, including the Commonwealth Fund, the Robert Wood Johnson Foundation (through its Aligning Forces for Quality program), and the Wisconsin Partnership Program. Learn more at http://www.wchq.org/.
1 G. C. Lamb, M. A. Smith, W. B. Weeks, et al., "Publicly Reported Quality-of-Care Measures Influenced Wisconsin Physician Groups to Improve Performance," Health Affairs, March 2013 32(3):536–43. http://content.healthaffairs.org/content/32/3/536.abstract
Studies by the Agency for Healthcare Research and Quality have shown that the sickest 5 percent of U.S. patients account for over half of the country's health care costs. These "high utilizers" often suffer from multiple chronic conditions and take many medications. The Camden Coalition of Healthcare Providers (CCHP) provides a model for effective, efficient care for the highest utilizers in the community it serves, improving the health of the community while reducing the cost of care. The CCHP has accomplished this by identifying high utilizers through analyzing local claims data and providing them with well-coordinated care through a personalized care management system. By combining typical health care services such as primary care and chronic care management with social support and behavioral health interventions, the CCHP addresses the full spectrum of factors that influence health.
Each day, the CCHP receives a feed from the local health information exchange with a list of the patients from all three of Camden's health systems who have been admitted three or more times in the past 6 months. The CCHP's staff triages the list, focusing on patients taking multiple medications and with language or social barriers. Nurses then visit the patients in the hospital to start the conversation about the health issues these patients have been facing. They then invite the patient to enroll in the home visiting program. If the patient accepts, the home-visiting intervention is deployed.
The first visit at the home occurs within 3 days of the person's discharge from the hospital. The goal is to help the person receive a primary care appointment within a week. The CCHP health team accompanies the individual to the primary care appointment to help build or rebuild his or her relationship with the primary care provider. After that, the CCHP health team follows up with weekly home visits with a personalized set of staff members based on the patient's needs,including family physicians, nurse practitioners, medical assistants, or social workers. The ultimate goal is to graduate socially and medically stable individuals who are connected to their primary care provider within 3 months.
This intervention has been successful in reducing the health care costs by half and hospitalizations by 40 percent for the individuals it serves. The Robert Wood Johnson Foundation expanded the model into six different Aligning Forces for Quality communities in 2012 to evaluate whether the results in Camden could be replicated across the nation.
These efforts promote effective communication and care coordination, promote wide use of best practices to enable healthy living, and make quality care more affordable.
The Board of Directors that governs CCHP includes three hospital systems, two Federally Qualified Health Centers, independent provider offices, social service and behavioral health organizations, and resident advocacy organizations. More information is available at http://www.camdenhealth.org/ .
The Colorado Beacon Consortium brings together physician leaders, hospitals, a community-based health information exchange, and a local payer to develop and implement new ways to improve the quality and patient experience of health care while controlling costs. The region-wide alliance strengthens the existing health information technology infrastructure and advances patient-centered primary care, to provide better care for the 320,000 patients the Consortium serves.
The Colorado Beacon Consortium engages more than half of the region's primary care practices through Learning Collaboratives and onsite consultations, leading the medical practices forward in their ability to report quality measures and take action on the results. The Consortium accomplishes this through team-based improvement in two complementary but distinct tracks. The first initiative is intended to transform primary care practices by enabling them to achieve meaningful use of electronic health records (EHRs) under the Medicare and Medicaid EHR Incentive Programs, which in Stage 1 requires meeting a set of objectives to capture and exchange clinical data. Onsite consultants help the practices redesign their clinical workflow to integrate health information technology for quality measure reporting, and the Learning Collaboratives allow practices to share common challenges and successes.
The second initiative is intended to expand health information exchange throughout the region. Through a regional health information exchange, the Quality Health Network, the Colorado Beacon Consortium bolstered existing health information exchange architecture to enable it to support advanced population health management functions and improved clinical decision support systems. Over the past year it has increased the number of providers connected to the exchange by 25 percent, bringing the total to 765 providers. By the end of 2012, more than 80 percent of practices in the Consortium were using an EHR system and more than 100 providers qualified for meaningful use through the support of the Consortium's Regional Extension Center. The Consortium also evaluates models of integrated primary care and behavioral health care that reduce costs through payment reform schemes such as global payments.
Nine practices in the Consortium also participate in the Centers for Medicare & Medicaid Services' Comprehensive Primary Care Initiative (CPCI), and will continue participating in that program even though the Beacon Communities grants have concluded. There are two additional tracks for other practices in the Consortium: a Masters program for Beacon graduates who are not participating in CPCI, and a Foundations program to bring in practices that did not participate in the Beacon Community.
These efforts promote the following NQS priorities: person- and family-centered care, effective communication and care coordination, and making quality care more affordable. Evaluation for this program includes tracking against several Beacon milestones, and assessing progress against health information technology, quality improvement, and practice transformation benchmarks. The 2012 Annual Report details the Consortium's results, accomplishments, and lessons learned.
The Colorado Beacon Consortium was one of 17 Beacon Communities selected by the Office of the National Coordinator for Health Information Technology to demonstrate the value of health information technology investments while achieving the National Quality Strategy's three-part aim. More information is available at http://www.healthit.gov/policy-researchers-implementers/colorado-beacon-community .
Launched in 2000, the Healthy Hawaii Initiative is a statewide effort to prevent and control chronic disease, extend and increase the quality of Hawaiians' years of life, and address health disparity. The program targets behavior change at the individual level, and addresses the social determinants of health that are influenced by organizations and the community. The initiative is made up of five interrelated components that promote healthy and active living among Hawaii's 1.4 million residents, targeting schools, community organizations, and organizations involved in public and professional education. The program also works to improve detection, treatment, and management of heart disease, stroke, cancer, diabetes, and asthma.
The Healthy Hawaii Initiative supports healthy lifestyles by implementing policies and programs to create sustainable changes in Hawaii's communities, schools, and workplaces. The prevention areas focus on reducing three core behaviors: smoking, inactivity, and poor diet. Numerous education campaigns such as "Step It Up Hawaii" and "You Gotta Start Somewhere" inform Hawaiians about lifestyle interventions they can take to improve their own health. State and county physical activity and nutrition coalitions, spearheaded by the initiative, are demonstrating best practices in community health promotion by hosting workshops, forums, and summits on obesity prevention and tobacco use cessation. The initiative also sponsors farmers markets throughout the State, and is conducting a campaign to discourage the use of sugary drinks and promote healthy eating. As a result of the initiative's efforts, wellness guidelines, physical activity guidelines, and health awareness tools have been added to nutritional guidelines for meals at public schools in Hawaii. A collaboration with local partners has increased the number of bike trails in Honolulu and has kicked off a bike-sharing program.
Healthy Hawaii produces "Health of Your District Reports" to help residents and policymakers see how their communities' health compares with that of their neighbors. The initiative also formed the Hawaii Health Data Warehouse to standardize and collect health data across the State. The Hawaii Health Data Warehouse produces a series of reports on the prevalence of chronic diseases and the adoption of healthy lifestyle behaviors, and also features detailed reports for 80 different Healthy People 2020 objectives across 30 topic areas.
Efforts such as these promote wide use of best practices to enable healthy living. The initiative is evaluated annually by partners at the University of Hawaii using prevention and healthy living process measures. The Healthy Hawaii Initiative also conducts an annual telephone survey to poll residents on the types of healthy living messaging they were exposed to over the past year.
The initiative is directed by the Hawaii State Department of Health. More information about it can be found at http://www.healthyhawaii.com/ .
In 2003, the Michigan Health and Hospital Association (MHA) Keystone Center, with funding from the Agency for Healthcare Research and Quality (AHRQ), organized a large-scale collaboration effort among Michigan's health and health care stakeholders, including hospitals, State government, payers, and employers. With these partners, the MHA Keystone Center forged evidence-based solutions that improve the quality of care offered to Michigan's residents. Many of the patient safety interventions developed by the MHA Keystone Center are now being used throughout the nation and around the world.
This group of stakeholders developed clinical interventions that Michigan hospitals implement to improve quality and patient safety in a variety of care settings and treatment scenarios. These include care transitions, emergency rooms, organ donations, hospital-associated infections, intensive care units, obstetrics, safe care, and surgery. One such example is the Comprehensive Unit-Based Safety Program (CUSP), which provides each hospital with a framework for intervention and integrates communication, teamwork, and leadership improvements to help create a culture free of patient harm. The MHA Keystone Center supports hospitals' transition into the CUSP by offering more than 3,000 annual learning opportunities including workshops, webinars, conference calls, and individual meetings.
The first broad-scale application of CUSP was in Michigan, under the leadership of the Michigan Health and Hospital Association, where it was used to significantly reduce central line-associated bloodstream infections (CLABSIs) in that State. Following that success, CUSP was expanded to 10 States and then nationally through an AHRQ contract with the Health Research and Educational Trust, the research arm of the American Hospital Association. This project is the largest national effort to combat CLABSIs to date, and involved hospital teams at more than 1,100 adult intensive care units in 44 States over a 4-year period. Hospitals participating in this initiative used CUSP to prevent more than 2,000 CLABSIs, a 40-percent reduction in the rate of CLABSIs. This reduction saved more than 500 lives and avoided more than $34 million in health care costs, according to results released in 2012.
Efforts such as these make care safer by reducing the harm caused in the delivery of care. The MHA Keystone Center's interventions improve the safety of patients, as demonstrated with their success in reducing central line-associated bloodstream infections by nearly 58 percent and ventilator-associated pneumonia by 62 percent since 2004.
The MHA Keystone Center is supported by Blue Cross Blue Shield of Michigan, the Centers for Medicare and Medicaid Services Partnership for Patients Hospital Engagement Network, the Michigan Department of Public Health, and Michigan hospitals. Find more about the MHA Keystone Center at http://www.mhakeystonecenter.org/ .
The New York State Health Foundation's Diabetes Campaign, "Reversing the Trend," seeks to address one of the State's most pervasive epidemics—diabetes. Nearly 10 percent of New Yorkers—or 1.4 million—are afflicted with this disease, and almost 4 million more suffer from prediabetes, causing harm to a significant portion of the State's population. Additionally, diabetes costs the State almost $13 billion a year in health care costs and productivity losses. The New York State Health Foundation, or NYSHealth, developed a three-pronged strategy to attack diabetes: (1) improve the way New York physicians treat chronic disease, (2) develop community-based prevention and management initiatives, and (3) progressively transform the chronic care system to a pay-for-performance mode.
NYSHealth has made significant strides in improving chronic care management in New York. To promote effective diabetes care, the campaign has helped more than 2,000 physicians achieve National Committee for Quality Assurance (NCQA) and Bridges to Excellence (BTE) Diabetes Recognition Certification. To mobilize communities to improve diabetes prevention, screening, and management, NYSHealth has established more than 200 diabetes prevention and self-management programs across the State. These programs change how health centers currently provide chronic care through the adoption of the Chronic Care Model and a more patient-centered approach. Also critical to these efforts is the establishment of adequate preventive measures to mitigate future adverse effects.
NYSHealth recently launched the next phase of its diabetes campaign, called "Meeting the Mark." This program builds upon existing efforts, and encourages additional primary care practices and health systems to apply for funding to help physicians receive NCQA and BTE Diabetes Prevention Recognition. This will help the program reach its goal of 3,000 newly NCQA- or BTE-certified physicians and health care practitioners in New York State.
NYSHealth has succeeded largely because it secured support from a wide range of stakeholders—payers, providers, and elected officials—to build a collaborative and comprehensive solution to diabetes prevention. Additionally, NYSHealth partners with Health Care Association of New York, Community Health Center Association of New York State, American College of Physicians—New York State Chapter, the Institute for Leadership, the Alliance of New York State YMCA, Inc., and the Institute for Health. These partners are instrumental in helping to improve diabetes prevention and reducing the human and financial toll of diabetes.
This campaign is aligned to two National Quality Strategy priorities: it promotes the most effective prevention and treatment practices for diabetes, and works with communities to promote wide use of best practices to enable healthy living.
This program is directed by the New York State Health Foundation, and more information can be found at: http://nyshealthfoundation.org/priority-areas/improving-diabetes-prevention/ .
The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), organized by the Health Resources and Services Administration, or HRSA, improves health care quality by providing patients suffering from complex conditions with evidence-based clinical pharmacy services. Now in its fifth year, PSPC works with teams of community health care providers to advance their medication and care management systems and improve patient safety.
Patients with complex conditions often receive care and medication from multiple providers. A lack of coordination among these providers could lead to adverse drug events or a duplication of therapy and interactions. Therefore, it is critical that these doctors, specialists, and nurses work collaboratively to provide effective health care.
The PSPC enables this collaboration by helping to spread practices that improve patient safety and health outcomes. PSPC equips teams with a “change package,” a set of field-tested best practices developed by expert national faculty and adapted from high-performing organizations. Provider teams also participate in integrated learning sessions that teach the Institute for Healthcare Improvement (IHI) Model for Improvement, allowing teams to measure, share, and track their progress.
Additionally, PSPC helps participating providers integrate their clinical pharmacy services into a Primary Health Care Home model. Each team of providers has a designated lead Primary Health Care Home, which reduces the complexity of managing patient information and health care services by integrating them into a central location. It enables providers and pharmacists to effectively coordinate care for a defined population of patients.
As of May 2013, 344 teams of community health providers participated in PSPC, representing more than 885 organizations of community-based health care providers across 48 States, the District of Columbia, Puerto Rico, and the Virgin Islands. By 2015, PSPC aims to have 400 teams in 3,000 communities across the country participating in the program.
Efforts such as these make care safer by reducing harm caused in the delivery of care and promote effective communication and coordination of care. Evaluation of this program is completed by the teams themselves, who share their progress monthly on multiple improvement measures, which include health outcomes and reductions in adverse drug events.
The Patient Safety and Clinical Pharmacy Collaborative is sponsored by the Health Resources and Services Administration. You can learn more at http://www.hrsa.gov/publichealth/clinical/patientsafety/index.html.
The Patient-Centered Medical Home (PCMH) model holds promise as a means to improve health and health care in America by transforming how primary care is organized, delivered, and funded. Building on the work of a large and growing community, the Agency for Healthcare Research and Quality (AHRQ) envisions the PCMH as a model of primary care that delivers patient–centered, high–quality care safely and efficiently through improved communication and coordination.
In order to facilitate widespread PCMH transformation, AHRQ established the PCMH Resource Center to give researchers and health policy makers the information they need. The Web site defines the PCMH and provides a series of in-depth white papers, focused policy briefs, systematic evidence reviews, and guides to innovative evaluation methods. These resources cover topics ranging from care coordination to patient engagement to health information technology. In the past year, the site has expanded to include more practical tools to support implementation of complex practice change.
The "Developing and Running a Primary Care Practice Facilitation Program: A How-to Guide" (PDF: Plugin help) provides instructions and resources for state and regional organizations with an interest in primary care quality improvement. The Guide highlights the potential of practice facilitation as a strategy for supporting widespread, systematic practice improvement across communities. It addresses important considerations for practice facilitation programs, such as administration, workforce management, financing, and evaluation, and details the steps necessary to address these issues. Four additional in-depth case studies of successful practice facilitation programs complement the lessons of the How-to-Guide. AHRQ established the Primary Care Practice Facilitation Learning Community to allow organizations interested in practice facilitation share their experiences and learn from one another.
AHRQ also facilitates and convenes the Federal PCMH Collaborative, bringing together partners from across the Federal Executive Branch to share lessons learned in work related to PCMH transformation.
Efforts such as this drive the transition of new delivery models forward, and support multiple NQS priorities, including patient safety, delivery of person- and family-centered care, effective communication and care coordination, and making quality care affordable.
The program is directed by the Agency for Healthcare Research and Quality, and more information can be found at: http://pcmh.ahrq.gov/.
Initiated in late 2009, this grant-funded program seeks to help reverse the childhood obesity epidemic, especially in lower-income communities and in populations at greatest risk. It provides four years of grant funding and technical assistance to 49 multidisciplinary partnerships across the country to implement policies, systems, and environmental change strategies to create sustainable community change.
Partnerships focus on different venues, such as neighborhoods, parks, and public housing developments to engage a range of strategies. These include developing and implementing farmers' markets, healthier corner stores, community gardens, healthy vending policies, physical activity and nutrition standards, complete streets and joint-use policies, and safe routes to schools and parks.
These efforts promote healthy living and well-being and work to improve the social, economic, and environmental factors within each of the grantee communities, directly aligning with one of the six NQS priorities: community health. Evaluation for this program includes tracking work plan milestones, assessing policy and environmental changes, engaging in group model building in each community, and conducting cross-site analyses among communities that are working on similar issues. A final report will be released in 2014 that addresses results, accomplishments, and lessons learned.
The program is directed by the Healthy Kids, Healthy Communities National Program Office, which is part of Active Living By Design at the Gillings School of Global Public Health at the University of North Carolina in Chapel Hill, NC. More information is available at www.healthykidshealthycommunities.org/ .
In 2010, the Health Resources and Services Administration (HRSA) launched the Flex Medicare Beneficiary Quality Improvement Program to improve the quality of care for Medicare beneficiaries served by critical access hospitals (CAHs). CAHs are rural community hospitals that have 25 or fewer inpatient beds, are at least 35 miles from another facility or are designated as a necessary providers, and receive cost-based reimbursement from Medicare and, in some states, Medicaid. This program helps CAHs prioritize quality measurement and improvement despite their limited resources and staff. In the post-health reform environment, CAHs may soon be compared with their urban counterparts to ensure public confidence in their quality of health services. This initiative enables CAHs to demonstrate the quality of care they provide.
The Flex Medicare Beneficiary Quality Improvement Program supports quality improvement initiatives through increased reporting on quality measures that are relevant to rural health care. Through expanded public reporting, the program allows for clear benchmarking of hospitals' performance and the identification of best practices. The program assists CAHs in developing their quality improvement and patient engagement efforts. The program also supports health system development and community partnerships, helping hospitals make the most of their funding and identify stakeholders to collaborate with on quality improvement activities. Currently, more than 1,200 of the 1,331 CAHs located in 45 States are voluntarily participating in the Flex Medicare Beneficiary Quality Improvement Program, and the program continues to strive for 100 percent engagement.
These efforts promote person and family engagement in care and work to improve the experience of care related to quality, safety, and access. Evaluation for this program includes tracking CAH participation, quality improvement measures, patient satisfaction, and outcome measures for each CAH in the program. The Medicare Rural Hospital Flexibility Monitoring team, which is made up of the Universities of Minnesota, North Carolina-Chapel Hill, and Southern Maine, provides monitoring and evaluation support.
The Flex Medicare Beneficiary Quality Improvement Program is directed by the Health Resources and Services Administration. More information is available at the National Rural Health Resource Center, at http://www.ruralcenter.org/tasc/resources/medicare-beneficiary-quality-improvement-project-mbqip .