Repairing the Quality Chasm: Health Centers Lead The Way Health Disparities Collaboratives Bureau of Primary Health Care Health Resources & Services Administration Grantmakers in Health May 6, 2004

About HRSA Mission: To improve and expand access to quality health care for all Goal: Moving toward 100% access to health care and 0 health disparities for all Americans

BPHC Primary Care Programs >850 Health Centers >3500 sites Serve 11.3 million people All in HPSAs - Safety Net Owned by Community Governed by Community Board

Source: Uniform Data System (UDS) 2002

Source: Uniform Data System (UDS) 2002

Source: Uniform Data System (UDS) 2002

Quality: Where We are Going Division of Clinical Quality 1. Health Disparities Collaboratives 500 participating ~56% grantees 500 participating ~56% grantees 2. External Accreditation FY02 – 285 JCAHO accredited FY02 – 285 JCAHO accredited 3. Risk Management ~ 80% FTCA deemed Health Centers ~ 80% FTCA deemed Health Centers

Total N= 500

HDC1999 HDC2000 HDC2001 HDC2001-Asthma Health Disparities Collaborative Progress 5 teams participated in the IHI Chronic Conditions I Collaborative, immediately serving as the lead teams for the HDC1999 with 88 diabetes teams participating. Infrastructure included cluster directors and there was an identified need for IS Specialists. Patient lives impacted = 13, diabetes teams participating. Patient lives at end of Phase 1, inclusive of HDC1999 = 37,007 Total of 97 teams: 62 diabetes/34 CVD participating. Patient lives impacted at end of year, inclusive of previous 3 collaboratives = 77,401 IHI BTS Asthma and 17 Depression teams. Patient lives impacted at end of Phase 1, inclusive of HDC1999,2000 = 42, teams. Patient lives impacted, inclusive of other collabs = 96,148 HDC2002 Total of 135 teams: 16 asthma, 20 CVD, 37 depression, 62 diabetes. Patient lives impacted by end of year, inclusive of all collaboratives = 141,319 HDC2003 Total of 134 teams: 21 cancer, 26 CVD, 24 depression, 63 diabetes. Patient impact NOW in combination with other Collaboratives 179,400 Current as of

Three Models…. What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan Study Do

Key Attributes of a Quality Care System Safe Effective* Patient/ Family Centered Timely Efficient Equitable* Source: Institutes of Medicine (IOM) study Crossing the Quality Chasm: A New Health System for the 21 st Century * Care resulting in optimal health for all

BPHC HDC: What we are learning.. Shared vision/mission and common national measures inform practice – Data on more than 180,000 patient records in CIS – Timely access to information on progress Improved tools for data collection/analysis, web-based reporting Collaborative learning model generates results faster than individual consultation model Create the will to implement change: – HP2010 and DHHS efforts to eliminate racial and ethnic disparities – IOM report “Crossing the Quality Chasm”

Collaborative Success “With federally funded health centers having fully embraced the (Health Disparities Collaborative) model…this has become arguably the largest, most important health care quality improvement initiative in the country. It’s exactly what the health care system needs right now - a demonstration that it is possible both to improve care dramatically and even reduce health care costs.” Tracy Orleans, Ph.D., senior scientist at the Robert Wood Johnson Foundation Advances Online, Robert Wood Johnson Foundation Newsletter, October 2002

Slides prepared by Cindy Hupke from data submitted on April 20 th, Conference call with Depression teams addressing mechanisms to improve self management approaches

Cancer: 21 teams with 31,171 total patients CVD: 26 teams with 3,582 total patients Depression: 26 teams with 2,566 total patients Diabetes: 62 teams with 9,592 total patients Cancer: 1,948 CVD: 143 Depression: 107 Diabetes: 177 Slides prepared by Cindy Hupke from data submitted on April 20 th,

Clinical Outcomes: Cancer General US Population = 71% Low Income Population = 50% 31,171 total patients in Diabetes registries at this time Slides prepared by Cindy Hupke from data submitted on April 20 th, Team range: 8% - 88% 76% of Cancer teams reporting this measure in April

Clinical Outcomes: Diabetes Slides prepared by Cindy Hupke from data submitted on April 20 th, 9,592 patients in registries at this time, with average registry size continuing to grow Team range: 6.2 – % of Diabetes teams reporting this measure in April

Clinical Outcomes: Depression Slides prepared by Cindy Hupke from data submitted on April 20 th, 1,745 patients with CSD (Clinically Significant Depression) in registries at this time Depression team range: 3% - 61% 81% of Depression teams reporting this measure in April

Slides prepared by Cindy Hupke from data submitted on April 20 th, Clinical Outcomes: Cardiovascular CVD Team range: 21% - 63% 93% of teams reporting this measure in April 3,165 Patients with Hypertension in registries at this time Non-Collaborative national level = 34%

Based on data reported as of Cindy Hupke

Based on data reported as of Cindy Hupke

Based on data reported as of Cindy Hupke Not a National measure until March 2000

Based on data reported as of Cindy Hupke

Based on data reported as of Cindy Hupke

Building for Future: HDC Pilots Diabetes Prevention Pilot Prevention Pilot – healthy weight, tobacco use, blood pressure, cholesterol, immunizations, lead screening, oral health, includes all lifecycles Redesign/Finance (RedeFin) Pilot – LS#3 Apr 04 Perinatal/Risk Management – Expert Panel and planning 2004

Architects for the health system of the future… Moving from the best kept secret in health care to center stage as being at the cutting edge Cited by IOM as one of the breakthrough initiatives in health care Accrediting Agencies adopting our measures Large System Change lessons helping a worldwide health care community