Integration of Clinical Care and Public HealthSystems: The need as reflected in the work of theAlliance to Reduce Disparit...
The Alliance Partners at Work    in their Communities       www.alliancefordiabetes.org
The Alliance to Reduce Disparities in Diabetes aims to change theoutlook for those who experience       the worst outcomes...
The Alliance aims to reduce disparitiesin diabetes outcomes by supporting:                  Evidence-based, community-focu...
Four U.S. cities and a Native American reservation arethe focus of the Alliance’s community level efforts:                ...
Alliance Community Programs havethree components:   1    Innovative, evidence-based patient        education   2    Front-...
The Alliance is capitalizingon the unique strengths of its community partners.                               7
Chicago, IllinoisThe University of Chicago has ahistory of community involvement insocial and political activism in theSou...
Memphis, TennesseeHealthy Memphis Common Table is acollaborative partner with over 100churches in the faith-basedcommunity...
Wind River ReservationThe Wind River Reservation Allianceleaders have a history of cultural bondsthat are shared across th...
Dallas, TexasBaylor Healthcare System’s Office ofHealth Equity partners with ProjectAccess Dallas to involve more than2,00...
Camden, New JerseyCamden Coalition of HealthcareProviders has exceptional capacityto work across health careinstitutions a...
Patient EducationAlliance communities are employingevidence-based patient education programsto enable diabetes self-manage...
Patient Level Education Examples    Chicago, IL                Dallas, TX                          Diabetes self-BASICS cu...
Patient Level Education Examples   Memphis, TN           Wind River Reservation3 sessions of DSME       Expanded diabetes ...
Health Provider Education      Alliance interventions aim to enable      clinicians to be more effective in working      w...
Provider Level Change Examples   Camden, NJ                 Chicago, IL                       Physician CME series (4Provi...
Provider Level Change Examples    Dallas, TX          Wind River ReservationCME training program    Workshops for IHS staf...
SUSTAINABLE ORGANIZATION AND       SYSTEMS CHANGE        Each Alliance community is introducing        sustainable changes...
Systems Level Change Examples        Camden, NJ              Chicago, ILo   Implementation of      Clinic Redesign’    Hea...
Systems Level Change Examples     Dallas, TX          Wind River ReservationInstitutionalizing the   Formation and expansi...
Preliminary and Promising        Evidence      www.alliancefordiabetes.org
Dallas Observational Study*       Average Hgb A1c decreased*Walton, J., it al. (2012) Reducing Diabetes Disparities Throug...
South Side of Chicago Improved diabetes care and controlData Source: Assessment of Chronic Illness Care (ACID) Tool       ...
25
Wind RiverImprovements in Diabetes Care provided    by the local Indian Health Service                                    ...
Results: (Indian Health Service)Assessment of IHS Diabetes Care                                              2009   2011• ...
CamdenSuccess in “Hot-spotting” high-cost, high-riskpatients in order to better coordinate medicalcare and social services...
29
Lessons Learned from collaboration withclinical staff, community organizations,and health systems to improve diabetescare ...
Lessons•   Targeting more intense self-management intervention to higher risk    patients can maximize intervention effect...
Needed Policy Changes and       Next Steps       www.alliancefordiabetes.org
Systems and Policy ChangeEvolving from the Community Level Noreen M. Clark, PhD Myron E. Wegman Distinguished University P...
The On-the-Ground ExperienceDespite great efforts and successin making substantive progress intheir communities, the Allia...
Barriers Faced by the Alliance Grantees• The current health care system focuses payments  based on units of care, on speci...
Success in turning the tide on diabetes and onreducing disparities requires that real world,on-the-ground experiences of h...
Alliance Invited Summit Convened• The Alliance Invited Summit was  organized to link national policymaking  and on-the-gro...
Target Policy ConsiderationsSystems Level:Consideration 1 – Integrate public health and healthcare systemsConsideration 2 ...
Target Policy Considerations (cont.)Provider Level:Consideration 4 – Make optimum Accountable CareOrganization’s (ACO) abi...
Focus on Integration of Public Health and        Clinical Health Systems  • March 28, 2012 – The IOM released a report    ...
Outside and inside                      •                September 12, 2012      Robert M. Pestronk, MPH      Executive Di...
National Association of County and City Health Officials            • Numbers            • Vision            • Mission
Better integration: Outside                    Governmental                    Public Health                    Department...
Better integration: Inside1) Collaboration and partnership2) Evidence-, experience-, and reality-based   practice3) Techno...
NACCHO Diabetes Today Grantees, 2010 - 2012
For More Information                        Amy Henes                  Senior Program Analyst                     Diabetes...
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Integration of Clinical Care and Public Health Systems: The need as reflected in the work of the Alliance to Reduce Disparities in Diabetes

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Integration of Clinical Care and Public Health Systems: The need as reflected in the work of the Alliance to Reduce Disparities in Diabetes

September 12, 2012

Moderator and Presenter
Belinda W. Nelson, PhD
Center for Managing Chronic Disease, University of Michigan
National Program Office, The Alliance to Reduce Disparities in Diabetes

Panelists:
Noreen Clark, PhD, Center for Managing Chronic Disease, University of Michigan
Director , National Program Office for the Alliance to Reduce Disparities in Diabetes

Robert Pestronk, Executive Director, National Association of County and City Health Officials (NACCHO)

Published in: Health & Medicine, Business
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Transcript of "Integration of Clinical Care and Public Health Systems: The need as reflected in the work of the Alliance to Reduce Disparities in Diabetes"

  1. 1. Integration of Clinical Care and Public HealthSystems: The need as reflected in the work of theAlliance to Reduce Disparities in Diabetes Moderator and Presenter Belinda W. Nelson, PhD Center for Managing Chronic Disease, University of Michigan National Program Office, The Alliance to Reduce Disparities in Diabetes Panelists: Noreen Clark, PhD, Center for Managing Chronic Disease, University of Michigan Director , National Program Office for the Alliance to Reduce Disparities in Diabetes Robert Pestronk, Executive Director, National Association of County and City Health Officials (NACCHO) www.alliancefordiabetes.org
  2. 2. The Alliance Partners at Work in their Communities www.alliancefordiabetes.org
  3. 3. The Alliance to Reduce Disparities in Diabetes aims to change theoutlook for those who experience the worst outcomes. 3
  4. 4. The Alliance aims to reduce disparitiesin diabetes outcomes by supporting: Evidence-based, community-focused interventions Efforts to ensure that successful programs and services are sustained in policy and practice Collaboration with key stakeholders at the national level through local levels to achieve policy and system change that reduces inequities in care and outcomes 4
  5. 5. Four U.S. cities and a Native American reservation arethe focus of the Alliance’s community level efforts: Dallas, Texas The Baylor Healthcare System’s Office of Health Equity Chicago, Illinois The University of Chicago Memphis, Tennessee The Healthy Memphis Common Table Camden, New Jersey The Camden Coalition of Healthcare Providers Wind River Reservation, Wyoming The Eastern Shoshone Tribe in partnership with the Northern Arapaho Tribe 5
  6. 6. Alliance Community Programs havethree components: 1 Innovative, evidence-based patient education 2 Front-line, proven health provider training including cultural competence Sustainable quality improvements in 3 health care access, coordination, and relevance 6
  7. 7. The Alliance is capitalizingon the unique strengths of its community partners. 7
  8. 8. Chicago, IllinoisThe University of Chicago has ahistory of community involvement insocial and political activism in theSouthside of Chicago. 8
  9. 9. Memphis, TennesseeHealthy Memphis Common Table is acollaborative partner with over 100churches in the faith-basedcommunity through Memphis HealthyChurches. 9
  10. 10. Wind River ReservationThe Wind River Reservation Allianceleaders have a history of cultural bondsthat are shared across the Shoshoneand Arapahoe tribes. 10
  11. 11. Dallas, TexasBaylor Healthcare System’s Office ofHealth Equity partners with ProjectAccess Dallas to involve more than2,000 physician volunteers. 11
  12. 12. Camden, New JerseyCamden Coalition of HealthcareProviders has exceptional capacityto work across health careinstitutions and coordinate city-wide information exchange. 12
  13. 13. Patient EducationAlliance communities are employingevidence-based patient education programsto enable diabetes self-management andempower patients to become: • more engaged • better at managing • adopters of productive behaviors • effective communicators 13
  14. 14. Patient Level Education Examples Chicago, IL Dallas, TX Diabetes self-BASICS curriculum management educationadapted and piloted adapted from CoDEtmfor the target and featuring 7 one-on-population - intensive, one education sessionsten-week series conducted by community health workers 14
  15. 15. Patient Level Education Examples Memphis, TN Wind River Reservation3 sessions of DSME Expanded diabetes self-based on management education“Conversation with 6 classes andMapping” diabetes including patienteducation with follow- coaching, support forup support provided lifestyle changes andby case managers. culturally appropriate diabetes materials 15
  16. 16. Health Provider Education Alliance interventions aim to enable clinicians to be more effective in working with diverse patients through training in cultural competence and effective communication skills. 16
  17. 17. Provider Level Change Examples Camden, NJ Chicago, IL Physician CME series (4Provider level sessions) that includes:‘Practice 1) cultural awareness,Transformation’ 2) motivational interviewing techniques,based on the Primary 3) treatment tailoring basedCare Medical Model on stages of behavior change, 4) shared decision making and a 4-month booster session 17
  18. 18. Provider Level Change Examples Dallas, TX Wind River ReservationCME training program Workshops for IHS staffentitled “A Patient- focusing on educationCentered Approach to regarding culturalCross-Cultural Care” beliefs, health literacyis integrated into an and effectiveexisting physician communication andforum in the Dallas motivational interviewingarea techniques. 18
  19. 19. SUSTAINABLE ORGANIZATION AND SYSTEMS CHANGE Each Alliance community is introducing sustainable changes to how health organizations and providers manage their patients with diabetes and identify patients at risk of developing diabetes. 19
  20. 20. Systems Level Change Examples Camden, NJ Chicago, ILo Implementation of Clinic Redesign’ Health Information following the “Model for Technology (HIT) Improvement” plan-do- study-act methodologyo Evolution into a to improve care for citywide Accountable patients with diabetes. Care Organization (ACO) 20
  21. 21. Systems Level Change Examples Dallas, TX Wind River ReservationInstitutionalizing the Formation and expansioncommunity health of a Diabetes Coalition ofworker role (diabetes key partners to improvehealth promoter) into the health of the tribesthe Baylor Health living on the Wind RiverCare System; career Reservation.path for DHP. 21
  22. 22. Preliminary and Promising Evidence www.alliancefordiabetes.org
  23. 23. Dallas Observational Study* Average Hgb A1c decreased*Walton, J., it al. (2012) Reducing Diabetes Disparities Through the Implementation of a CHW–led Diabetes Self-Management Program. Family and Community Health: 35(2), 161-171. 23
  24. 24. South Side of Chicago Improved diabetes care and controlData Source: Assessment of Chronic Illness Care (ACID) Tool 24
  25. 25. 25
  26. 26. Wind RiverImprovements in Diabetes Care provided by the local Indian Health Service 26
  27. 27. Results: (Indian Health Service)Assessment of IHS Diabetes Care 2009 2011• HbA1c <7.0 28% 32%• HbA1c 11.0 or higher 19% 17%• Blood Pressure <120/<70 20% 25%• Diet Instruction by any provider 32% 49%• Exercise Instruction 18% 25%• Other Diabetes Education 55% 83%Results are believed from a Combined Effort 27
  28. 28. CamdenSuccess in “Hot-spotting” high-cost, high-riskpatients in order to better coordinate medicalcare and social services to address theirneeds. 28
  29. 29. 29
  30. 30. Lessons Learned from collaboration withclinical staff, community organizations,and health systems to improve diabetescare in high-risk populations 30
  31. 31. Lessons• Targeting more intense self-management intervention to higher risk patients can maximize intervention effects, improvement in health outcomes, and reduction in health care costs.• Practice/clinic transformation is most successful with a variety of ways to engage based on practice/clinic interests and capacity and with coaching support.• It is important to document capacity for “readiness” of organizations to invest in change and to understand organizational and political dynamics and culture.• Committed “champions” and opinion leaders are essential to program success, mobilizing community support, and planning for sustainability long-term.• Leverage the evidence to advance policies and align with other strategic initiatives. 31
  32. 32. Needed Policy Changes and Next Steps www.alliancefordiabetes.org
  33. 33. Systems and Policy ChangeEvolving from the Community Level Noreen M. Clark, PhD Myron E. Wegman Distinguished University Professor Director, Center for Managing Chronic Disease, University of Michigan Director, National Program Office, The Alliance to Reduce Disparities in Diabetes September 2012 www.alliancefordiabetes.org
  34. 34. The On-the-Ground ExperienceDespite great efforts and successin making substantive progress intheir communities, the Alliancesites continue to face real,systemic barriers in the health caresystem that affect the success ofthe interventions.
  35. 35. Barriers Faced by the Alliance Grantees• The current health care system focuses payments based on units of care, on specialty care, and on high- cost, high-tech interventions.• State credentialing standards present barriers to payments for vital health workers.• Technological, cost and policy barriers can obstruct a timely, comprehensive and robust exchange of patient information.• A lack of designated and consistent payment for community health worker services inhibits linking of people with diabetes to community resources and to education.
  36. 36. Success in turning the tide on diabetes and onreducing disparities requires that real world,on-the-ground experiences of health careproviders and health systems are reflected inhealth policies and regulations implementedat federal, state and local levels.
  37. 37. Alliance Invited Summit Convened• The Alliance Invited Summit was organized to link national policymaking and on-the-ground realities.• A series of considerations sparked discussion about achievable actions that can bring about significant reductions in health care disparities among people with diabetes.
  38. 38. Target Policy ConsiderationsSystems Level:Consideration 1 – Integrate public health and healthcare systemsConsideration 2 – Share and report community-widehealth dataConsideration 3 – Eliminate incentives that encourageunderinvestment in low-income high-risk patients
  39. 39. Target Policy Considerations (cont.)Provider Level:Consideration 4 – Make optimum Accountable CareOrganization’s (ACO) ability to reduce disparitiesConsideration 5 – Support deployment of CommunityHealth Workers (CHWs)Patient Level:Consideration 6 – Enhance coverage for self-management supports
  40. 40. Focus on Integration of Public Health and Clinical Health Systems • March 28, 2012 – The IOM released a report calling for more integration between primary care and public health. The report reviewed new and promising integration models, many of which include shared accountability for improved community and population health outcomes. • The need for greater integration between clinical systems and public health emerged as a consistent theme at the Alliance’s National Summit. Experts from around the country identified this as a top concern.
  41. 41. Outside and inside • September 12, 2012 Robert M. Pestronk, MPH Executive Director National Association of County and City Health Officials
  42. 42. National Association of County and City Health Officials • Numbers • Vision • Mission
  43. 43. Better integration: Outside Governmental Public Health DepartmentsClinical Practice Other people andSettings organizations in a community
  44. 44. Better integration: Inside1) Collaboration and partnership2) Evidence-, experience-, and reality-based practice3) Technology4) Workforce5) Funding/Sustainability
  45. 45. NACCHO Diabetes Today Grantees, 2010 - 2012
  46. 46. For More Information Amy Henes Senior Program Analyst Diabetes Projects Ahenes@naccho.org http://www.naccho.org/topics/HPDP/diabetes/index.cfm
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