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Be There San Diego - Cardiovascular Disease Prevention, a Regional Quality Collaborative | DII

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2017 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium

Be There San Diego: Improving Cardiovascular Disease Prevention through a Regional Quality Collaborative
Christine Thorne, MD, MPH - University of California, San Diego
Allen Fremont, MD, PhD - RAND Corporation; UCLA; VA Greater Los Angeles HealthCare System

For more information on DII, go to: https://ctsi.ucla.edu/patients-community/pages/dissemination_implementation_improvement

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Be There San Diego - Cardiovascular Disease Prevention, a Regional Quality Collaborative | DII

  1. 1. Improving Cardiovascular Disease Prevention through a Regional Quality Collaborative Southern California Dissemination Implementation and Improvement Science Symposium Christine Thorne, MD, MPH May 3, 2017
  2. 2. Be There San Diego § A quality collaborative in San Diego County focused on preventing heart attacks and strokes through improved management of cardiovascular disease risk factors. o Spread best practices o Scale up evidence based approaches o Use data to motivate and evaluate progress
  3. 3. Health Care Organizations Kaiser-Permanente La Maestra Community Health Center* Mountain Health and Community Health Services Multicultural IPA Neighborhood Healthcare* North County Health Services* San Diego Family Care* Scripps Clinic Scripps Coastal Medical Center Sharp Rees-Stealy Medical Group UCSD Medical Group Vista Community Clinic* *Federal Qualified Health Clinic Data Quality Collaborative Participants § Quality Measures Tracked • Hypertensives with BP <140/90 • Diabetics with BP <140/90 • Diabetics with HbA1c <8 • Diabetics with HbA1c >9 • 209,688 patients with hypertension • Approximately 1 in 3 hypertensives in the County are included in our data • For every 2 % gain another 4200 patients have their hypertension under control
  4. 4. BTSD: BP Control Rate among Hypertension Patients by Year (all payers) 4 83% 84% 82% 72% 74% 76% 79% 50% 60% 70% 80% 90% 100% Weighted average across groups reported in a given year CA Avg (2015) Nat 90th (2015)
  5. 5. Changing size and Mix of Data Group HTN population as DFQ Matured 5 0 20000 40000 60000 80000 100000 120000 140000 160000 180000 200000 2010 2011 2012 2013 2014 Number of HTN reported on by year and group UCSD Sharp-RS Scripps Coastal Scripps Clinic MultiCultural IPA Kaiser CCC Arch
  6. 6. Comprehensive Approach to Cardiovascular Disease across the Determinants of Health 8 Clinical – Community Linkages Interventions • Engage community pharmacists • Engage community health workers • Develop bi-directional referral recommendations • Promote partnerships between faith-based organizations and clinicians Clinical Interventions • Promote use of the ASCVD Risk Calculator • Promote the use of the CVD Risk Medication Bundle • Promote team based care, including pharmacists on the care team and health coaches • Test innovative technologies for CVD risk • Promote sharing of best practices Community Interventions • Engage faith-based organizations in creating heart health PSEs • Promote use of community blood pressure screenings • Promote home blood pressure monitoring • Raise awareness of CVD risk factors • Partner with community leadership groups Health Care System Transformation Interventions • Share intermediate outcome data between medical groups • Assess and promote the use of clinical decision support tools • Promote pharmacist integration across the health care system • Support linkages between clinical and public health community • Develop payment model to support population health We are a regional integrator with a commitment to increasing health equity, working collaboratively across sectors, and creating sustainable change. Our infrastructure is built on strategic planning, coalition building, data management and analytics, outcome evaluation, and developing financial sustainability.
  7. 7. Influences from Outside of Be there San Diego 9
  8. 8. What has been the progress towards the goal of BP control in 80% of hypertension patients? 10 71 89 69 71 58 70 66 67 75 69 80 87 80 79 58 71 74 59 64 79 76 63 0 10 20 30 40 50 60 70 80 90 100 Percentage of Hypertension Patients with Controlled Blood Pressure (BP < 140/90) in Q1 2015 and Q4 2016 Q1 2015 Q4 2016 80% Goal * Combined percentage is weighted and accounts for patients within groups shown in figure only (i.e., excludes Groups A, I, K which lacked validated 2015 data). At or above goal Within 5% of goal
  9. 9. Outcomes: Comparison of Two Divergent Groups 11 50% 55% 60% 65% 70% 75% 80% 85% Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Trend in Hypertension Control Rate Q1 2015 - Q4 2016 Group 2 Group 7 All Groups Combined
  10. 10. Outcomes: High Achieving Group 12 Attendance – University of Best Practices 2014-2016 Total Attendance (All Persons) 31 Total Medical Director 20 • Measure Up/Pressure Down Collaborative 2013 • Heart Attack and Stroke Free Zone Project Participant 2015-Present 0.64 0.66 0.68 0.7 0.72 0.74 0.76 0.78 0.8 0.82 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Trend in Hypertension Control Rate Q1 2015 - Q4 2016 Group 2 All Groups Combined Adopted BTSD Simplified Approach to Hypertension Treatment Algorithm Hypertension Workflow Toolkit Rolled Out Standardized training and toolkit implementation
  11. 11. Outcomes 13 UCSD Hypertension treatment approach 2017 Health Coach Project 2015-2017 Attendance – University of Best Practices 2014-2016 Total Attendance (All Persons) 16 Medical Director 0 0.5 0.55 0.6 0.65 0.7 0.75 0.8 0.85 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Trend in Hypertension Control Rate Q1 2015 - Q4 2016 Group 7 All Groups Combined Heart Attack and Stroke Free Zone Project Participant 2015-Present Roll-Out of System Wide Hypertension Treatment Approach - 2017
  12. 12. Feedback from Teams § “We talk to our physicians and we tell them, ’the community clinics can do this with their patients. If they can do that, why are your patients not at goal?’” § “When a doctor/medical director starts to question if they can do it, [you realize] you can too.” § “It allows other benchmarks [of peers in the community]” § “Always stay focused on the ultimate goal of improving the health of the community in which the groups practice, rather than the performance results of any individual group.” —Dan Dworsky, MD, Vice President of Quality and Value, Scripps Clinic Medical Group 14
  13. 13. Be There San Diego: Quality Improvement Next steps § Recommendations: • Undiagnosed Hypertension • Team-Based Care • Self-Management of Blood Pressure § Improving data quality and expanding measures § Considering next steps in looking at tackling another chronic disease with more complex quality measures, such as diabetes 15
  14. 14. Thank you

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