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SPARC â€" A Model for Improving Access to Care


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SPARC â€" A Model for Improving Access to Care

  1. 1. Connecting Public Health and Medicine through Prevention: The SPARC Program Sickness Prevention Achieved through Regional Collaboration Doug Shenson, MD MPH Austin, TX June 15, 2010
  3. 3. Echocardiography Flu Vaccination Dementia Screening Pneumococcal Vaccine Mammogram Colorectal cancer Screening Pap Test Thyroid Disease screening Hepatitis B Vaccine STD Screening PPD test EKG Blood Pressure Screening HIV screening Downs Syndrome Screening Carotid artery stenosis Screening Cholesterol Screening Glaucoma Screening Skin Cancer Screening Prostate cancer Screening Diabetes Screening Lung cancer Screening Osteoporosis Screening Pregnancy Screening Abdominal Aortic aneurysm Screening PKU Screening
  4. 4. Clinical Preventive Services <ul><li>Flu Shots </li></ul><ul><li>Pneumococcal immunization </li></ul><ul><li>Mammography </li></ul><ul><li>Pap Test </li></ul><ul><li>Colorectal cancer screening </li></ul><ul><li>Hypertension screening </li></ul><ul><li>Cholesterol screening </li></ul><ul><li>Tetanus immunization </li></ul><ul><li>Adolescent immunizations </li></ul><ul><li>Child immunizations </li></ul>
  6. 6. Estimated Percentage Of U.S. Adults Aged >65 Up-to-date On Routine Clinical Preventive Services. 1997, 2002, 2004 Behavioral Risk Factor Surveillance System. Am J Prev Med 2007;32(1)
  7. 7. Estimated Percentage Of U.S. Adults Aged 50-64 Up-to-date On Routine Clinical Preventive Services. 1997, 2002, 2004, 2006 Behavioral Risk Factor Surveillance System.
  8. 8. Adults and Infants “Up-to-Date” with Clinical Preventive Services (2006 BRFSS)
  10. 10. Diffuse Responsibility: Patient Pulmonologist Cardiologist Low Community-wide Preventive Service Delivery Rate Patient Patient Patient Patient Patient Patient Patient Primary Care Clinician Obstetrician / Gynecologist Gastroenterologist Geriatrician
  11. 11. Acute Care Visits Patient Primary Care Clinician Current Preventive Service Delivery Rates Patient Patient Patient Patient Patient Patient Patient Patient Patient Patient Patient
  12. 12. Adults Age > 65 “Up-to-date” with CPS Insurance Status, Provider status, and Recent Checkup (2006 BRFSS)
  14. 14. Obstacles to Preventive Service Delivery We Know About: Clinicians <ul><li>Poor office reminder and flagging systems </li></ul><ul><li>Disease prevention a lower priority </li></ul><ul><li>Doctors not aware of changing guidelines </li></ul><ul><li>Low insurance reimbursement rates </li></ul>
  15. 15. Obstacles to Preventive Service Delivery We Know About: Patients <ul><li>Patients not aware of health benefits </li></ul><ul><li>Patient focused exclusively on treatment </li></ul><ul><li>Patient not aware that insurance covers preventive care </li></ul>
  16. 16. Patient Patient Patient Patient Patient Community Resident Primary Care Clinician Patient Primary Care Clinician Community-wide Preventive Service Delivery Community Resident Community Resident Community Resident Community Resident Community Resident Community Resident Community Resident Community Perspective
  17. 17. SPARC: Program Rationale and System Critique <ul><li>Currently no responsible local agency for population-wide provision of clinical preventive services </li></ul><ul><li>Currently no local accountability </li></ul><ul><li>Currently no coordination of delivery </li></ul><ul><li>Clinical preventive services falls between the cracks of medicine and public health </li></ul>
  19. 19. Patient Clinician Office System Community Resident New Community Access Point Increase Supply of CPS Increase Demand for CPS Higher Community-wide Delivery Population-Wide Perspective Accountable Agency (SPARC) Data
  20. 20. Build local collaborations of prevention service “stakeholders” <ul><li>Visiting nursing agencies </li></ul><ul><li>Elder services </li></ul><ul><li>Public health agencies </li></ul><ul><li>Churches and synagogues </li></ul><ul><li>Hospitals </li></ul><ul><li>Public schools </li></ul><ul><li>Medical practices </li></ul><ul><li>Community centers </li></ul>
  21. 21. Elements of Success <ul><li>Establish a SPARC Steering Committee </li></ul><ul><li>Selection of one or more geographically-bounded communities </li></ul><ul><li>Selection of community (non-clinical) sites </li></ul><ul><li>Selection of clinical preventive services to be delivered </li></ul><ul><li>Plan community-base activities </li></ul><ul><li>Plan evaluation strategy </li></ul><ul><li>Develop information links back to the medical home </li></ul>
  22. 22. Outcomes Assessment <ul><li>Reach (inclusions and exclusions) </li></ul><ul><li>Efficacy (meeting outcomes goals) </li></ul><ul><li>Adoption assessment </li></ul><ul><li>Implementation assessment </li></ul><ul><li>Maintenance assessment </li></ul>
  24. 26. Percent Change in Pneumococcal Immunization Rates, Connecticut Counties 1997 HCFA Reimbursement Claims
  25. 27. Bundling Preventive Services: Vaccinations and Cancer Screening Can mammography rates be improved by facilitating breast cancer screening at community-based flu clinics?
  26. 28. SPARC VNA DPH MD RAD PLANNING Mamm. Scheduling Radiology Dept. Community Flu Clinics Medical Home Residents Data
  27. 29. Mammography rates, Litchfield County, CT, women age >65. Am J Prev Med 2001;20(2).
  28. 30. Offering Annual Fecal Occult Blood Tests at Annual Flu Shot Clinics Increases Colorectal Cancer Screening Rates Michael B. Potter, MD 1 , La Phengrasamy, MPH 1 , Esther S. Hudes, PhD, MPH 2 , Stephen J. McPhee, MD 3 and Judith M.E. Walsh, MD, MPH 2,3 1 Department of Family and Community Medicine, University of California San Francisco, San Francisco, California 2 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 3 Department of Medicine, University of California, San Francisco, San Francisco, California CORRESPONDING AUTHOR : Michael B. Potter, MD Department of Family and Community Medicine Box 0900, UCSF, San Francisco, CA 94143 [email_address]
  29. 32. Why Vote & Vax? <ul><li>More than 126 million Americans vote in national elections. </li></ul><ul><li>Approximately 70% the voters are over age 50. </li></ul><ul><li>Fewer than 40% of adults ages 50-64 receive an annual flu shot. </li></ul>
  30. 33. Why Polling Places? <ul><li>They attract residents from all communities. </li></ul><ul><li>They are mandated to be maximally accessible. </li></ul><ul><li>They are widely distributed throughout all communities. </li></ul><ul><li>There are 186,000 of them </li></ul>
  31. 34. Vote & Vax Guidelines <ul><ul><li>Permission from Local Election Authority </li></ul></ul><ul><ul><li>Not Just for Voters </li></ul></ul><ul><ul><li>Charge for Vaccine as Usual </li></ul></ul><ul><ul><li>For All Communities </li></ul></ul>
  32. 35. Vote & Vax National Collaborators <ul><li>AARP </li></ul><ul><li>American Public Health Association (APHA) </li></ul><ul><li>Association of Immunization Managers (AIM) </li></ul><ul><li>Association of State and Territorial Health Officials (ASTHO) </li></ul><ul><li>Immunization Coalitions Technical Assistance Network (IZTA) </li></ul><ul><li>National Association of Area Agencies on Aging (n4a) </li></ul><ul><li>National Association of Chronic Disease Directors (NACDD) </li></ul><ul><li>National Association of County and City Health Officials (NACCHO) </li></ul><ul><li>National Association of State Units on Aging (NASUA) </li></ul><ul><li>Visiting Nurse Associations of America (VNAA) </li></ul>
  33. 36. How Did We Do in 2008? <ul><li>Vote & Vax clinics delivered 21,434 flu vaccinations at 331 locations in 42 states plus the District of Columbia. </li></ul>
  34. 37. Vote & Vax : A Nationwide Success
  35. 38. We hit the most important targets… 67% were in CDC priority groups.
  36. 39. We reached new populations… <ul><li>48 % were irregular or unlikely flu shot recipients – that is, they did not receive a shot last year or would not have otherwise received one this year. </li></ul><ul><li>52% were regular flu shot recipients. </li></ul>
  37. 40. Including underserved populations… Percent irregular and unlikely flu shot recipients: 60% among African-Americans 65% among Hispanics 71% among uninsured
  38. 41. SUMMING UP
  39. 42. The SPARC Program <ul><li>Community-based program focused on expanding prevention across entire population </li></ul><ul><li>Emphasis on primary and secondary prevention of major chronic diseases (USPSTF A or B) </li></ul><ul><li>Builds community-wide accountability for better access to preventive services </li></ul><ul><li>Vehicle for public health & healthcare integration </li></ul>
  40. 43. Tools and Assistance <ul><li>Project manuals and research findings </li></ul><ul><li>SPARC presentations </li></ul><ul><li>Conference Calls </li></ul><ul><li>Technical Assistance </li></ul><ul><li>Site Visits </li></ul><ul><li>SPARC Action Guide </li></ul>
  41. 44. Lessons Learned <ul><li>Ambition </li></ul><ul><li>Systems </li></ul><ul><li>Sustainability </li></ul><ul><li>Allies </li></ul><ul><li>Creativity </li></ul>
  42. 46. Leading SPARC Funders <ul><li>National </li></ul><ul><li>AARP </li></ul><ul><li>CDC Healthy Aging Program </li></ul><ul><li>CDC National Immunization Program </li></ul><ul><li>HRSA </li></ul><ul><li>Local Initiatives Funding Partners Program of RWJF </li></ul><ul><li>Pfizer Foundation </li></ul><ul><li>Robert Wood Johnson Foundation (RWJF) </li></ul><ul><li>Regional and Local </li></ul><ul><li>Atlanta Regional Commission </li></ul><ul><li>Berkshire Taconic Community Foundation </li></ul><ul><li>Jessie B. Cox Trust </li></ul><ul><li>Patrick and Catherine Donaghue Foundation </li></ul><ul><li>QIOs of CT, MA, NY </li></ul><ul><li>Seth Sprague Foundation </li></ul><ul><li>Weinberg Foundation </li></ul>