Quality Improvement: Implications for CHCs Serving AA&NHOPIs Practice Transformation Webinar Series - Webinar 1 April 1, 2015 | Moderator: June Kim, Program Director of Technical Assistance

About AAPCHO

• National association of 35 community health organizations serving Asian Americans, Native Hawaiians, and other Pacific Islanders (AA&NHOPIs).

• Dedicated to improving the health status and access of these medically underserved communities

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Practice Transformation Webinar Series

•  To provide latest information on practice transformation

•  Information on quality improvement, meaningful use, accountable care organizations, and patient centered medical homes

•  Impact on community health centers serving Asian Americans, Native Hawaiians and other Pacific Islanders

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Speaker

Ignatius Bau Health Policy Consultant

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Housekeeping

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Questions

If you have questions during the presentation portion of the webinar, you can submit them by typing into the “Questions” field on your Control Panel. We will answer questions at the end of the webinar.

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Webinar Slides

Slides and audio recording from today’s presentation will be emailed to registered attendees after the webinar.

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Quality  Improvement:  Implica5ons  for  Community  Health  Centers    Serving  Asian  Americans,  Na5ve  Hawaiians  

and  Other  Pacific  Islanders  

Associa4on  of  Asian  Pacific  Community  Health  Organiza4ons  April  1,  2015  

• What  do  we  know  about  the  quality  of  health  care  in  the  U.S.,  especially  for  Asian  Americans,  Na5ve  Hawaiians,  and  Other  Pacific  Islanders  (AANHOPIs)?  

• What  are  some  key  frameworks  for  quality  improvement?  

•  How  does  the  Affordable  Care  Act  support  quality  improvement?  

• What  are  the  implica5ons  for  CHCs  serving  AANHOPIs?  

Outline  of  Today’s  Webinar

•  Medical  errors,  especially  in  hospitals  •  Failure  to  follow  clinical  guidelines/evidence-‐based  medicine  

•  Regional  varia5ons  in  u5liza5on  and  costs  unrelated  to  outcomes  

• Waste/over-‐u5liza5on  from  fragmenta5on  and  defensive  medicine    

What  do  we  know  about    the  quality  of  health  care  in  the  U.S.?

Ins4tute  of  Medicine:    Reduce  Medical  Errors  

• First, do no harm • Overuse • Underuse

• Misuse • 44,000-98,000 preventable deaths/year

On  average,  people  in  the  U.S.  receive:  •  Appropriate  acute  health  care  services  80%  of  the  5me  

•  Recommended  chronic  disease  management  services  70%  of  the  5me  

•  Recommended  preven5ve  health  care  services  60%  of  the  5me  

What  do  we  know  about    the  quality  of  health  care  in  the  U.S.?

•  11th  year  of  these  na5onal  reports  •  Some  progress  on  quality  but  improvement  is  very  incremental  and  slow  

•  Con5nued  dispari5es  in  quality  of  care  for  racial  and  ethnic  minori5es,  low-‐income,  limited  English  proficient,  including  AANHOPIs  

What  do  we  know  about    the  quality  of  health  care  in  the  U.S.?

•  Ins5tute  of  Medicine  •  Ins5tute  for  Healthcare  Improvement  •  Chronic  Care  Model  **********************************  •  HHS  Na5onal  Quality  Strategy  •  HHS  Partnership  for  Pa5ents  

What  are  some  key  frameworks  for  quality  improvement?

Ins4tute  of  Medicine:    Improve  Quality  

• Safe • Timely • Effective

• Efficient • Equitable

• Patient-Centered

1.  Care  is  based  on  con5nuous  healing  rela5onships  

2.  Care  is  customized  according  to  pa5ent  needs  and  values  

3.  The  pa5ent  is  the  source  of  control  4.  Knowledge  is  shared  and  informa5on  

flows  freely  5.  Decision-‐making  is  evidence-‐based  

Ten  “rules”

6.  Safety  is  a  system  priority  7.  Transparency  is  necessary  8.  Needs  are  an5cipated  9.  Waste  is  con5nuously  decreased  10.  Coopera5on  among  clinicians  is  a  

priority  

Ten  “rules”

 

 

Ins4tute  of  Medicine:  Reduce  Health  Dispari4es  

• Increase awareness • Collect/monitor data • Change systems

• Improve communication/trust • Engage communities

Ins4tute  of  Medicine:  Integrate  Quality  Improvement  and    

Dispari4es  Reduc4on  

• Highlight value and equity • Add access measures • Add care coordination and system infrastructure measures

• Add types of care • Establish national goals and objectives

           ACCESS  

 QUALITY                  COST  

PATIENT  EXPERIENCE  OF  CARE  

REDUCED  COST  POPULATION  HEALTH  

   

 100,000  Lives  Campaign  Goals                    (2004  –2006)  

•  Save  100,000  lives  •  Enroll  more  than  2,000  hospitals  in  the  

ini5a5ve  •  Build  a  reusable  na5onal  infrastructure  for  

change  •  Raise  the  profile  of  the  problem  (variability  

in  the  quality  of  American  health  care)  

   

The  100,000  Lives  Campaign  Results  •  An  es5mated  122,300  lives  saved  by  par5cipa5ng  hospitals    •  Over  3,100  hospitals  enrolled  

–  Over  78%  of  all  discharges  –  Over  78%  of  all  acute-‐care  beds  –  Over  85%  of  par5cipa5ng  hospitals  sending  IHI  mortality  data  

•  Par5cipa5on  in  campaign  interven5ons:  Rapid  Response  Teams:  60%  AMI  Care  Reliability:  77%  Medica5on  Reconcilia5on:    73%  Surgical  Site  Infec5on  Bundles:    72%  Ven5lator  Bundles:    67%  Central  Venous  Line  Bundles:    65%  All  six:  42%      

   

–  2008-‐2010  –  Avoid  five  million  incidents  of  harm  over  24  months  –  Enroll  more  than  4,000  hospitals  and  their  communi5es  in  this  work  

–  Strengthen  the  na5onal  infrastructure  for  change  and  transform  it  into  a  na5onal  asset  

–  Raise  the  profile  of  the  problem    

     Pa5ent  Protec5on  and  Affordable  Care  Act    

 • Bemer  Care  

• Healthy  People/  Healthy  Communi5es  

• Affordable  Care  

1.  Making  care  safer  by  reducing  harm  caused  in  the  delivery  of  care  

2.  Ensuring  that  each  person  and  family  are  engaged  as  partners  in  their  care  

3.  Promo5ng  effec5ve  communica5on  and  coordina5on  of  care  

Na5onal  Strategy  for  Quality  Improvement  

4.  Promo5ng  the  most  effec5ve  preven5on  and  treatment  prac5ces  for  the  leading  causes  of  mortality,  star5ng  with  cardiovascular  disease  

5.  Working  with  communi5es  to  promote  wide  use  of  best  prac5ces  to  enable  healthy  living  

6.  Making  quality  care  more  affordable  for  individuals,  families,  employers,  and  governments  by  developing  and  spreading  new  health  care  delivery  models  

   

•  Launched  by  HHS  in  2011  • First  federal  government  hospital  pa5ent  safety  ini5a5ve  

• 8,000  partners,  including  3,700  hospitals,  are  par5cipa5ng  

• Established  and  achieving  specific  goals  for  pa5ent  safety  improvements  

 

$1,000,000,000  =  $1  Billion!  107  three-‐year  awards  expected  to  save  $1.9  billion    

39 Additional Awards Announced in 2014

Awards to be announced in April 2015

•  Have  valid  measures  •  Collect  data  on  performance  •  Know  baseline  and  set  goals  for  improvement,  using  evidence/best  prac5ces  

•  Try  out  improvements/measure  results  •  Adjust/adapt  •  Repeat/sustain  improvements  

What works to improve the quality of health care?

•  Community  health  centers  have  experience  with  quality  improvement  

•  Some  data  showing  effec5veness,  e.g.  in  improving  diabetes-‐related  outcomes  

•  Keys  seem  to  be  good  data,  focus  on  pa5ent  panels,  engage  all  staff,  track  results  

•  Also  importance  of  collabora5ves/peer  support  

What  are  the  implica5ons    for  CHCs  serving  AANHOPIs?  

•  Limle  published/known  about  quality  improvement  among  Asian  Americans,  Na5ve  Hawaiians,  Pacific  Islanders  

•  AAPCHO  focus  on  enabling  services  and  quality  is  an  important  founda5on  

•  Need  more  quality  improvement  experience  and  outcomes  data  

•  Need  to  integrate  dispari5es  reduc5on  

What  are  the  implica5ons    for  CHCs  serving  AANHOPIs?  

Future Webinars April 8: Health information technology April 22: Patient-centered medical homes April 29: Accountable care organizations May 6: Culturally and linguistically appropriate services

Questions and comments?

Q&A

You can submit questions by typing them into the “Questions” field on your Control Panel.

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Thank you!

Next Webinar Health Information Technology: Implications for CHCs Serving AA&NHOPIs Wednesday, April 8, 2015 9am HST/12pm PDT/3pm EDT To register or for more information, go to http://bit.ly/PCMH2015webinars or visit AAPCHO’s website at www.aapcho.org.

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