The Pacific Innovation Collaborative - NYU Langone Health · PDF fileThe Pacific Innovation...
Transcript of The Pacific Innovation Collaborative - NYU Langone Health · PDF fileThe Pacific Innovation...
The Pacific Innovation Collaborative:!Using local data to advance knowledge and improve health / health care practices!!December 3, 2011!
Jeffrey Caballero, MPH!
Association of Asian Pacific Community Health Organizations!
ASSOCIATION OF ASIAN PACIFIC COMMUNITY HEALTH ORGANIZATIONS
• Est. 1987 non-profit national membership organization !• 29 community health organizations in 9 states - 21 FQHCs in 70 clinic sites!
• Mission is to improve access to care and health status ofmedically underserved AA&NHPIs!
• Over 450,000 patients annually!• 75% - 100%FPL; 90% - 200%FPL!• 38% Uninsured; 35% Medicaid!• 78% AA & NHPI!• 62% LEP!
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EMERGING HEALTHCARE ENVIRONMENT
• Began 2006!• Health safety net threatened!• Must prove our value:!
• Improve patient care and safety!• Reduce the cost of healthcare!• Improve population health – aligns with Mission, Goals, & Values!
• Develop an electronic infrastructure to exchange information & track performance data!
• Build on prior collaborative learning experiences!• Learn how to share data and use information!
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PIC PROJECT MEMBERS • Federally Qualified Health Centers
§ Country Doctor Community Health Center § HealthPoint § Family Health Centers (FHC) § Interna;onal Community Health Services (ICHS) § Kalihi-‐Palama Health Center (KPHC) § NeighborCare Health § Waianae Coast Comprehensive Health Center (WCCHC) § Waimanalo Health Center (WHC)
• Health Plans § AlohaCare § Community Health Plan of Washington (CHPW)
• Regional Aggrega;on Sites § Hawaii Pa;ent Accoun;ng Services (HPAS) § PTSO of Washington
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PIC DATA AGGREGATION FLOW
Neighborcare
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PIC PERFORMANCE INDICATORS Measures Impact of Innova;on
1. % by age 2 years, with 4 DTaP, 3 OPV/IPV, 1XMMR, 3XHepB, 3XHib (and Varicella)
EffecEveness & Safety, Risk Management, & Quality
2a. % of paEents with either Type 1 or Type 2 Diabetes whose HBA1c is > 9 EffecEveness & Efficiency
2b. % of diabeEc paEents with a behavioral health (mental health or substance) diagnosis whose HBA1c is > 9
EffecEveness
3a. % of pts < 7yo who had a primary care visit within the last 12 months EffecEveness & Timeliness
3b. % of pts > 6 yo who had a primary care visit within the last 24 months EffecEveness & Timeliness
3c. Third next available appt EffecEveness & Timeliness 4a. % of paEents seen in ER with low complexity problems EffecEveness
4b. % of paEents seen in ER who f/u with primary care. EffecEveness
5. % of pts with well child visits: a) In first 15 months; b) At 3-‐6 years; c) At 12-‐21 years
EffecEveness
6. % of paEents on whom early noEficaEon of pregnancy was made to the Health Plan.
Timeliness & Efficiency
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• Availability of historic data from 2007 • De-‐iden;fied data at central report site • Disaggregate ethnicity data for AA&NHPIs • Data from mul;ple vendors and disparate systems
• NextGen, Centricity, and WCCHC’s EPM • Availability of current data
• Exchanged daily for Hawaii health centers and weekly for Washington • Ability to compare data via the PIC Compara;ve Dashboard • Scheduled / automated & ad-‐hoc reports • Sharing of best prac;ces at CHCs and health plans across states
• Development of HIE that serves as a founda;on for many current & future projects (i.e. P4P, PIC ES) • Trend analysis – planned for future development • Risk stra;fica;on – planned for future development
• HRSA CHARN Pa;ent-‐Centered Outcomes Research
PROJECT STRENGTHS & BENEFITS
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• Improves quality of care data exchange between health centers and health plan
• Ability to test interven;ons on target high-‐risk pa;ents by selected performance measures • Measure impact of specific clinical or non-‐clinical services, cultural
appropriate services, & team care models • Measure impact on specific race, ethnici;es, age, gender, etc
RWJ PAY-FOR-PERFORMANCE (P4P) STUDY
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• Preliminary Findings • A Pay-‐for-‐Performance/Health Informa;on Technology program led to
decreased ER visits • Contribu;on to reduce/eliminate Health dispari;es by assessing
effec;veness of P4P incen;ves
P4P/HIT IMPACT ON PATIENT OUTCOMES
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HRSA HIE DIABETES DECISION TOOL
• Key features of the decision support tool include: • A decision support tree, or flow chart that allows staff to monitor processes and steps in managing a pa;ent’s diabetes and care
• Auto alerts/reports a pa;ent need (e.g. medica;on; follow-‐up appointment with a specialist, etc.)
• Provider feedback: • Easy to use • Enjoy customized work flow
• The tool allows CHCs to maximize their team approach to care in order to improve pa;ent outcomes
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Summary of Local Data Capacity Benefits:
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• Builds staff and organiza;onal capacity at community level -‐ Data Usability • Current not old data • Visual analy;cal dashboards and auto/scheduled reports • Monitors/measures performance & quality • Rapidly iden;fy & correct nega;ve trends -‐ Supports Evidence-‐based System Change • Monitors pa;ent/popula;on health status • Ability to evaluate/compare interven;ons, incen;ves, and services • Facilitate sharing of best prac;ces between providers, orgs., etc. • Demonstrates quality improvement • Measures health & health care disparity reduc;on/elimina;on efforts
• Demonstrate alignment with Mission, goals, and values • Founda;on for future research and capacity development
Government-‐Community Integra;on • Strengthen support for data collec;on and engagement of
community of color by state level en;;es. (ie. HIE, Beacon Communi;es, and Regional Extension Centers)
Research Dissemina;on • Na;onally partner to facilitate sharing of best prac;ces, tools,
lessons learned, and rapid learning techniques.
Recommendations:
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