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Collaborative Background
The Health Disparities Collaboratives were developed to
change primary health care practices in order to improve
the health care provided to everyone and to eliminate health
disparities. In 1998, BPHC funded one Primary Care Association/Clinical
Network team in each of five regional clusters, in addition,
National Clinical Networks focused on oral health, migrant
farm worker health care, and homeless health care.
These organizations worked with the Institute for Healthcare
Improvement (IHI) to develop the infrastructure to support
the Health Disparities Collaboratives. During the fall of
1998, BPHC selected eighty-eight health centers to participate
in the BPHC Health Disparities Collaborative, which focused
on diabetes. Since 1998, 496 out of approximately 900 health
centers have participated in the Health Disparities Collaboratives
including:
- Diabetes II, January 2000 (115 health centers)
- Asthma and Depression I, March 2000 (40 health centers)
- Diabetes III/Cardiovascular 1, April 2001 (97 health
centers)
- Asthma II, August 2001
- Current collaboratives also include Cancer and Prevention.
The Collaborative
The BPHC Collaboratives support health centers to sustain
and disseminate positive changes and results gained by participating
in a Collaborative. Collaborative support includes:
- Participation in the Learning Model developed by the
Institute for Healthcare Improvement.
- Guidance to implement the Chronic Care Model developed
by Dr. Ed Wagner at the MacColl Institute for Healthcare
Innovation.
- Training and support in using the Improvement Model,
also developed by the Institute for Healthcare Improvement.
- Information system software development and technical
assistance, which is necessary for health centers to successfully
implement a clinical information system.
In the first Diabetes Collaborative, 88 health centers
participated; developing registries and enrolling 16,000
people with diabetes. The national shared performance measure
of two Hemoglobin A1c (HbA1c) tests done within a year increased
by almost 300% during Diabetes 1. 115 health centers participated
in the second Diabetes Collaborative (Diabetes 2). 40 health
centers and school-based health centers participated in
the Asthma and Depression Collaboratives. Strong supportive
partnerships with the Centers for Disease Control and Prevention
(CDC) and state Diabetes Control Programs have resulted
in over $2 million additional resources to participating
health centers in Diabetes 1 and 2.
Partnerships have formed at the national, state and community
level. The partnerships have increased access to expert
faculty, computer software, discounted pharmaceuticals and
HbA1c laboratory equipment, direct community resources for
patients, health education materials, and community level
marketing and educational resources.
Collaborative Structure
The Health Disparities Collaboratives are organized around
five regional clusters of states. A state Primary Care Association
(PCA) in each cluster serves as the lead agency for the
region. Within lead PCAs are Cluster Directors, Cluster
Coordinators, Clinical Coordinators and IS Specialists.
These individuals provide oversight, management, training,
networking, technical assistance and support to Collaborative
participants in the region. Cluster Directors also work
with regional Clinical Networks, and other local, state,
and national partners. Each Cluster has a Steering Committee
composed of representatives from all health center disciplines.
At the national level, there is a BPHC Health Disparities
Collaborative Director who provides leadership for Collaborative
operations, management, and evaluation. A national Expert
Panel of individuals experienced in diabetes, asthma, depression,
cardiovascular, cancer, preventative care, health center
operations, the chronic care model for delivering health
care, process improvement/redesign, and evaluation strategies,
guide the Health Disparities Collaboratives.
Collaborative Model
The model for this Health Disparities Collaborative combines
an interactive process improvement approach with rapid change
using a Chronic Care Model. This model draws from the experience
of the Bureau of Primary Health Care's (BPHC) Diabetes I,
II, and Asthma/Depression Collaboratives. The model has
been successfully implemented in over 200 health centers
nationwide to improve the care of patients with Diabetes,
Asthma and Depression. Another distinctive feature of this
Collaborative is the focus on patients' needs and self-management
abilities as drivers of heath change efforts. By taking
a redesign approach, results are achieved organization-wide
as opposed to within one department or area. This strategy
assumes that health centers are not bound by the current
system, that they can effect changes identified as useful,
and that they desire a system that is efficient, effective,
and satisfying for both patient and staff.
What is Required for a
Health Center to Participate?
Eligible health centers and clinics include Federally Qualified
Health Centers (FQHCs) and National Health Service Corps
sites. Executive Directors and Medical Directors of centers
interested in participating in this collaborative must commit
to:
- Engage the staff in efforts to improve care for patients
as set forth by the Collaborative through well-defined
measures and testing.
- Connect the goals of the Collaborative to a strategic
initiative in the organization.
- Provide a senior leader (must be CEO or Medical Director)
to:
- serve as sponsor for the Health Care Improvement
Team;
- serve as champion for spread of positive changes.
- Attend all four Learning Sessions.
- To attend a minimum of one team meeting per month in
the center.
- Complete all prework requirements prior to the Kickoff
& Learning Session.
- Ensure monthly reports are submitted to the Cluster
Director on the due date.
- Participate in the full duration of the initiative.
- Work with the Cluster Director to select a team to participate
in this initiative (at least one physician must participate
on the team).
- Provide team members' time devoted to improvement activities.
For each team member a minimum of 3-4 hours per week and
at least twice monthly team meetings are required. The
site will not in any manner penalize team members for
time spent working on the Collaborative.
- Provide resources to support the team including resources
necessary for Cluster Learning Sessions and other activities,
and time to implement and test changes in the practice.
- Collect data as defined by the Collaborative at least
monthly, and plot the data over time as part of the monthly
report for the duration of the initiative.
- Provide team members with electronic mail and access
to a computer daily. E-mail is the primary communication
tool for the Collaborative.
- Share experiences and data openly so that knowledge
and learning can be summarized.
- Maintain a project notebook that documents data, progress
and experience of the participating health center.
- Assure that at least one team member participates in
each cluster conference call as scheduled by the Cluster
Director.
- Collaborate with appropriate state and local programs,
such as the state Diabetes Control Programs (DCP), American
Heart Association, and American Lung Association.
What Can My Health Center
Expect from Participation in this Collaborative?
Over the life of the Collaborative, Health Centers can expect
a competitive advantage to result from:
- Transformation of clinical practice through models of
care, improvement and learning.
- Enhanced quality of interaction, between patients and
staff focused on their chronic disease.
- Enhanced patient understanding in managing their own
care.
- Enhanced productivity of providers and staff by reducing
duplication, eliminating waste, and simplifying the system.
- Reduced costs by focusing on preventative and proactive
efforts and increasing provider and staff productivity
- Receipt of extensive technical assistance in the area
of quality management and disease management.
- Documentation of improved health outcomes for underserved
populations.
- Development of infrastructure, expertise and multi-disciplinary
leadership to support and drive improved health status.
The Collaborative agrees to:
- Pay for travel and lodging for team members to attend
learning sessions.
- Provide curriculum and faculty for all learning sessions.
- Provide ongoing technical assistance to the teams through
the use of models of care, improvement strategies and
shared learning.
- Provide coaching and feedback on monthly reports to
the teams.
- Facilitate strategic partnerships with local, state,
and national organizations and government agencies.
How Much Does This Cost
My Health Center?
There is no application fee to participate in the Collaborative.
The health center will allow administrative time for team
members to meet weekly to work on the Collaborative and
attend four learning sessions during the first year of the
collaborative and to participate in yearly reunions during
their participation in the collaborative.
Is Our Organization Ready
to Participate in a Collaborative?
If your organization shares the following characteristics,
then the methodology will probably work for you:
- A CEO who desires streamlined processes and understands
that quality improvement is an investment in the bottom
line
- A learning organization focused on excellence in patient
care and services.
- A cadre of top management staff who can live with/work
with a self-directed team.
- The ability to provide team-members with weekly times
to mprove the system of care.
- A clinical person who understands the need for chronic
disease management and fervently believes in its applicability
to your center.
What Commitment Must Management
Make?
Management (CEO, Medical Director, Nurse Manager, etc) support
of the Collaborative must be unwavering. It is important
for management to understand that the Collaborative is a
destabilizing force (since systems cannot remain as they
are) but the team can be successful. It is therefore normal
that some staff will resist initial efforts to redesign
the systems. These same people are likely to become key
champions and enthusiastic supporters of the collaborative.
The success of the team is directly proportional to the
support received from senior leadership.
How does the Collaborative
fit in with MWCN?
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