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Beyond the Status Quo: Building Effective Coalitions
Crystal Conner, MA Shannon Medical Center
Mimi Baugh, MSNAngelo State CareGiver Research Institute
Tom Green County
13.9% population 65 years old or older
57% White, non-Hispanic 36.3% Hispanic 6.7 % Other
24.3% Uninsured 75.7% Insured
20.4% Medicaid 13.6% Medicare
Source: US Census, 2010, Small Area Health Insurance Estimates; Department of State Health Services, County Health Facts; Texas HHSC Medicaid Enrollment by County, November 2012.
Population 110,224
Tom Green County
From 2006-2011, adult residents (18+) of Tom Green County received $214,677,910 in charges for hospitalizations that were potentially preventable.
Source: US Census, 2010; Department of State Health Services
Population 110,224
The Problem
Hospitalizations for the conditions selected are called “potentially preventable,” because if the individual had access to and cooperated with appropriate outpatient healthcare, the hospitalization would likely not have occurred.
Source: Center for Health Statistics, Texas Department of State Health Services
Preventable Hospitalizations
Condition Definition
Bacterial Pneumonia A serious inflammation of the lungs caused by an infection. Bacterial pneumonia primarily impacts older adults.
Urinary Tract Infection (UTI)
Usually caused when bacteria enter the bladder and cause inflammation and infection. It is a common condition, with older adults at highest risk. In most cases, an uncomplicated UTI can be treated with proper antibiotics.
Chronic Obstructive Pulmonary Disease (COPD)
Characterized by decreased flow in the airways of the lungs. It consists of three related diseases: asthma, chronic bronchitis and emphysema. Because existing medications cannot change the progressive decline in lung function, the goal of medications is to lessen symptoms and/or decrease complications. Source: Center for Health Statistics, Texas Department of State
Health Services
Selected Conditions
Potentially Preventable Hospitalizations for Adult Residents of Tom Green County, Texas
Number of Hospitalizations 2005-2010.
Average Hospital Charge
Total Hospital Charges
Hospital Charges Divided by 2010 Adult County Population
Bacterial Pneumonia
2,666 $21,876
$58,322,558
$692
Urinary Tract Infections
1,445 $15,182
$21,938,091
$260
Chronic Obstructive Pulmonary Disease
1,396 $21,226
$29,631,897
$352
Source: Center for Health Statistics, Texas Department of State Health Services
Financial Impact 2005-2010
Collaborating Organizations• Administrative agency for
County Indigent Program, serving approx. 1,400 clients
• Provides case management• Agreement with local
providers for indigent health services
• Fiscal agent for Preventable Hospitalizations project
Collaborating Organizations• Full Continuum of Care—Independent
Living, Memory Care, Long Term Care, Skilled Nursing, Home Health, Hospice, Peace of Mind Program, Rotary House of Hope, and Outpatient Therapy
• Unique concept of Continuum of Care found nowhere else in this area
• 100 acres, 600 residents, 300+ employees
• Has served the Concho Valley area since 1951
• A leader in innovation with many different options in various Senior Living areas
Collaborating Organizations• 171-bed acute care hospital• Designated Level III Trauma Center• Concho Valley's only accredited
Chest Pain Center• Concho Valley’s only accredited
Congestive Heart Failure facility• Comprehensive Heart and Vascular
program, including open heart surgery
• Robotic-assisted surgery• Level III-A Neonatal Intensive Care
Unit
Collaborating Organizations• The leader and advocate in
facilitating supportive services and opportunities that enable older citizens to be able to live more independently and productive
• One of 28 Area Agencies in Texas
• The region covers over 16,000 miles and approximately 112,000 citizens
• Locally sponsored by the Concho Valley Council of Governments
Collaborating Organizations• 409-bed safety net hospital• Over 225 providers• Locally owned non-for profit
medical center and clinic• With more than 20 locations,
Shannon provides a range of services for Tom Green and 18 surrounding counties
• The lead Level III Trauma Center and Air Med 1 air ambulance serving a 200-mile radius
• The primary stroke center for the region
Collaborating Organizations• Serves older adults, frail elders,
caregivers, and all people providing care to others
• The main focus is helping those providing care to others and education of nurses specifically taking care of the elderly or working in long-term care settings
• The mission of CRI is to ensure that we have caregivers, both formal and informal, who are well-equipped to care for this distinctive group. CRI draws from many campus resources, and a variety of nursing specialties, to help caregivers and nurses provide exceptional care to older adults
Core Partners
Assets Resilience Sustainability
Teach a man to fish.
Partnering Organizations
Intrepid Home Health Odyssey Hospice Meals for the Elderly Myer’s Drug Disability
Connections Relative Marketing &
Design
Sam’s Club San Angelo Standard
Times KIXY radio KKCN radio KLST/KSAN news
Collective Impact: Rules of Engagement Framework for Success
Common Agenda All participants have a shared vision for change including a common understanding of the problem and a joint approach to solving it through agreed upon actions.
Shared Measurement Collecting data and measuring results consistently across all participants ensures efforts remain aligned and participants hold each other accountable.
Mutually Reinforcing Activities
Participant Activities must be differentiated while still being coordinated through a mutually reinforcing plan of action.
Continuous Communication
Consistent and open communication is needed across the many players to build trust, assure mutual objectives, and create common motivation.
Backbone Support Creating and managing collective impact requires a separate organization(s) with staff and a specific set of skills to serve as the backbone for the entire initiative and coordinate participating organizations and agencies.
Common Agenda
Not a transfer of costs Savings to one organization is savings to all
Organizations serve similar populations Collaboration of efforts
Support from organizational leaders Relationships based on shared objectives
Commitment to improving health in Tom Green County
Shared Measurement
DSHS Data brought it to our attention DSHS defined the data sets Allowed for comparisons among the
community DSHS defined accountability
(interventions are evidence-based efforts are targeted)
Mutually Reinforcing Activities
Differentiated interventions with coordinated efforts
Public events, provider conferences, immunization clinics
Print Ads Billboards Online Media (Website, Facebook, Patient
Channel)
April 2012 Public Event October 2012 Provider Event October 2012 Heloise Public
Event Heart of Texas Conference on
Aging Speakers Bureau Health Fairs/Events
Interventions: Events
Education Events
Area Agency on Aging Station 618 Senior
Center Diabetes Update Seminar Sunset Mall Health Fair Friday Immunization
Clinics
Interventions: Immunization Clinics
Hand Sanitizer Hydration Cups Hydration card (urine) Rack Cards in Spanish & English Immunization Records (lifetime & adult) Walking booklet COPD Consult, Harvard Health Publications COPD Manuals, UT Tyler
Interventions: Education Materials
Television, radio, newspaper, classifieds coverage and print ads
Stethoscoop & Heartbeat, hospital newsletters Health Beat Hospital Magazine Direct mail www.tgcpartnershipforbetterhealth.org Patient Channel, The Wellness Network Facebook Page
Interventions: Media
Billboards
Continuous Communication
DSHS Roadmap Required monthly meetings; planning and
status updates Monthly Technical Assistance calls with DSHS
and 16 participating counties Two face-to-face meetings with 16 Counties in
Austin and DSHS experts/staff Sub-committee meetings Intervention Ad Hoc group meetings as needed,
PRN
Backbone SupportOrganization Support Valuable Impact
Educational/Clinical expertise; Educational Provider/Community outreach
Perceived neutrality; Public interest; Health education expertise
Education/Community Advocacy; Direct access to target population
Public interest; Community Outreach; Local governmental entity.
Direct access to target population; Strong understanding of the issue
Public sector “seal of approval”; Credibility
Backbone SupportOrganization Support Valuable Impact
Financial resources;Educational expertise;Logistical support; Direct access to target population.
Represent Private, For-profit health care corporation and providers; Credibility
Financial resources;Educational expertise;Logistical support; Direct access to target population; Grant coordination expertise.
Safety-net hospital; Private, non-profit local provider. Marketing/media expertise. Internal communication; Credibility.
Direct access to target population; Strong understanding of the issue; Start-up funding; Logistical support
Public sector/ local governmental entity “seal of approval”; Credibility; Perceived neutrality.
Where are we now?
Provider/Public Education Collateral materials Website Mobilized immunization resources Center of educational expertise and resources
5,459 high risk adults vaccinated for Bacterial Pneumonia
17,228 high risk adults vaccinated for Influenza 564 high risk adults educated on Bacterial
Pneumonia and ways to possibly avoid it 12 education opportunities provided 505 healthcare providers educated 1,895 smoking cessation services provided
to high risk adults
Bacterial Pneumonia Interventions
305 high risk adults educated on UTI and ways to possibly avoid it
12 education opportunities provided to the general population
505 healthcare providers educated
Urinary Tract Infection (UTI) Interventions
1,594 adults diagnosed with COPD vaccinated for Bacterial Pneumonia
1,169 adults diagnosed with COPD vaccinated for Influenza
1,998 adults diagnosed with COPD educated on the condition and ways to manage it
2652 adults educated on COPD and ways to manage it
505 healthcare providers educated 2,260 diagnosed with or at risk for COPD
provided with smoking cessation services
Chronic Obstructive Pulmonary Disease (COPD) Interventions
Success begets MORE success
Sustainability + Assets = Resilience
Resilience = Effectual Change
Effectual Change Improved
Community Health
“Train the Trainer” program for long-term care & assisted living facilities
Collaborate with existing events and organizations
Promote the website and Facebook page October 18, 2013: Provider Education Look for additional funding/support
Opportunities/Future Efforts
The Status is not Quo.
Contact Information
Mimi Baugh, MSN, RN-BC, RAC-CTDirector, Caregiver Research Institute, Angelo State University
325.486.6607 [email protected]
Crystal Conner, MARegional Health Coordinator, Shannon Health & Wellness
Shannon Medical Center325.657.5677 [email protected]