Overview of Evidence Based StrategiesBeatriz Whitmore [email protected]...

Overview of Evidence Based StrategiesBeatriz Whitmore with Integrated Health Partners

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Agenda

1. Brief overview of Integrated Health Partners (IHP)2. IHP’s Coaching Model3. Evidence Based Strategies:

• Quality Data Board• Decrease in Emergency Department utilization• Medical Assistant Learning Collaborative


Integrated Health Partners

• Physicians Organization (PO) in Battle Creek, Calhoun County MI

• 167 physicians are part of our organizationo 60 Primary Care Physicianso 107 Specialist Physicianso 72 Advanced Practice Professionals

• 78 practices

• Specialist offices include Chiropractors, Behavioral Health and Physical Therapy


IHP’s Coaching Model

• Support practices with Lean/process improvement activities

• Patient Centered Medical Home and Patient Centered Medical Home – Neighbor concepts and requirements

• Evidence Based Care quality measures such as HEDIS, Emergency Department and Radiology utilization

• Data analysis and performance tracking and improvement


Evidence Based StrategiesQuality Data Boards


Emergency Department Utilization

Current State (2014/2015)• Through data provided by health plans and local hospital, practice identified great opportunity

for improvement • Average of 1000 patients visiting the ED monthly

Process Change Steps (July 2015)• Involved office staff in creating a campaign to prevent patients from going to the ED• Tracked ED data weekly and monthly to see progress

Outcomes• ED visits were reduced by about 40% • ED follow-up visits were reduced• Office has increased operating hours to facilitate patient access


Medical Assistant Learning Collaborative

Current State (2014)• Medical Assistants (MA) struggling to set self-management goals with patients due to lack of

knowledge of disease states• “How can I sit down with a patient and help them, if I don’t understand the disease myself?” • Office managers reporting consistent MA turn over and limited training they receive while in

school

Goal Strengthen medical assistant’s confidence in caring for patients with chronic conditions and

supporting patients with self-management of their condition Empower medical assistants in their role in providing team-based healthcare Improve medical assistant’s customer service skills with both internal and external

“customers” Advance medical assistant’s skills in performing PCMH and PCMH-N related processes Gain new ideas and share best practices


Steps to initiate the learning collaborative (1st quarter 2015)

• Surveyed Office Managers for content and frequency desired for meetings

• Researched education topics offered by pharmaceutical companies, MDHHS, Health Department, IHP providers and other community partners

• Applied for Medical Assistant education credits

• Completed pre-assessment and Memorandum of Understanding

• Requested internal Executive Sponsorship

• Recruited offices

• Developed calendar: sessions were held for four hours each, three to four weeks apart


Collaborative Learning Content:

5/14 – Four Foundational Factors in Team Success

6/11 – Customer Service Standards and Managing Up

7/9 – Diabetes Education and Meal Planning Strategies

8/13 – Smoking Cessation, Coordinating Care with Schools and Colorectal Cancer Screening

9/10 – Diabetic Foot Exams and Pain Management

10/1 – Immunizations

11/5 – Advance Directives, Med Rec, Self-Management Support and Community Resources

12/3 – Maximizing Care and Reimbursement through Health Plan Incentive Programs, Putting it All Together in the PCMH Neighborhood, and Process Improvements


Outcomes• 36 participants

o 18 practices totalo 5 specialist practiceso 13 primary care practices

• 96% of participants answered yes when asked if as a result of this training they have improved their skills

• Office Managers have verbally reported MAs performance improvement

• Second Medical Assistant Learning Collaborative starting May 19, 2016.


Thank you!

Contact Information

Integrated Health Partners 77 East Michigan Avenue

Battle Creek, MI 49017Phone: 269-425-7110

Beatriz [email protected]

269-425-7118


Colorectal Cancer Evidence-based Intervention Within the

Arab American Community

Arab Community Center for Economic and Social Services (ACCESS)

Hiam Hamade, BSN. MA. MPH


Background of Arab AmericansWho are Arabs ?

Arabs are those who speak Arabic as their native tongue and who identify themselves as Arabs,

350,000 million people live in 22 independent countries that make up the Arab world, 8 countries in Africa and 14 in Asia


Challenges

Educational level Cultural differences Religious beliefs Language barriers Topic Indifference & disengagement


Barriers to health care servicesSocioeconomic barriers

Lack of health and medical insurance coverage Lack of access to health care High unemployment especially among new

immigrants and refugees Language barriersCultural barriers Cultural inhabitation around diseases Lack of culturally competent health services Stereotypes, bias and prejudice from care giver Lack of interpreters, bilingual and bicultural

materials Westernization Change in diet Increase in sedentary activities Stress of life style changes


Psychosocial and Cultural Factors

• Psychosocial Factors associated with Cancer– Fear of screening process– Fear of negative results– Embarrassment and stigmatization– Language barriers– Lack of knowledge about colon cancer– Transportation and economic barriers– Cultural and religious barriers


Strategies for SuccessfulColorectal Cancer Measures

• Objectives & Strategies– Assessing our Needs

Structural barriers

– Identifying how to reduce barriers– Methods to track results– Outcomes and measuring results


Fundamental structural changes needed to improve our health care system!

Fundamental structural changes needed to improve our health care system!

Tertiary Care

SecondaryCare

Primary

Care

Tertiary Care

Secondary

CarePrimaryCare


Structural Barriers```````````````

Outreach Education```````````````

Sending Reminders& Calls

``````````````Knowledge Assessment

Measure &Outcome Specialty

certification

Outcomes

Strategies for Successful Colorectal Cancer Activities


Screening Barriers Understanding

How do we help?

Designing outreach activities to increase our enrollment and screening efforts.


Outreach Activities

Performing more presentations in regards to CRC in the community. Such presentations and outreach activities are provided in both Arabic and English languages. Through these presentations, we hope for overcoming some language barriers within the community which allows us to send our voice further.


Additional Outreach Activities

Performing more Media outreach: – TV & Radio– Articles

Planning focus groups to further increase awareness and understanding for colorectal cancer within the community

Reducing Structural Barriers (navigation/follow up/translation & Transportation)


Strategies for SuccessColon Cancer

• Evidence Based Interventions (Client Directed)– Client Reminders Cards: Client reminders are written (letter, postcard, email) or

– telephone messages (including automated messages) advising people that they are due for screening.


Reminder Cards Sent out to our Clients


Reducing Structural barriers to colon cancer screening

Offering transportation services to clients facing transportation barriers


Assessing Community Knowledge Regarding Colorectal Cancer

• A knowledge assessment study composed of 18 questions in the form of True/False or Yes/No

• The goal is to assess the knowledge of the community regarding colorectal cancer.

• The knowledge questions/phrases address various aspects pertinent to colorectal cancer. These include:– Total Knowledge of CRC– General Knowledge of CRC– Knowledge of CRC Risk Factors– Knowledge of CRC Screening– Knowledge of Physician Interactions


Successes

• We have identified our age eligible patients and sent out 100 reminder cards, called 75 patients and have assessed 60 of those patients to determine eligibility and refer them to the appropriate screening program.

• In Quarter 2 of the grant, we have already tripled the number of patients who have been screened or have been referred for a colonoscopy. We feel confident those referrals will be completed screenings.


Wrap up

• To Conclude: – By assessing our current process, and adding some new systems changes which are proven to be effective, we have been very successful in increasing our colorectal cancer screening rates.


Thank you!

Questions?


Lenawee County Health Department

THERESA ENRIQUEZ – WISEWOMAN COMMUNITY NAVIGATOR


HISPANIC/MIGRANT POPULATION

Michigan has about 100,000 undocumented immigrants according to the Detroit Free Press with 45% coming from Mexico

Number of Lenawee County residents born outside U.S is 1,655

36% originate from Latin America 46% foreign-born residents are now U.S. citizens

Information gathered from the U.S. Census Bureau


WHAT ARE THE BARRIERS?

Language barrier

Immigration status

Affordable/Attainable Healthcare

Transportation


LANGUAGE BARRIERS

Approximately only 30 percent of the Migrant Farm Workers can speak English well

Paperwork is not available in Spanish

No translator available


What have we done:

Have a full-time translator at our Health Department

Translated forms into Spanish which cuts down 15-20 minutes on clinic time per woman who needed questions translated

Send reminder letters in Spanish Make reminder calls for appointments


Immigration Status

Misconception that immigration officials coordinate with health centers

We let them know that a Social Security number is not necessary to receive services


Affordable/Attainable Healthcare

Undocumented Immigrants are only able to receive Emergency Medicaid

Cannot purchase healthcare with their own money in Marketplace


Transportation

Most migrant workers rely on others for transportation

We offer free Dial-A-Ride tickets

There are Community Volunteers who will transport


SOCIAL, ECONOMIC AND ENVIRONMENTAL CONDITIONS

Migrant workers make up 1/3 of the agricultural industry’s labor force

Pesticides can cause rashes, headaches, vomiting, neurological damage, birth defects, and cancer

Receive low wages

Close living quarters makes it easier to acquire/spread communicable disease


Migrant Worker Housing at Camps

THEN NOW


Outreach

Set up at Community Events: Cinco de Mayo Festival in Adrian on May 3, 2015 Attend Migrant Resource Council (MRC) every 3rd Monday

each month and network with other agencies Market Fresh Coupon distribution on June 13, 2015 at

Downtown Farmers Market Market Fresh Coupon distribution on July 11, 2015 at

Downtown Farmers Market Migrant/Seasonal Farmworkers Health Fair on July 16, 2015 at

Blissfield School


Outreach continued…

Focus Groups held on August 11, 2015 held at the Lenawee Christian School

Preservation Class on September 02, 2015 held in Demo Kitchen at DHHS building

Stress Less With Mindfulness (Begin with the Breath)on September 28, 2015 at the Adrian Public Library

Stress Less With Mindfulness (Mindful Eating) on October 26, 2015 at the Adrian Public Library


Continued…

Attended Hunger Free Lenawee Breakfast on January 13, 2016 at DHHS and networked with food pantries

Project Connect at the Lenawee County Fairgrounds on January 27, 2016

Conference for Growers and Service Providers on April 6, 2016

WISEWOMAN Community Group Workshop in Demo Kitchen at DHHS on April 21, 2016


Fiscal year numbers

FY15 we had 60 Hispanic women come through the clinic which accounted for 28.3% of our caseload

FY16 we have had 30 Hispanic women come through the clinic which accounts for 30% of our caseload


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Overview of Evidence Based StrategiesBeatriz Whitmore [email protected]...

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