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Linking Clinical Care and Communities for Improved Prevention Web Seminar Sept. 1, 2011 Follow Linking Clinical Care and Communities for Improved Prevention Web Seminar Sept. 1, 2011 Follow this event on Twitter Hashtag: #AHRQIX 1

Using the Webcast Console Using the Webcast Console

What Is the Health Care Innovations Exchange? n Publicly accessible, searchable database of health What Is the Health Care Innovations Exchange? n Publicly accessible, searchable database of health service delivery innovative strategies and tools n Successes and attempts n Innovators’ stories and lessons learned n Expert commentaries n Learning and networking opportunities n New content posted to the Web site every two weeks 3

Innovations Exchange Web Event Series How to find archived materials Go to the Events Innovations Exchange Web Event Series How to find archived materials Go to the Events & Podcasts tab on our site: http: //www. innovations. ahrq. gov. A transcript of this event along with the slides will be available in a week. Next Events Look for announcements 4

Housekeeping n For help, notify the Vcall team through the question window at the Housekeeping n For help, notify the Vcall team through the question window at the bottom right hand side of the screen. n To refresh your screen, hit f 5. n Recording, slides, and transcript available on Web site by next week. n Today’s slides are available now. 5

Submitting Questions Submitting Questions

Today’s Event Moderator Tess Miller, Dr. PH Director, Prevention & Care Management Portfolio, Center Today’s Event Moderator Tess Miller, Dr. PH Director, Prevention & Care Management Portfolio, Center for Primary Care, Prevention & Clinical Partnerships Agency for Healthcare Research and Quality (AHRQ) 7

AHRQ’s Mission To improve the quality, safety, efficiency, and effectiveness of health care for AHRQ’s Mission To improve the quality, safety, efficiency, and effectiveness of health care for all Americans Health care providers, patients, policymakers, payers, administrators, and others use AHRQ research findings to improve health care quality, accessibility, and outcomes of care

AHRQ’s Portfolios n Comparative Effectiveness n Health Information Technology n Innovations & Emerging Issues AHRQ’s Portfolios n Comparative Effectiveness n Health Information Technology n Innovations & Emerging Issues n Patient Safety n Prevention/Care Management n Value

P/CM Portfolio Strategic Goals 1. To support clinical decision making for preventive services through P/CM Portfolio Strategic Goals 1. To support clinical decision making for preventive services through the generation of new knowledge, the synthesis of evidence, and the dissemination and implementation of evidence-based recommendations

P/CM Portfolio Strategic Goals 2. Support the evidence base for and implementation of activities P/CM Portfolio Strategic Goals 2. Support the evidence base for and implementation of activities to improve primary care and clinical outcomes through: § § § Health care redesign Clinical-community linkages Self management support Integration of health information technology Care coordination

AHRQ’s Goal n To understand whether fostering linkages between clinical practices and community organizations AHRQ’s Goal n To understand whether fostering linkages between clinical practices and community organizations enhances delivery of preventive services and ultimately improves health outcomes n To understand how to foster and sustain linkages

Potential Benefits of Linkages n Creating sustainable linkages between primary care and community settings Potential Benefits of Linkages n Creating sustainable linkages between primary care and community settings can be a WIN-WIN n Patients: Increased patient access to preventive and chronic care services n Clinicians: Ability to refer out to services in the setting where their patients live, work, and play n Communities: The services that they work hard to provide will get used more, leading to better care and potentially sustained funding n Community settings have the ability to offer intense, ongoing, accessible services that may not be possible in primary care practices

AHRQ’s Activities n Co-sponsor of Prescription for Health n First environmental scan and summit AHRQ’s Activities n Co-sponsor of Prescription for Health n First environmental scan and summit 2008 n 2009 -2010 – Environmental scan – Case studies – Summit of stakeholders to develop a national strategy for promoting linkages n Development of Innovations Exchange page to facilitate the ongoing collaborative work of Summit participants and interested stakeholders

Conceptual Model for Linkages Conceptual Model for Linkages

Our Innovators Carol Ann King, DNP, FNP-BC Wayne Action Teams for Community Health (WATCH); Our Innovators Carol Ann King, DNP, FNP-BC Wayne Action Teams for Community Health (WATCH); Eastern Carolina College of Nursing La. Tonya Chavis Keener, MS Centers for Disease Control and Prevention (CDC) 17

Colorectal Cancer Screening and Tobacco Cessation in a Free Primary Care Program for the Colorectal Cancer Screening and Tobacco Cessation in a Free Primary Care Program for the Uninsured Carol Ann King, DNP, FNP-BC WATCH Lead Nurse Practitioner Clinical Assistant Professor East Carolina University College of Nursing

What is WATCH? Wayne Action Teams for Community Health n Grant and donation-funded since What is WATCH? Wayne Action Teams for Community Health n Grant and donation-funded since 2000 n Safety net primary health care for the uninsured n No charge to the patients n Over 10, 000 registered patients n 1, 000 patient visits per month

WATCH Mobile Unit WATCH Mobile Unit

North Carolina Prevention Collaborative n Joint project with Kate B. Reynolds Charitable trust, UNC North Carolina Prevention Collaborative n Joint project with Kate B. Reynolds Charitable trust, UNC Dept. of Family Medicine, Wake AHEC n 1 year quality improvement program n Improvement of office systems n CRC screening —only 16% screened n Tobacco use very prevalent with high risk population— 40% use tobacco, only 66% offered tobacco cessation

Why Colorectal Cancer and Tobacco Use? n CRC: Third leading cancer diagnosis in 2009 Why Colorectal Cancer and Tobacco Use? n CRC: Third leading cancer diagnosis in 2009 – 90% survival if localized – 68% survival if regional – 10% survival with distant metastasis n Deaths can be reduced by 33% with CRC screening beginning at 50 (CDC) n Socioeconomic and racial disparities n High rates of tobacco related mortality and morbidity n Can we do the screening and interventions necessary to address these issues?

Evidence for Interventions n Three options: fecal occult blood tests, sigmoidoscopy, & colonoscopy n Evidence for Interventions n Three options: fecal occult blood tests, sigmoidoscopy, & colonoscopy n Annual three-card FOBTs done on 3 different samples n Referral for positive results n Tobacco assessment n Stages of Change Model/PDSA Cycle n Multilevel interventions

Partnerships n n n Staff Patients Local Providers Hospital NC State Resources n YMCA Partnerships n n n Staff Patients Local Providers Hospital NC State Resources n YMCA – In-house clinic – Mutual Goals – Access to mutual services – Counseling

Partnerships n Population investment n Overall community cost savings n Building capacity n Mutual Partnerships n Population investment n Overall community cost savings n Building capacity n Mutual benefits and goals

Recommendations n Promote your program n Outcomes n Integrate into the community n Help Recommendations n Promote your program n Outcomes n Integrate into the community n Help others with their goals

Discussion/Implications n WATCH able to implement CRC screening n CRC Risk Reduction Education n Discussion/Implications n WATCH able to implement CRC screening n CRC Risk Reduction Education n Tobacco cessation and reduction focus n Committed to the end n Trial and error n Commitment n Integrated into existing workflow n Policy and procedure

Lessons Learned n. Communicate! n. Revised patient instructions n. Training n. Take advantage of Lessons Learned n. Communicate! n. Revised patient instructions n. Training n. Take advantage of opportunity to screen and educate n. Patients “buy-in” because provider recommended

No Such Thing as “Free Care” n $773 for the sample n $3, 500 No Such Thing as “Free Care” n $773 for the sample n $3, 500 annually n $1600 staffing for sample n $8, 000 annually n $11. 87 per patient n $475 per polyp detection

Case Presentations 56 year-old male: n Never screened, no known risks, symptoms or signs, Case Presentations 56 year-old male: n Never screened, no known risks, symptoms or signs, positive FOBT n Precancerous polyps removed 45 year-old female: n 30 year smoker, 2 packs/day n Quit and remains tobacco-free n YMCA full membership

Sustainability n Build costs into budget n Find community partners n Local, state, and Sustainability n Build costs into budget n Find community partners n Local, state, and federal resources n Multiple staff trained n Reminders n Time and repetition

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH La. Tonya Chavis Keener, MS Cooperative Agreement RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH La. Tonya Chavis Keener, MS Cooperative Agreement U 50 DP 422161 -05

Goals for REACH 2010 To eliminate disparities in health status experienced by racial and Goals for REACH 2010 To eliminate disparities in health status experienced by racial and ethnic minority populations in key areas

u. Focus: Cardiovascular Disease & Diabetes u. Based on disease prevention strategies u. NW u. Focus: Cardiovascular Disease & Diabetes u. Based on disease prevention strategies u. NW Area of Charlotte (approximately 14 defined neighborhoods) u 95% African American

Coalition Partners u Carolinas Healthcare System u University Park Neighborhood Association u Mecklenburg County Coalition Partners u Carolinas Healthcare System u University Park Neighborhood Association u Mecklenburg County Health Department u Cluster I Neighborhood Leadership u Mc. Crorey Family YMCA u Substance Abuse Prevention Services, Inc. u North Carolina Department of Health and Human Services

Community-Based Primary Prevention Interventions Risk Factor Reduction Blood Pressure Reduction Weight Reduction Interventions -Enhanced Community-Based Primary Prevention Interventions Risk Factor Reduction Blood Pressure Reduction Weight Reduction Interventions -Enhanced access -Community campaigns -Point of decision prompts -Social Support Behavior Changes Participation in Regular Exercise Cholesterol Reduction -Community Campaigns -Point of Contact Interventions -School Standards Healthy Dietary Habits Smoking Cessation Risk Factor Reduction -Faith-based settings -Smoking bans -Media Campaigns Smoking Use of Primary Medical Care Educate, Motivate, Recruit, Reinforce Lay Health Advisors -Disease Management -Quality Improvement

“But what it did for me is…. help me with my self-esteem. It helped “But what it did for me is…. help me with my self-esteem. It helped me! I began to exercise, I started at the Y too. I came down here for my financial reasons, I came down here because they have the same things down here as they do at the Y, and I exercise, I learned about nutrition because we have the nutritional program here, and I’m a lot more outgoing. You would never believe that I was very, very introverted, very. ” - Neighborhood Resident

Neighborhood Farmer’s Market Neighborhood Farmer’s Market

“It’s just like a meeting place on Saturday mornings, you know, everybody be up “It’s just like a meeting place on Saturday mornings, you know, everybody be up there on Saturday mornings to get your little vegetables, you stand around and talk. Somebody will give you advice on how to cook them. ” - Neighborhood Farmers’ Market Customer

Percent Reporting Diabetes Data Analysis by National Opinion Research Center (NORC) and ABT Percent Reporting Diabetes Data Analysis by National Opinion Research Center (NORC) and ABT

Impact of Charlotte REACH 2010 on Diabetes: n Increased knowledge of diabetes & community Impact of Charlotte REACH 2010 on Diabetes: n Increased knowledge of diabetes & community resources n Healthier eating habits (5 or more servings of fruits & vegetables per day) n Greater physical activity n Decrease in reported complications n Greater adherence to recommendations for eye exams n Mixed success in adherence to recommendations for foot exams Data Analysis by National Opinion Research Center (NORC) and ABT

Sustainability u. Neighborhood-operated Farmers’ Market remains in community u. Diabetes Nurse position maintained at Sustainability u. Neighborhood-operated Farmers’ Market remains in community u. Diabetes Nurse position maintained at Carolinas Healthcare System u. Lay Health Advisors and neighborhood leaders continue to lead efforts

“I think overall I think of the community at large, all over everyone is “I think overall I think of the community at large, all over everyone is encouraging better health, exercise, eating better, and the fact that we encourage friends and family to come, you know, is a real plus, and I think it’s like a snowball effect the more we talk about it, the better we look. As you said we got to walk the walk to talk the talk, and by losing weight, health, and people commenting, you know, it does make a difference. ” - Charlotte REACH LHA

Additional Information n http: //www. annfammed. org/cgi/content/full/ 2/2/103 Additional Information n http: //www. annfammed. org/cgi/content/full/ 2/2/103

Innovator Contact Information n Carol Ann King: kingca@ecu. edu n La. Tonya Chavis Keener: Innovator Contact Information n Carol Ann King: [email protected] edu n La. Tonya Chavis Keener: [email protected] gov

The Innovations Exchange Visit our Web site: http: //www. innovations. ahrq. gov/ Follow up The Innovations Exchange Visit our Web site: http: //www. innovations. ahrq. gov/ Follow up on Twitter: #AHRQIX