Health Disparities Collaboratives Prove Successful in Montana’s Migrant and Community Health Centers (M/CHCs)

In January 1999, the Bureau of Primary Health Care (BPHC) partnered with the Institute of Healthcare Improvement to initiate the Health Disparities Collaborative Care Model. This care model is part of a multi-year BPHC strategy to improve health outcomes for underserved patient populations with chronic illnesses. The Collaborative approach focuses on a practice-designated registry of patients within a clinic. The practice sets specific health-related goals for their registry, and utilizing rapid change theory, staff from every level of the practice is involved in planning and implementing day-to-day changes to reach those goals.

Some common Collaborative activities include redesigning the patient visit, planning for patient education, developing teaching tools, creating referral relationships in the community, establishing new funding sources for low-income patients. This population-based care model contributes to a higher quality patient visit which becomes visible in measurable ways: lower blood sugars, better pulmonary function, more reported regular exercise, etc.

A computerized database is established for the registry; specific data from each patient visit is entered which includes care rendered, referrals made, and lab results. Staff can generate and evaluate the data by patient or by population, and continue to apply the rapid change principles to further improve patient outcomes. The successful model represents a true collaboration between a clinic’s patients, medical and administrative staff, board of directors, and with community, state, and federal entities.

The following Montana M/CHC’s have demonstrated success in implementing the Collaborative care model:

Diabetes I, 1999: Community Health Partners, Livingston, (one of eleven CHC’s nationwide selected for the initial BPHC pilot program)

Diabetes II, 2000: Butte Community Health Center; Cooperative Health Center (Helena) and Partnership Health Center (Missoula)

Diabetes III, 2001: Deering Community Health Center (Billings)

Cardiovascular I, 2001: Montana Migrant Council (Billings); Community Health Partners (Livingston)

All of the centers are beyond their first year of intensive practice changes and are now challenged by sustaining and spreading the Collaborative. Patients and staff recognize its benefits and are motivated in continuing their efforts. The care model promotes problem solving for sustainability by the health center itself; support at the regional and federal levels is also available. Most practices are spreading the care model to new providers and sites within their centers, and/or adding another chronic illness to an existing Collaborative. Ideally, the Collaborative Care Model sustains itself as it becomes embedded in each practice’s health care system.

(L-R) Julie O’Dell, LPN, Dawn Gormely, FNP, and Paula Block, RN of the Cooperative Health Center in Helena work on their action plan at the Diabetes II Collaborative Training.

For more information regarding the Health Disparities Collaborative Model, contact Jenifer Sheehy, MPCA, 406-442-2750.