MPCA News

Montana CHCs Are Successfully Reducing Health Disparities

Montana’s Community and Migrant Health Centers (C/MHCs) have been involved in an innovative program designed to improve health outcomes and reduce health disparities since the program’s inception in 1998. Sponsored and developed by the Bureau of Primary Health Care (BPHC), the Health Disparities Collaborative (HDC) is a model of care that utilizes rapid change theory to address specific chronic illnesses in populations. The model emphasizes organization-wide commitment to clinical processes that encourage and motivate patients to make the positive and often difficult lifestyle changes that lead to better management of chronic disease. HDC also utilizes a tracking database to monitor health outcomes for individual patients and for each facility’s program as a whole.

Currently, ten of Montana’s twelve C/MHCs are participating in the HDC, with the remaining two centers planning to initiate the program in 2006. Each facility selects one of four chronic illnesses prevalent in its population to which the HDC model is applied: Diabetes, Cardiovascular Disease, Asthma, or Depression. Teams can also select Access Redesign, in which the facility modifies practice management strategies to better meet the needs of its patients. Rather than delegating the tasks of improving outcomes to a team of clinicians, in the HDC a multi-disciplinary team is formed at each facility consisting of staff persons representing the clinical, administrative, clerical and financial components of the organization. During the initial year’s Learning Phase, teams learn problem-solving in the following six components of care:

1. Self-Management Support: Teams assist patients to become more active in developing individualized, effective plans of care.
2. Delivery System Design: The facility as a whole develops effective patient services.
3. Decision Support: Teams utilize evidence-based models to promote improved clinical decision making.
4. Clinical Information Systems: Teams initiate and maintain computerized databases to track clinical outcomes.
5. Health Care Organization: Teams identify and address facility/organizational problems that may impede HDC processes and improved quality of care.
6. Community: Teams learn to mobilize community resources that lead to improved outcomes for CHC patients.

The cornerstone of Collaborative participation is the Rapid Change Model, which incorporates four steps, Plan, Do, Study, and Act (PDSA). Teams apply the PDSA model continuously as they modify their practices to better emphasize a patient-centered approach to care.

Examples of the HDC’s effectiveness lie in the M/CHC data. Community Health Partners (CHP) in Livingston, the first in the state to participate in a Collaborative, has expanded the HDC to address Diabetes, Cardiovascular Disease, Depression, and Access Redesign. CHP Executive Director Laurie Francis recognizes that “Changing our own care

paradigm, and utilizing a team approach, has the biggest impact on health outcomes.” CHP has seen improvements in indicators in all of the areas addressed by the HDC.

Butte Community Health Center, under the leadership of Executive Director Cindy Stergar, is participating in Diabetes, Depression, and Access Redesign Collaboratives. Stergar reports that in the Depression Collaborative, 100% of patients have made improvements or health-related changes. In the Diabetes Collaborative, average Hemoglobin A1C, a marker of blood glucose levels over the past 3 months, is 7.9%, considered an excellent outcome, especially in an underserved population. Through Access Redesign, waiting times have been reduced to less than 20 minutes, an aspect of clinical practice important to access and continuity of care. “There are many organizational changes as a result of the Collaborative that are immeasurable, but lead to better practice and patient outcomes,” comments Stergar.

Betsy Seglem, Special Projects Coordinator at Glacier County CHC in Cut Bank, echoes Stergar, noting that the HDC “focus on evidence-based medicine filters into all areas of the practice.” Glacier County CHC initiated the Diabetes Collaborative in 2004, and plans to address Cardiovascular Disease and Depression utilizing HDC in 2006.

Like Cut Bank, Sweet Community Health Center in Chinook is relatively new to the HDC, having started the Depression Collaborative in 2004 and currently in the midst of utilizing rapid change PDSA to restructure clinical processes. An important startup task in the first HDC year lies in initiating a database, incorporating it into the clinical practice, and utilizing the data. “We have already improved the percentage of patients having two A1C tests 90 days apart,” states Executive Director Karen Bradway, commenting on an evidence-based practice associated with the successful lowering of blood glucose levels.

Montana’s M/CHC participation in HDC is representative of a national effort to achieve strategic system change in the delivery of primary health care. Since 1998, HDC has evolved as a significant force in creating a CHC infrastructure nationwide to improve the delivery of prevention and acute care services. Over 450 BPHC-supported health centers from across the United States are participating in Collaboratives . The HDC effort is regarded as a model for system change for quality improvement.

For more information on BPHC Health Disparities Collaborative processes, check out these links:

www.healthdisparities.net

www.bphc.hrsa.gov/programs

Montana Primary Care Association 1805 Euclid Avenue Helena, MT 59601 Phone: (406) 442-2750 Fax: (406) 449-2460