Health Disparities Collaboratives
(General Information)
Overview

The Health Disparities Collaboratives (HDC) are an exciting initiative of the Bureau of Primary Health Care (BPHC), in cooperation with the Institute for Healthcare Improvement (IHI). This initiative utilizes a new approach towards quality improvement to accelerate learning, innovation and change. It is designed as a multi-year project to improve care and outcomes for chronic diseases.
The initiative works on a quality improvement model implemented in health centers by a team of clinical and administrative staff. Measures of success already show improved self-management skills for over 100,000 patients across the country. The organization of the BPHC Health Disparities Collaboratives is in five regional clusters.
Currently, the Collaboratives are in the ninth year of focus on chronic conditions and other related topics, such as asthma, cancer, cardiovascular disease, depression, diabetes, diabetes prevention, and finance/redesign.
For further information on the Health Disparities Collaboratives within your state, contact your state primary care association. (See 14 State PCA Directory)

Background
The Health Resources and Services Administration (HRSA) Health Disparities Collaboratives (HDC) were developed to transform primary health care practices in order to improve the health care provided to everyone and to eliminate health disparities. In 1998, HRSA funded one Primary Care Association/Clinical Network team in each of five regional clusters, in addition to National Clinical Networks focused on oral health, migrant farm worker health care, and homeless health care to work together to develop the infrastructure support for the HDC. HRSA worked with these organizations and the Institute for Healthcare Improvement (IHI) to develop the evidence-based systems of improvement within the HRSA Health Disparities Collaboratives.
During the fall of 1998, HRSA selected eighty-eight health centers to participate in the HRSA Health Disparities Collaborative, which focused on diabetes. Since that time, other Collaborative areas of focus have included asthma, depression, cardiovascular disease, cancer screening/planned care, finance/redesign, prevention, diabetes prevention, perinatal/patient safety, and oral health. Approximately 800 health centers are participating in the HRSA Health Disparities Collaboratives as of September 2006.  This includes a number of health centers that have participated in HDC-equivalent collaborative activities sponsored by Primary Care Associations, foundations, and county and state health departments.

Collaboratives Structure
HRSA has developed an infrastructure to support the work of the HDC. At the federal level, HRSA provides funding, leadership and oversight for Collaborative operations, program management, national knowledge management and evaluation. National experts in a variety of fields (clinical care, business case/redesign, health center operations, community oriented primary care, the planned care model, process improvement and health information technology) provide their expertise to the HRSA Health Disparities Collaboratives.
The HRSA Health Disparities Collaboratives infrastructure is further organized around five geographic Clusters of states (Contact Us). States are regionally linked together to form Clusters; each Cluster encompasses 2 Regions, as designated by the U.S. Department of Health and Human Services (HHS).  There are currently five Clusters:

Within each Cluster, a state Primary Care Association (PCA) currently serves as the lead agency. The PCA partners with a selected Clinical Network, as well as with all PCAs and Health Center Controlled Networks within the Cluster. Cluster staff provides day-to-day “hands on” coaching, management, training, networking, technical assistance and support to HDC participants. External partnerships are critical and are purposefully developed by the Cluster infrastructure. Cluster staff work with local, state, and national partners.
Health centers that decide to participate in the HDC complete a process that includes a formal application to clarify reasons and goals for their participation, and may include an interview with the center’s Executive Director and Medical Directors to assure leadership commitment. See "Health Center Application" Section.

With the help of the Cluster staff, a participating health center initially selects a multi-disciplinary team of 3-5 staff members. Health center staff include the “senior leader”, who has the authority to allocate the time and resources necessary to achieve the team’s aim; a “day-to-day leader” or “key contact”, who manages the team, arranges meetings, assures tests are being completed, and data is collected; a “clinical champion”, who believes strongly in quality improvement and is willing to work with others to test, implement, and spread changes; a “technical expert”, who has a strong understanding of the process to be improved and changes to be made and also provides expertise in process improvement, data collection and analysis and team function. The health center agrees to make time available to each member of the team to work on the HDC. In addition, the team must be given time away from the health center to participate in learning sessions or summits. This multi-disciplinary health center team is responsible for disseminating the lessons learned throughout the entire health center organization in order to spread the improvements to reach all sites, providers, and areas of focus aiming for total system transformation.

HRSA Collaborative Process
Participation in a HRSA Health Disparities Collaborative introduces health centers to three models: The Care Model, The Model for Improvement, and The Learning Model. (See HDC Models)

HRSA currently provides support to approximately 800 health centers that are working to implement these models in their own organizations.

HRSA support includes:

Collectively these systems facilitate communication, coaching and infrastructure support so that learning can be shared and improvements accelerated.
Health Centers participating in HRSA Health Disparities Collaboratives agree to adopt shared national measures, as well as local measures based on proven guidelines. Measures are aligned with expert guidelines, external reporting requirements such as HEDIS, or other community standards of care. One important shared national measure of every HRSA Health Disparities Collaborative is “patient self-management”, since supporting self-care is an integral part of the Care Model, crossing all conditions as well as prevention and cancer screening.

Organizations will typically spend about 12 – 13 months learning and applying the models to improve their healthcare delivery systems by adapting the general principles to their unique environments and communities. Resource expenditures vary greatly, but include staff participation in learning sessions and conference calls, and the staff time to learn, design and monitor changes.

As the Health Centers embed their work into their organizational frameworks and continue improvements, they are supported by continued coaching and feedback.

Collaborative participants will tell you that change is difficult and that hard work is required. But most will also say that they never want to go back. Supported by the objective data that includes improved patient outcomes and higher provider and patient satisfaction, we are encouraged to continue this work to provide the best patient care possible.

HDC Models
HRSA Health Disparities Collaboratives have involved between 120 and 150 health center organizations per year, working together in an initial learning phase. Expert faculty guidance, sharing among participants and application of the learning in individual settings provide a rich supportive environment for participants.  Following the initial learning phase, participants continue to sustain and spread the improvement methods with an aim of total system transformation as part of the national HDC community.  Used together, these three models have a proven track record of leveraging healthcare improvements that have helped hundreds of thousands of patients across the nation.

Planned Care Model
Knowing what you should do and actually being able to consistently do it has proven to be a challenge in today’s busy practices. So part of every collaborative is a “change package”, which is designed by the experts to help teams eliminate the gap. These ideas guide participants to focus on key areas that have been demonstrated to create positive change.

The HRSA Health Disparities Collaboratives use the structure of the Planned Care Model. This model identifies 6 major categories that must be addressed to achieve substantial change:

These components interact with each other as depicted in the schematic.

Acknowledgements:
Improving Chronic Illness Care, a national program of the Robert Wood Johnson Foundation, MacColl Institute, Seattle, WA

More about Care Model Change Concepts can be found at http://www.improvingchroniccare.org/change/model/components.html.  

Model for Improvement

Participants learn about specific changes that can be made within each area. Changes are then “tested” at each site, guided by the Model for Improvement designed by Associates in Process Improvement, Inc (API). Part of the learning of the collaborative is the art of making small changes and learning from each change – the PDSA process. Changes that are effective are expanded. Multiple changes in high leverage areas result in transformational change. This is the “execution” part of the equation.

More about the applications of the Model for Improvement can be found at http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/.

Learning Model

The “ideas” come from a variety of sources that appeal to adult learners. The Learning Model adopted by the Institute for Healthcare Improvement (IHI) uses a process of pre-work, learning and action periods designed to effect organizational change.

                                          (3-6 month time frame)



PECS
Disease registries are computer-based and provide an up-to-date source of patient and population clinical data. Health centers are encouraged to partner with community organizations to leverage health programs and resources for patients.

The Patient Electronic Care System (PECS) is a software program specifically aimed at supporting the adoption of the Care Model in the care of patients with diabetes, cardiovascular disease, asthma, depression, HIV/AIDS, cancer, and preventive service needs. It is the latest iteration of registries supported by the BPHC for the Health Disparities Collaborative. Former registries are DEMS, CVDEMS and HEMS. For more specific information please visit the PECS Data Dictionary.

If you are a member of the HDC Community and would like to communicate with the other PECS Users, please join the Clinical Information Systems (CIS) virtual office. Instructions for joining the virtual office are available on the national website at http://healthdisparities.net/hdc/help.site.myaccount.aspx.      

Health Disparities Collaboratives
(Southeast Atlantic Cluster)
Mission
The mission of Southeast Atlantic Health Disparities Collaboratives (SAC) is to facilitate effective leadership of health care delivery systems through the integration of direction, training, and resources to improve outcomes for every patient in the Southeast Atlantic Region.

Vision
The vision of the Southeast Atlantic Health Disparities Collaboratives is the widespread implementation and integration of a continuous learning model, leading to a primary care delivery system in which every patient has access to planned care that results in measurable improvement in health outcomes.

Objectives
In an effort to obtain our mission and vision, the Southeast Atlantic Cluster has set forth the following objectives:

Southeast Atlantic Cluster Staff
The Southeast Atlantic Cluster staff members located throughout the Southeast Atlantic Region assist participating community health centers with the development of infrastructure, expertise, and leadership to support and drive improved health outcomes through continual learning, improvement and change. For more information regarding the SAC staff, please visit http://www.healthdisparities.net/hdc/html/about.maps.clusterMap.aspx.    

Southeast Atlantic Cluster Teams
As of April 1, 2007, approximately 85% of Primary Care Centers in the Southeast Atlantic Region have participated/are participating in the HDC. 

Although organizations within the Collaboratives pursue goals matched to local needs, all work to accomplish the national goals and outcome measures as well.
Click on the below area of focus to see national outcome measures.  

PECS

The Patient Electronic Care System (PECS) is a software program specifically aimed at supporting the adoption of the Care Model in the care of patients with diabetes, cardiovascular disease, asthma, depression, HIV/AIDS, cancer, and preventive service needs. It is the latest iteration of registries supported by the BPHC for the Health Disparities Collaborative. Former registries are DEMS, CVDEMS and HEMS. For more specific information please visit the PECS Data Dictionary.

If you are a member of the Southeast Atlantic Health Disparities Collaboratives Cluster and would like more information on the Southeast Atlantic Cluster Clinical Information Systems (CIS), please join the SAC web portal at www.sacsupport.net.  

Partnerships

In an effort to provide the participating community health center teams with support and encouragement as they embark on their Collaborative journey, the Southeast Atlantic Cluster has partnered with various local, state and national entities, including the fourteen Southeast Atlantic Primary Care Associations, State Cardiovascular and Diabetes Prevention and Control Programs, Health Care for the Homeless Clinician’s Network, Migrant Clinician’s Network, and National Network for Oral Health Access.

For further information on the Southeast Atlantic Health Disparities Collaboratives, contact Kenya L. Mingo, MBA, SAC Administrative Director at 803.788.2778 x204 or kenyam@scphca.org.