1
|
Bolen SD, Joseph JJ, Dungan KM, Beverly EA, Perzynski AT, Einstadter D, Fiegl J, Love TE, Spence D, Jenkins K, Lorenz A, Uddin SJ, Adams KM, Konstan MW, Applegate MS. A Medicaid-Funded Statewide Diabetes Quality Improvement Collaborative: Ohio 2020‒2022. Am J Public Health 2023; 113:1254-1257. [PMID: 37824811 PMCID: PMC10632832 DOI: 10.2105/ajph.2023.307410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 10/14/2023]
Abstract
We used a collective impact model to form a statewide diabetes quality improvement collaborative to improve diabetes outcomes and advance diabetes health equity. Between 2020 and 2022, in collaboration with the Ohio Department of Medicaid, Medicaid Managed Care Plans, and Ohio's seven medical schools, we recruited 20 primary care practices across the state. The percentage of patients with hemoglobin A1c greater than 9% improved from 25% to 20% over two years. Applying our model more broadly could accelerate improvement in diabetes outcomes. (Am J Public Health. 2023;113(12):1254-1257. https://doi.org/10.2105/AJPH.2023.307410).
Collapse
Affiliation(s)
- Shari D Bolen
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Joshua J Joseph
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Kathleen M Dungan
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Elizabeth A Beverly
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Adam T Perzynski
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Douglas Einstadter
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Jordan Fiegl
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Thomas E Love
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Douglas Spence
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Katherine Jenkins
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Allison Lorenz
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Shah Jalal Uddin
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Kelly McCutcheon Adams
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Michael W Konstan
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| | - Mary S Applegate
- Shari D. Bolen is with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. Joshua J. Joseph is with the Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. Kathleen M. Dungan is with the Department of Medicine, The Ohio State University Wexner Medical Center, Columbus. Elizabeth A. Beverly is with the Department of Primary Care at The Diabetes Institute, Ohio University, Athens. Adam T. Perzynski is with the Department of Medicine and Department of Sociology, The MetroHealth Medical Center and Case Western Reserve University. Douglas Einstadter and Jordan Fiegl are with the Department of Medicine, The MetroHealth Medical Center and Case Western Reserve University. Thomas E. Love is with the Department of Medicine and Population and Quantitative Health Sciences, The MetroHealth Medical Center and Case Western Reserve University. Douglas Spence, Katherine Jenkins, Allison Lorenz, and Shah Jalal Uddin are with The Ohio State Government Resource Center, Columbus. Kelly McCutcheon Adams is with the Institute for Healthcare Improvement, Boston, MA. Michael W. Konstan is with the Department of Pediatrics, Case Western Reserve University. Mary S. Applegate is with the Ohio Department of Medicaid, Columbus
| |
Collapse
|
2
|
Bolen SD, Koroukian S, Wright JT, Persaud H, Einstadter D, Fiegl J, Perzynski AT, Gunzler D, Sullivan C, Lever J, Konstan M, Crane D, Lorenz A, Menegay M, Spence D, RajanBabu A, Groznik W, Oberly T, Qian X, Jordan CR, Virgil P, Yarberry S, Saunders E, Teall AM, Zurmehly J, Nance M, Albanese S, Wharton D, Applegate MS. A Medicaid Statewide Hypertension Quality Improvement Project: Initial Results. Cureus 2023; 15:e36132. [PMID: 37065351 PMCID: PMC10100600 DOI: 10.7759/cureus.36132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/16/2023] Open
Abstract
Background Hypertension control is critical to reducing cardiovascular disease, challenging to achieve, and exacerbated by socioeconomic inequities. Few states have established statewide quality improvement (QI) infrastructures to improve blood pressure (BP) control across economically disadvantaged populations. In this study, we aimed to improve BP control by 15% for all Medicaid recipients and by 20% for non-Hispanic Black participants. Methodology This QI study used repeated cross-sections of electronic health record data and, for Medicaid enrollees, linked Medicaid claims data for 17,672 adults with hypertension seen at one of eight high-volume Medicaid primary care practices in Ohio from 2017 to 2019. Evidence-based strategies included (1) accurate BP measurement; (2) timely follow-up; (3) outreach; (4) a standardized treatment algorithm; and (5) effective communication. Payers focused on a 90-day supply (vs. 30-day) of BP medications, home BP monitor access, and outreach. Implementation efforts included an in-person kick-off followed by monthly QI coaching and monthly webinars. Weighted generalized estimating equations were used to estimate the baseline, one-year, and two-year implementation change in the proportion of visits with BP control (<140/90 mm Hg) stratified by race/ethnicity. Results For all practices, the percentage of participants with controlled BP increased from 52% in 2017 to 60% in 2019. Among non-Hispanic Whites, the odds of achieving BP control in year one and year two were 1.24 times (95% confidence interval: 1.14, 1.34) and 1.50 times (1.38, 1.63) higher relative to baseline, respectively. Among non-Hispanic Blacks, the odds for years one and two were 1.18 times (1.10, 1.27) and 1.34 times (1.24, 1.45) higher relative to baseline, respectively. Conclusions A hypertension QI project as part of establishing a statewide QI infrastructure improved BP control in practices with a high volume of disadvantaged patients. Future efforts should investigate ways to reduce inequities in BP control and further explore factors associated with greater BP improvements and sustainability.
Collapse
|
4
|
Bolen SD, Love TE, Einstadter D, Lever J, Lewis S, Persaud H, Fiegl J, Liu R, Ali-Matlock W, Bar-Shain D, Caron A, Misak J, Wagner T, Kauffman E, Cook L, Hebert C, White S, Kobaivanova N, Cebul R. Improving Regional Blood Pressure Control: a Positive Deviance Tiered Intensity Approach. J Gen Intern Med 2021; 36:1591-1597. [PMID: 33501526 PMCID: PMC8175516 DOI: 10.1007/s11606-020-06480-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Accelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities. OBJECTIVE To determine whether a positive deviance approach would improve blood pressure (BP) control across diverse health systems. DESIGN Quality improvement study using 1-year cross sections of electronic health record data over 5 years (2013-2017). PARTICIPANTS Adults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (N = 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative. INTERVENTIONS Identification of a "positive deviant" and dissemination of this system's best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (low: Learning Collaborative events describing the best practices; moderate: Learning Collaborative events plus consultation when requested; and high: Learning Collaborative events plus practice coaching). MAIN MEASURES We used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics. KEY RESULTS BP control post-intervention improved by 7.6% [95% confidence interval (CI) 6.0-9.1], from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5-13.5), Hispanic (10.5%, 95% CI 8.4-12.5), and African American (9.0%, 95% CI 7.7-10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2-19.5; moderate: 5.2%, 95% CI 0.8-9.5; low: 0.2%, 95% CI-3.9 to 4.3). CONCLUSIONS Employing a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.
Collapse
Affiliation(s)
- Shari D Bolen
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA.
- Better Health Partnership, Cleveland, OH, USA.
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA.
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | - Thomas E Love
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas Einstadter
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Steven Lewis
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | - Harry Persaud
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jordan Fiegl
- Department of Data Science and Analytics, University Hospitals, Cleveland, OH, USA
| | | | | | - David Bar-Shain
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | - Aleece Caron
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | - James Misak
- Department of Family Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | | | | | | | | | - Suzanne White
- Northeast Ohio Neighborhood Health Services, Inc., Cleveland, OH, USA
| | | | - Randall Cebul
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|