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This
document provides supplemental application guidance
and performance expectations for the Health
Disparities and Patient Visit Redesign Collaboratives.
Activities under these collaboratives will cover
the period April 1, 2001 to March 31, 2002.
During fiscal year (FY) 2001, the Bureau of
Primary Health Care (BPHC) has $7.2 million
available for the 3rd year of the health disparities
initiative that focuses on diabetes mellitus,
cardiovascular disease, cancer, prevention and
pesticides as well as depression and asthma.
Of the $7.2 million, $100,000 will be made available
on a one-time basis, to support activities for
each National Clinical Network (CNs). National
CNs must apply for this funding opportunity
through one of the five lead cluster Primary
Care Associations (PCA) and CNs. In addition,
$770,155 is available for the transition of
Together for Tots (TOTs) into the Health Disparities
Collaboratives.
In addition, BPHC will make available $650,000
to support the Patient Visit Redesign Collaborative
for FY 2001. There will be one award nationally
to one cluster’s lead PCA and CN.
Major directions for the coming year include:
(1) a new health disparity collaborative for
cardiovascular disease and a third diabetes
collaborative; (2) development of collaborative
for cancer and prevention; (3) development of
web-based depression module and a web-based
asthma module; (4) a second asthma collaborative;
(5) an additional half day at the kick-off for
information system training and the addition
of a training session on cognitive and problem
solving therapy in a minimum of one Learning
Session per collaborative; (6) integration of
the TOTs program into the health disparities
collaboratives; (7) strengthening and expanding
the role of the cluster steering committees
and (8) identifying National and State partners
with expertise in our collaborative activities
to assist health centers using Centers for Disease
Control and Prevention and the State-based Diabetes
Control Program as a model. The BPHC Health
Disparities Collaborative National Director
and the Institute for Healthcare Improvement
(IHI) Health Disparities Collaborative National
Director will provide leadership and assistance
in the coming year's activities.
Major capacity building initiatives include:
(1) additional resources for lead cluster PCA
and CN to support teams; (2) opportunity to
align and train current PCA clinical staff;
(3) opportunity to build State capacity for
clinician involvement in health disparity support
activities; (4) strengthening the clinical focus
of the PCA by having the PCA provide evidence
of a CN or committee with a documented track
record of activities that have improved clinical
practice and outcomes and a governance structure
with significant representation by a group of
clinicians with active practices in health centers
or National Health Service Corps (NHSC) sites,
or have a plan to phase into such a structure
within the next 12-18 months; and, (5) transition
for community and
migrant health centers from clinical measures
to health disparities performance and improvement.
As health centers successfully participate and
complete a health disparity collaborative, they
will continue to measure and improve on a core
number of health disparity measures.
Health centers participating in collaboratives
will be expected to continue to report on core
collaborative measures after completing the
collaborative. They will not be required to
report on clinical outcome measures, although
they are encouraged to use some or all of these
measures for internal improvement efforts and
for documenting clinical performance for payers.
SECTION
I HEALTH DISPARITIES COLLABORATIVES
To be eligible to participate in this project,
the lead PCA and CN must present a project plan
consistent with performance expectations (attached)
and the following issues in the application
for support:
-
Have a steering committee with representation
from other PCAs in their cluster, including
those PCAs with TOTs Coordinators, multidisciplinary
CNs, health center senior leadership and clinicians,
and the Health Resources Services and Administration
(HRSA) Field Office; have completed two strategic
planning sessions, and submit an annual report
with the budget request.
-
Have bylaws and charter or plan that opens
membership to all BPHC-supported organizations,
and have a policy and plan to share all collaborative
information and opportunities with all BPHC-supported
organizations including Health Care for the
Homeless, Public Housing Primary Care and
Healthy Schools, Healthy Communities grantees
and NHSC free-standing sites.
-
Include both a lead PCA and multidisciplinary
CN. The CN may be part of the PCA or may be
independent. The PCAs and independent CNs
are ineligible for this project if they apply
separately. Requests for support of the additional
State-based collaborative coordinators must
be included as part of the request from the
lead PCA and CN and be included in the budget
from the lead PCA and CN. Individual State
requests will not be accepted.
- Site
visit plan for information system coordinators
and cluster and State coordinators, including
the number and frequency of anticipated visits
to health centers and NHSC sites per year,
training and mentoring activities, Technical
Assistance to sites, faculty support in other
cluster learning sessions and collaboration
with other agencies.
-
A process to monitor whether activities are
in fact improving health outcomes and shared
national goals at a cluster level, utilizing
monthly health center reports and information
available from partner agencies, should be
included.
-
Principal activities to be performed by the
Executive Director of the PCA and the CN to
support the aims and performance of cluster
teams, and to facilitate partnerships and
communication.
-
The cluster mission statement and strategic
plan.
-
Agreement by the lead PCA Executive Director
and the CN to participate in the quarterly
meetings with BPHC, the cluster steering committee
meetings and the BPHC cluster site visits.
-
Description of partnership building activities
that support collaborative goals.
-
A plan, coordinated by the cluster steering
committee, for spread to all States and BPHCsupported
sites should be included as well as a process
to monitor whether activities are in fact
improving care.
-
Principal activities to be performed by the
manager of the CN.
-
Role of a CN or committee in strategic planning
and implementation of the health disparities
collaborative with a documented track record
of activities that have improved clinical
practice and outcomes.
-
A PCA governance structure with significant
and meaningful representation by a group of
clinicians with active practices in health
centers or NHSC sites, or proposal to phase
into such a structure within the next 12-18
months
-
Prepare a budget in accordance with PHS 5161-1
along with a one to three page justification.
It should describe personnel and travel costs
as appropriate, and should clearly define
resources for the lead CN. If appropriate,
it should include contractual arrangements
with other organizations, PCAs and/or CNs.
-
Plan to distribute the BPHC and IHI produced
marketing and training videos to health centers,
health departments, other PCAs and other partners
as appropriate.
NATIONAL CNs APPLICATION REQUIREMENTS
The Health Care for the Homeless Clinicians'
Network, Migrant Clinicians Network and National
Network for Oral Health Access (NNOHA) are invited
to submit a proposal for the Health Status and
Performance Improvement Collaborative. The proposal
should not exceed 10 pages in length. Awards
will be $100,000.
To be eligible to participate in this project,
these organizations must apply through one of
the lead cluster PCAs. Health Care for the Homeless
Clinicians' Network must apply for a grant through
BPHC Homeless Branch, Migrant Clinicians Network
to apply through the Migrant Branch, NNOHA to
apply through Michigan PCA.
Copies of National grant applications should
be included in PCA applications and should reflect
integration with the lead PCA activities.
National CNs will work with BPHC, IHI, HRSA
Field Office and their lead PCA when developing
any materials for the collaborative to assure
integration with the collaborative models.
-
National CNs activities will support collaborative
infrastructure in their work with health centers
to maximize national goals.
-
Budget and justification for all costs.
EVALUATION
CRITERIA
All applications submitted under this funding
announcement will undergo a review based on
the following criteria. There will be one PCA
and CN team funded per cluster.
-
Performance in the diabetes collaborative
during the past year.
-
Quality of the proposed approach and its effectiveness
in meeting or exceeding the performance goals
for the coming year. See attached timeline
and operational guidance.
-
Evidence of partnership building activities
supportive of collaborative goals.
-
The degree of collaboration in the development
and design of the proposed approach.
-
Capacity of the PCA and CN to engage in these
activities.
-
Evidence of a PCA governance structure with
significant representation by a group of clinicians
with active practices in health centers or
NHSC sites, or have a plan to phase into such
a structure within the next 12-18 months.
Application due dates for these funding opportunities
are March 19, 2001. The original application
must be submitted to: BPHC Office of Grants
Management, 4350 East-West Highway, 7th floor,
Bethesda, Maryland 20814 with a copy to the
appropriate HRSA Field Office.
SECTION II - PATIENT VISIT REDESIGN
COLLABORATIVE
I. Introduction
This section provides supplemental application
guidance for the Patient Visit Redesign Collaboratives.
Activities under these collaboratives will cover
the period April 1, 2001 to March 31, 2002.
During FY 2001, the BPHC will make available
$650,000 to support the Patient Visit Redesign
Collaborative for FY 2001. There will be one
award nationally to one cluster’s lead
PCA and CN.
Resources will be available for the 3rd year
of the Quality Center’s cluster-specific
reengineering collaboratives, engaging approximately
15 BPHC sites in each of the 2-6 month collaboratives
planned for this fiscal year.
This year will be a transition year for the
applications for the bureau’s Quality
Center initiatives including sponsorship of
the Patient Visit Redesign Collaboratives. Complimentary
and related Quality Center activities will be
outlined in the Excellence in Practice Policy
Information Notice to be issued separately.
II. Eligibility
Eligible Organizations: One
lead PCA and CN nationally. To be eligible to
participate in this project, the lead PCA and
CN must:
- Have
a participated or been the lead in a Cluster-specific
Patient Visit Redesign Collaborative in the
past 2 years.
-
Include both a lead PCA and CN. The PCA’s
and independent CN’s are ineligible
for this project if they apply alone.
- Have
bylaws/charter or other governing guidance
that clearly opens membership to all BPHC-supported
organizations; allows for special populations
program representatives on the board; states
commitment to representing all BPHC-supported
organizations in State and community level
issues and share information with all BPHC-supported
organizations.
III. Guidance for Application Content
To be eligible to participate in this project,
the sponsoring PCA and CN must present a project
plan consistent with performance expectations
(attached) and address the following issues
in the application for support:
-
Identification and management of Cluster-Specific
Applicant Review Panel in cooperation with
Health Disparities Cluster Steering Committee.
-
Formation and support of the Cluster-Specific
Redesign Expert Team for each collaborative
in conjunction with National Redesign Expert
team.
-
Coordination, planning and implementation
of learning sessions in conjunction with National
Redesign Expert Team.
-
Documentation of learning session evaluations
and results.
-
In collaboration with the National Redesign
Expert Team, development of strategy and ongoing
support and spread of redesign efforts.
-
Prepare a budget in accordance with PHS 5161-1
along with a one to three page justification.
It should describe personnel and travel costs
as appropriate, and should clearly define
resources.
EVALUATION CRITERIA
All applications submitted under this funding
announcement will undergo a review based on
the
following criteria:
-
Performance in the 1998-2000 Redesign Collaboratives.
- Quality
of the proposed approach and its effectiveness
in meeting or exceeding the performance goals
for the coming year.
- The
degree of collaboration in the development
and design of the proposed approach.
-
Capacity of the PCA and CN to engage in these
activities.
-
Evidence of a CN or committee with a documented
track record of activities that have improved
clinical practice and outcomes, and a governance
structure with significant representation
by a multi-disciplinary group of clinicians
with active practices in health centers or
NHSC sites, or have a plan to phase into such
a structure within the next 12-18 months.
-
Application due dates for these funding opportunities
are March 19, 2001. The original application
must be submitted to: BPHC Office of Grants
Management, 4350 East-West Highway, 7th floor,
Bethesda, Maryland 20814 with a copy to the
appropriate HRSA Field Office.
FISCAL YEAR 2001 – 2002
PERFORMANCE EXPECTATIONS
I. INTRODUCTION
For several years, the Bureau of Primary Health
Care (BPHC) has focused its efforts on the compelling
vision of achieving 100% Access and 0 Health
Disparities. All BPHC activities are driven
by and designed to move towards this vision,
both through direct interventions with Bureau
resources and by leveraging other resources
through partnerships with others committed to
the same vision.
One of the key strategies being employed by
the Bureau is "Quality Improvement.”
This strategy derives from the concept that
we must strive to do all things in the best
and most effective way possible; all of our
"products" must be of the highest
quality if we are going to achieve our vision.
Quality includes more than clinical practice,
and encompasses administrative, financial, and
operational aspects of what our supported sites
and we do every day. Through Quality Improvement
across all objectives in the Strategic Plan
(Strengthening the Safety Net, Mobilizing the
Workforce, Creating New Access, and Excellence
in Practice), access can be increased through
more efficient and effective systems of care
and disparities can be reduced, bringing us
closer to our vision.
The Quality Improvement Model is a key mechanism
the BPHC has chosen to implement this overall
Quality Improvement strategy. A number of organizations
have developed or adapted this basic model for
bringing about change and improving their organizations.
The Institute for Health Care Improvement developed
a Collaborative Model for focusing on clinical
practices, and this model has become the core
of the BPHC Quality Improvement strategy. The
model may vary from place to place and among
various target issues, but the key elements
remain the same:
-
There is a focus on a specific problem or
issue to be addressed.
-
There is a focus on a specific outcome or
objective to be achieved.
-
An Interdisciplinary Learning Team from the
Site serves as the "change agent."
-
A curriculum is provided that offers possible
solutions and options to address the chosen
problem.
-
Periodic working/learning sessions bring several
teams together to learn relevant content,
share experiences, offer support.
-
There is a continual assessment of progress
towards the defined objective and adjustment
of approaches; rapid change model.
-
It includes tracking and reporting of performance.
- There
will be a long-term impact on the organization
though the institutionalization of both the
changes made and the learning process itself
into their everyday work; they will pursue
applications to other areas to implement additional
improvements.
This
collaborative model forms the foundation for
the BPHC Quality Improvement efforts. Thus far,
it has been implemented in two key areas: chronic
disease management and patient visit redesign.
While these two initiatives vary in some details
of implementation, they each have the elements
of the model described above. In addition, implementation
of the model in each area requires a level of
infrastructure support (i.e., data systems,
staff and logistics, etc.) to succeed. Each
of the current efforts has linkages for infrastructure
support with BPHC partners such as Primary Care
Associations (PCAs) and Clinical Networks (CNs).
These partners assist in the implementation
of the actual learning/improvement team process
in some fashion for each collaborative.
To accomplish these aims, the goal is to involve
all health centers and a significant number
of National Health Service Corps (NHSC) sites
during the next 5 years in at least one collaborative
learning experience dedicated to one or more
health disparities with a similar 3-year plan
to assimilate key redesign principles into all
Bureau activities and programs. Priority will
be given to health centers that have not participated
in any previous collaboratives. The term "health
center,” throughout the document, refers
to community, migrant, homeless and public housing
primary care health centers and Healthy Schools,
Healthy Communities grantees. Through this process,
each BPHC-supported site has the opportunity
to apply evidence and population-based care
to
their patients and community, and to document
improved health status. In addition, once the
care and improvement models are established
in a health center or NHSC site, they can be
applied to other clinical issues or used to
improve administrative systems.
Yet,
the goal for eliminating health disparities
and increasing access extends beyond Federal
policy. It is also a key strategy for success
in the current and future health care marketplace.
Employers, public and private insurers, and
consumers seek health systems that manage health,
are accountable, share cost and quality measurements,
focus on communities and populations, and are
patient centered. The design and implementation
of the health disparities and redesign
strategies supports these goals.
Health Disparities Collaborative
National Project Goals and Activities: April
1, 2001 to March 31, 2002
I. SUSTAINING AND DISSEMINATION: BUILDING THE
COLLABORATIVE COMMUNITY
Goal: Health centers and NHSC
sites in Diabetes I (88) continue progress with:
(1) 100 percent of the 12 monthly reports completed
by January 2002; (2) 90 percent of health centers
reaching the national goal by January 2002;
(3) maintaining or exceeding an average team
score of 4.0; (4) documenting the integration
of the care model into on-going clinical and
management systems in additional health center
sites (spread) and patients (registry enrollment);
and, (5) demonstrating an increase of 25 percent
or more in the health center patients with diabetes
enrolled into a registry information system
by May 2001.
Goal: Health Centers and NHSC
sites in Diabetes II (120) continue progress
with: (1) 100 percent of the monthly reports
completed by January 2002; (2) 50 percent of
health centers meeting the national goal by
October 2001; (3) maintaining or exceeding an
average team score of 4.0; (4) documenting the
integration of the care model into on-going
clinical and management systems in additional
health center sites (spread) and with additional
patients (registry enrollment); and, (5) demonstrating
an increase of 25 percent or more in the health
center patients with diabetes enrolled into
a registry and information system by October
2001.
Goal: Health centers in Depression
and Asthma continue progress with: (1) 100 percent
of the monthly reports completed by March 2001;
(2) with 50 percent of the health centers reaching
the national goal(s) by October 2001; (3) maintaining
or exceeding an average team score of 4.0; (4)
documenting the integration of the care model
into on-going clinical and management systems
in additional health center sites (spread) and
additional patients (registry enrollment); and,
(5) demonstrating an increase of 25 percent
or more in the health center patients with depression
or asthma enrolled into a registry and information
system by October 2001. (A Post-collaborative
Expert Panel will meet in March 2001.)
Goal: Select health centers
and NHSC sites in the HIV-Bureau sponsored HIV
Collaborative continue progress with (1) 100
percent of the quarterly reports completed by
January 2002; (2) 50 percent of the health centers
reaching the national project goal(s) for HIV
by January 2002; (3) maintaining or exceeding
an average team score of 4.0; and, (4) demonstrating
an increase of 25 percent or more in the health
center patients with HIV enrolled into a registry
and information system by January 2002. (See
support system for additional related goals
and activities.)
Goal: In collaboration with
lead cluster PCA and CNs, National Association
of Community Health Centers NACHC), Center for
Disease Control and Prevention (CDC), Institue
for Healthcare Improvement (IHI), Substance
Abuse Mental Services Health Administration
(SAMSHA), National Cancer Institute (NCI), environmental
Protection Agency (EPA) and other national partners,
plan a health disparities congress for March
or April 2002.
Performance Expectations:
PCA and CN:
-
Design and implement a cluster-wide strategy
to support Diabetes I, II, Asthma, Depression
and HIV teams that have completed the first
year of the collaborative. This may include
one or more cluster and State learning sessions
for teams and senior leaders, mentoring of
new cluster coordinators, regular conference
calls, listserv, and site visits.
- Establish
and implement a cluster strategy to sustain
and promote high performing teams and improve
performance for lower performing teams.
-
Identify high performing teams and senior
leaders to participate as faculty and mentors
to sustain and accelerate positive change.
Travel high performing teams to national conferences.
- Develop
relationships among health centers and State
Diabetes Control Programs (DCP) and other
appropriate State agencies to help sustain
the work of health center teams. Support and
facilitate implementation of State DCPs and
health center team aims. Explore existing
State or regional telecommunication systems,
and form appropriate partnerships, for more
effective and cost efficient communication
and learning.
-
Establish and implement a data distribution
and communication protocol to share monthly
data with sites, cluster and national steering
committees and partners, utilizing the standard
cluster and national report formats. The protocol
should include a monthly conference call schedule
for cluster steering committees.
-
National CNs to act as faculty for collaborative
activity and help support the spread of the
collaborative (e.g., school-based health clinic,
homeless or public housing primary care, migrant
population) within the same organization.
In support of these national Goals,
the BPHC plans to:
-
Provide resources to PCA budgets for support
of an additional collaborative coordinator,
including travel, as well as assistance in
developing and implementing an orientation
and training strategy for the new coordinator.
The new coordinator, location to be determined
in partnership with the cluster steering committee
and located in a cluster partner PCA and CN,
will receive programmatic oversight by the
cluster collaborative director. Recognizing
the organizational titles may differ, “cluster
directors” shall have uniform components
in job descriptions and be responsible for
the programmatic management of the collaboratives
at the cluster level.
-
In collaboration with IHI and NACHC develop
two communication and training videos, one
focused on a general audience, and the other
focused on orienting new health center team
members.
-
In collaboration with IHI and NACHC disseminate
breakthrough change concepts developed during
previous BPHC-sponsored collaboratives and
IHI Breakthrough Series. This may be through
published and web-based vehicles.
-
In collaboration with NACHC, lead cluster
PCAs and CNs, IHI, CDC, SAMHSA, NCI, EPA and
other national partners, plan a health disparities
congress for March or April 2002.
- Support
the national CN in sustaining and spreading
collaboratives to maximize the health
outcomes of migrant and seasonal farmworkers
and homeless populations and assist to
maximize oral health in all populations.
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