Tricia Trinité, MSPH, APRN; Sally Phillips, PhD, RN;
Helen Burstin, MD, MPH; Therese Miller, DrPH

Agency for Healthcare Research & Quality
National Prevention Summit
Washington DC
October 27, 2006

(image: AHRQ logo)

• Six goals proposed to improve preventive services and health care delivery:
  • Safe
  • Effective
  • Patient-centered
  • Timely
  • Efficient
  • Equitable
• How do we get there?

Quality Chasm Series: Transforming Health Care Quality, January 2003

Evolving new practice models include the following and result in prepared/proactive clinical teams and informed/activated patients:

• Patient self-management support
• Health Information Technology/Registries
• Clinical decision support
• Full use of multi-disciplinary teams
• Linking clinical practice with community based programs: Partnerships, Communication and Coordination

• Health information technology/registries:
  • Able to search practice populations and proactively reach patients that need preventive care, such as immunizations and screenings
  • Electronic personal health records
• Clinical decision support
  • Electronic prompts and references available when needed, such as at the point of care
  • Tools and processes to assist clinicians do the right thing at the right time for patients– such as evidence-based clinical preventive services

• Patient self management support
  • Prepare and support patients to manage their own health and health care
    • Diabetes education and self-care
  • Community Health Workers (CHW) reach out to the community supporting health and wellness. Promote health, enhance communication and connection to clinical providers.
  • Additional CHW support to promote self-triaging and self-care during emergencies related to health needs

Community Resources and Clinical linkage

• Form partnerships with community organizations to support and develop interventions that fill gaps in needed services
• Community health workers facilitate linkages with community programs

• Surge Capacity
  • The ability of a health care system to rapidly expand beyond normal services to meet the increased demand for medical care and public health services in the event of a public health emergency or disaster.
• Symptom/Syndromic Surveillance

Goal: To develop, implement and test a model to reverse engineer patient call centers, such as poison control centers, nurse call lines, etc, to support home care/shelter-in-place approaches in certain mass casualty incidents.

Using protocols and algorithms developed for certain scenarios, the model will be used to advise community members how to identify symptoms, call in, be managed in homes or on site ( ie: schools, businesses) potentially with home/ on-site visits, blood assessments, tele-health systems, and seek care within the primary care networks

This community strategy will enhance surge capacity by managing a segment of the population at home or on site at a school, place of business or other sites

• Launched by the Cincinnati Pediatric Research Group, which includes 45 providers in 22 practices
• Web-based surveillance system
• Facilitates communication between community providers and government agencies which monitor health data
• Regular two-way communication allows tracking of both naturally occurring and intentional outbreaks

• Providers enter data about prevalent symptoms and any unusual cases presenting to them
• Interactive computer graphs enable physicians to view customized snapshot of symptoms prevalent in their region which they can compare with what they are seeing in their practice
• Weekly online data collection on password protected site takes about 10 minutes to complete
• Involving community providers in responding to a potential public health emergency
• Allows for timely detection of disease outbreaks

• Institute for Urban Family Health
  • Health Center - medically underserved in New York City
  • 180,000 primary care visits / 60,000 patients
• Fully paperless since September 2002
  • Epic Electronic Health Record (EHR)

Source: Neil Calman, MD

• Patient Address
• Race / Age / Gender
• Medical history
• Provider Location
• Reason for visit
• Problem list
• Temperature
• Height/weight
• Respirations
• Procedures
• Medications
• Lab results
• Diagnoses

Source: Neil Calman, MD

(image: chart titled "Fever AND respiratory syndrome" showing a spike over baseline as more pronounced for the EHR fever/Resp syndrome. with an increase from about 0.06 to 0.24 (or fourfold) for just fever and a 0.06 to 0.42 increase (or sevenfold) for the combination syndrome)

(image: diagram illustrating a two-step integration of epidemiologic data into clinical care: (1) EHR institution to public health agency-clinical encounters, and (2) Public health agency to EHR institution-epidemiologic awareness)

Emergency preparedness professionals need to dialog with primary care professionals

• Create common language and coordination
  • Including HIT as possible and when needed
• Consistent message to communities may help to instill confidence during emergencies
• Avoid waste and duplication
• Leverage resources and new developments in the field of primary care and preparedness
• It is about relationships