sparc â€" a model for improving access to care
TRANSCRIPT
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Connecting Public Health Connecting Public Health and Medicine through and Medicine through
Prevention: Prevention: The SPARC ProgramThe SPARC Program
Sickness Prevention Achieved Sickness Prevention Achieved through Regional Collaborationthrough Regional Collaboration
Doug Shenson, MD Doug Shenson, MD MPHMPH
Austin, TXAustin, TX
June 15, 2010June 15, 2010
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THE RIGHT THE RIGHT TOOLS FOR TOOLS FOR
COMMUNITY-COMMUNITY-WIDE WIDE
PREVENTIONPREVENTION
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Echocardiography
Flu Vaccination
Dementia Screening
Pneumococcal Vaccine
Mammogram
Colorectal cancer Screening
Pap Test
Thyroid Disease screening
Hepatitis B Vaccine
STD Screening
PPD test
EKG
Blood Pressure Screening
HIV screening
Downs Syndrome Screening
Carotid artery stenosis Screening
Cholesterol Screening
Glaucoma Screening
Skin Cancer Screening
Prostate cancer Screening
Diabetes Screening
Lung cancer Screening
Osteoporosis Screening
Pregnancy Screening
Abdominal Aortic aneurysm Screening
PKU Screening
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Clinical Preventive Clinical Preventive ServicesServices
Flu ShotsFlu Shots Pneumococcal Pneumococcal
immunizationimmunization MammographyMammography Pap TestPap Test Colorectal Colorectal
cancer cancer screeningscreening
Hypertension Hypertension screeningscreening
Cholesterol Cholesterol screeningscreening
Tetanus Tetanus immunizationimmunization
Adolescent Adolescent immunizationsimmunizations
Child Child immunizationsimmunizations
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HOW WELL ARE HOW WELL ARE WE DOING?WE DOING?
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Estimated Percentage Of U.S. Adults Estimated Percentage Of U.S. Adults Aged >65 Up-to-date On Routine Aged >65 Up-to-date On Routine
Clinical Preventive Services. Clinical Preventive Services. 1997, 2002, 1997, 2002, 2004 Behavioral Risk Factor Surveillance System. Am J Prev 2004 Behavioral Risk Factor Surveillance System. Am J Prev
Med 2007;32(1)Med 2007;32(1)
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Estimated Percentage Of U.S. Adults Estimated Percentage Of U.S. Adults Aged 50-64 Up-to-date On Routine Aged 50-64 Up-to-date On Routine
Clinical Preventive Services. Clinical Preventive Services. 1997, 2002, 1997, 2002, 2004, 2006 Behavioral Risk Factor Surveillance 2004, 2006 Behavioral Risk Factor Surveillance
System.System.
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Adults and Infants “Up-to-Adults and Infants “Up-to-Date” Date”
with Clinical Preventive with Clinical Preventive Services Services
(2006 BRFSS)(2006 BRFSS)
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THE CURRENT THE CURRENT STRATEGYSTRATEGY
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10
Patient
Pulmonologist
Cardiologist
Low Community-wide Preventive Service Delivery Rate
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Diffuse Responsibility: Diffuse Responsibility:
Primary Care Clinician
Obstetrician / Gynecologist
Gastroenterologist
Geriatrician
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Patient Primary Care Clinician
Current Preventive Service Delivery Rates
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Acute Care Acute Care VisitsVisits
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Adults Age Adults Age >>65 “Up-to-date” with CPS65 “Up-to-date” with CPSInsurance Status, Provider status, and Insurance Status, Provider status, and
Recent CheckupRecent Checkup(2006 BRFSS)(2006 BRFSS)
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THE CHALLENGE THE CHALLENGE WE FACEWE FACE
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Obstacles to Preventive Obstacles to Preventive Service Delivery We Know Service Delivery We Know
About: CliniciansAbout: Clinicians Poor office reminder Poor office reminder
and flagging systemsand flagging systems Disease prevention a Disease prevention a
lower prioritylower priority Doctors not aware of Doctors not aware of
changing guidelines changing guidelines Low insurance Low insurance
reimbursement ratesreimbursement rates
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Obstacles to Preventive Obstacles to Preventive Service DeliveryService Delivery
We Know About: Patients We Know About: Patients
Patients not aware Patients not aware of health benefitsof health benefits
Patient focused Patient focused exclusively on exclusively on treatmenttreatment
Patient not aware Patient not aware that insurance that insurance covers preventive covers preventive carecare
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Patient
Patient
Patient
Patient
Patient
Community Resident
Primary Care Clinician
Patient
Primary Care Clinician
Community-wide Preventive Service Delivery
Community Resident
Community Resident
Community Resident
Community Resident
Community Resident
Community Resident
Community Resident
Community Community PerspectivePerspective
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SPARC: Program SPARC: Program RationaleRationale
and System Critiqueand System Critique Currently no responsible local Currently no responsible local
agency for population-wide provision agency for population-wide provision of clinical preventive servicesof clinical preventive services
Currently no local accountability Currently no local accountability Currently no coordination of deliveryCurrently no coordination of delivery Clinical preventive services falls Clinical preventive services falls
between the cracks of medicine and between the cracks of medicine and public healthpublic health
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DEVELOPING A DEVELOPING A FRESH STRATEGYFRESH STRATEGY
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Patient Clinician Office System
Community Resident
New Community Access Point
Increase Supply of
CPS
Increase Demand for
CPS
Higher Community-wide Delivery
Population-Wide Perspective
Accountable Agency (SPARC)
Data
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Build local Build local collaborations of collaborations of
prevention service prevention service “stakeholders”“stakeholders”
Visiting nursing Visiting nursing agencies agencies
Elder servicesElder services Public health Public health
agenciesagencies Churches and Churches and
synagoguessynagogues
HospitalsHospitals Public schoolsPublic schools Medical Medical
practicespractices Community Community
centerscenters
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Elements of SuccessElements of Success
Establish a SPARC Establish a SPARC Steering CommitteeSteering Committee
Selection of one or Selection of one or more more geographically-geographically-bounded bounded communitiescommunities
Selection of Selection of community (non-community (non-clinical) sitesclinical) sites
Selection of clinical Selection of clinical preventive services preventive services to be deliveredto be delivered
Plan community-Plan community-base activities base activities
Plan evaluation Plan evaluation strategystrategy
Develop information Develop information links back to the links back to the medical homemedical home
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Outcomes AssessmentOutcomes Assessment
Reach Reach (inclusions and (inclusions and exclusions)exclusions)
Efficacy Efficacy (meeting (meeting outcomes goals)outcomes goals)
Adoption Adoption assessmentassessment
ImplementatioImplementation assessmentn assessment
Maintenance Maintenance assessmentassessment
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BUILDING THE BUILDING THE RIGHT TACTICAL RIGHT TACTICAL
APPROACH:APPROACH:EXAMPLES OF EXAMPLES OF
PROJECTSPROJECTS
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Percent Change in Percent Change in Pneumococcal Immunization Pneumococcal Immunization Rates, Connecticut CountiesRates, Connecticut Counties
1997 HCFA Reimbursement Claims1997 HCFA Reimbursement Claims
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Bundling Preventive Bundling Preventive Services: Services:
Vaccinations and Cancer Vaccinations and Cancer ScreeningScreening
Can mammography Can mammography rates be improved by rates be improved by
facilitating breast facilitating breast cancer screening at cancer screening at community-based flu community-based flu
clinics?clinics?
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SPARCVNA DPH MD RAD
PLANNING
Mamm.Scheduling
RadiologyDept.
Community Flu Clinics
MedicalHome
Residents
Data
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Mammography rates, Mammography rates, Litchfield County, CT, women Litchfield County, CT, women
age >65. age >65. Am J Prev Med 2001;20(2).Am J Prev Med 2001;20(2).
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Offering Annual Fecal Occult Blood Tests at Annual Flu Shot Clinics Increases Colorectal Cancer Screening RatesMichael B. Potter, MD1, La Phengrasamy, MPH1, Esther S. Hudes, PhD, MPH2, Stephen J. McPhee, MD3 and Judith M.E. Walsh, MD, MPH2,3 1 Department of Family and Community Medicine, University of California San Francisco, San Francisco, California2 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California3 Department of Medicine, University of California, San Francisco, San Francisco, California CORRESPONDING AUTHOR: Michael B. Potter, MD Department of Family and Community Medicine Box 0900, UCSF, San Francisco, CA 94143 [email protected]
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Why Vote & Vax?Why Vote & Vax?
More than 126 million Americans More than 126 million Americans vote in national elections.vote in national elections.
Approximately 70% the voters Approximately 70% the voters are over age 50.are over age 50.
Fewer than 40% of adults ages Fewer than 40% of adults ages 50-64 receive an annual flu shot.50-64 receive an annual flu shot.
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Why Polling Places?Why Polling Places?
They attract residents from all They attract residents from all communities.communities.
They are mandated to be maximally They are mandated to be maximally accessible.accessible.
They are widely distributed They are widely distributed throughout all communities.throughout all communities.
There are 186,000 of themThere are 186,000 of them
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Vote & Vax GuidelinesVote & Vax GuidelinesPermission from Permission from
Local Election Local Election AuthorityAuthority
Not Just for Not Just for VotersVoters
Charge for Charge for Vaccine as UsualVaccine as Usual
For All For All CommunitiesCommunities
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Vote & VaxVote & VaxNational CollaboratorsNational Collaborators
AARPAARP American Public American Public
Health Association Health Association (APHA)(APHA)
Association of Association of Immunization Immunization Managers (AIM)Managers (AIM)
Association of State Association of State and Territorial Health and Territorial Health Officials (ASTHO)Officials (ASTHO)
Immunization Immunization Coalitions Technical Coalitions Technical Assistance Network Assistance Network (IZTA)(IZTA)
National Association of National Association of Area Agencies on Aging Area Agencies on Aging (n4a)(n4a)
National Association of National Association of Chronic Disease Chronic Disease Directors (NACDD)Directors (NACDD)
National Association of National Association of County and City Health County and City Health Officials (NACCHO)Officials (NACCHO)
National Association of National Association of State Units on Aging State Units on Aging (NASUA)(NASUA)
Visiting Nurse Visiting Nurse Associations of America Associations of America (VNAA)(VNAA)
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How Did We Do in 2008?How Did We Do in 2008?
Vote & Vax Vote & Vax clinics delivered clinics delivered 21,434 flu vaccinations at 21,434 flu vaccinations at 331 locations in 42 states 331 locations in 42 states plus the District of Columbia.plus the District of Columbia.
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Vote & VaxVote & Vax: A : A Nationwide SuccessNationwide Success
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We hit the most important targets…
67% were in CDC priority groups.
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We reached new We reached new populations…populations…
48 % were irregular or unlikely 48 % were irregular or unlikely flu shot recipients – that is, they flu shot recipients – that is, they did not receive a shot last year did not receive a shot last year or would not have otherwise or would not have otherwise received one this year.received one this year.
52% were regular flu shot 52% were regular flu shot recipients.recipients.
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Including underserved populations…
Percent irregular and unlikely flu shot recipients:
60% among African-Americans
65% among Hispanics
71% among uninsured
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SUMMING UPSUMMING UP
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The SPARC ProgramThe SPARC Program Community-based program focused on Community-based program focused on
expanding prevention across entire expanding prevention across entire populationpopulation
Emphasis on primary and secondary Emphasis on primary and secondary prevention of major chronic diseases prevention of major chronic diseases (USPSTF A or B)(USPSTF A or B)
Builds community-wide accountability Builds community-wide accountability for better access to preventive servicesfor better access to preventive services
Vehicle for public health & healthcare Vehicle for public health & healthcare integrationintegration
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Tools and AssistanceTools and Assistance
Project Project manuals and manuals and research research findings findings
SPARC SPARC presentationspresentations
Conference Conference CallsCalls
Technical Technical AssistanceAssistance
Site VisitsSite Visits SPARC Action SPARC Action
GuideGuide
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Lessons LearnedLessons Learned
AmbitionAmbitionSystemsSystemsSustainabilSustainabilityity
AlliesAlliesCreativityCreativity
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Leading SPARC FundersLeading SPARC FundersNationalNational
AARPAARP CDC Healthy Aging ProgramCDC Healthy Aging Program CDC National Immunization CDC National Immunization
ProgramProgram HRSAHRSA Local Initiatives Funding Local Initiatives Funding
Partners Program of RWJFPartners Program of RWJF Pfizer FoundationPfizer Foundation Robert Wood Johnson Robert Wood Johnson
Foundation (RWJF)Foundation (RWJF)
Regional and LocalRegional and Local
Atlanta Regional Atlanta Regional CommissionCommission
Berkshire Taconic Berkshire Taconic Community FoundationCommunity Foundation
Jessie B. Cox TrustJessie B. Cox Trust Patrick and Catherine Patrick and Catherine
Donaghue FoundationDonaghue Foundation QIOs of CT, MA, NYQIOs of CT, MA, NY Seth Sprague Seth Sprague
FoundationFoundation Weinberg FoundationWeinberg Foundation