Beyond the Status Quo: Building Effective Coalitions

Crystal Conner, MA Shannon Medical Center

Mimi Baugh, MSNAngelo State CareGiver Research Institute

Tom Green County

13.9% population 65 years old or older

57% White, non-Hispanic 36.3% Hispanic 6.7 % Other

24.3% Uninsured 75.7% Insured

20.4% Medicaid 13.6% Medicare

Source: US Census, 2010, Small Area Health Insurance Estimates; Department of State Health Services, County Health Facts; Texas HHSC Medicaid Enrollment by County, November 2012.

Population 110,224

Tom Green County

From 2006-2011, adult residents (18+) of Tom Green County received $214,677,910 in charges for hospitalizations that were potentially preventable.

Source: US Census, 2010; Department of State Health Services

Population 110,224

The Problem

Hospitalizations for the conditions selected are called “potentially preventable,” because if the individual had access to and cooperated with appropriate outpatient healthcare, the hospitalization would likely not have occurred.

Source: Center for Health Statistics, Texas Department of State Health Services

Preventable Hospitalizations

Condition Definition

Bacterial Pneumonia A serious inflammation of the lungs caused by an infection. Bacterial pneumonia primarily impacts older adults.

Urinary Tract Infection (UTI)

Usually caused when bacteria enter the bladder and cause inflammation and infection. It is a common condition, with older adults at highest risk. In most cases, an uncomplicated UTI can be treated with proper antibiotics.

Chronic Obstructive Pulmonary Disease (COPD)

Characterized by decreased flow in the airways of the lungs. It consists of three related diseases: asthma, chronic bronchitis and emphysema. Because existing medications cannot change the progressive decline in lung function, the goal of medications is to lessen symptoms and/or decrease complications. Source: Center for Health Statistics, Texas Department of State

Health Services

Selected Conditions

Potentially Preventable Hospitalizations for Adult Residents of Tom Green County, Texas

Number of Hospitalizations 2005-2010.

Average Hospital Charge

Total Hospital Charges

Hospital Charges Divided by 2010 Adult County Population

Bacterial Pneumonia

2,666 $21,876

$58,322,558

$692

Urinary Tract Infections

1,445 $15,182

$21,938,091

$260

Chronic Obstructive Pulmonary Disease

1,396 $21,226

$29,631,897

$352

Source: Center for Health Statistics, Texas Department of State Health Services

Financial Impact 2005-2010

Collaborating Organizations• Administrative agency for

County Indigent Program, serving approx. 1,400 clients

• Provides case management• Agreement with local

providers for indigent health services

• Fiscal agent for Preventable Hospitalizations project

Collaborating Organizations• Full Continuum of Care—Independent

Living, Memory Care, Long Term Care, Skilled Nursing, Home Health, Hospice, Peace of Mind Program, Rotary House of Hope, and Outpatient Therapy

• Unique concept of Continuum of Care found nowhere else in this area

• 100 acres, 600 residents, 300+ employees

• Has served the Concho Valley area since 1951

• A leader in innovation with many different options in various Senior Living areas

Collaborating Organizations• 171-bed acute care hospital• Designated Level III Trauma Center• Concho Valley's only accredited

Chest Pain Center• Concho Valley’s only accredited

Congestive Heart Failure facility• Comprehensive Heart and Vascular

program, including open heart surgery

• Robotic-assisted surgery• Level III-A Neonatal Intensive Care

Unit

Collaborating Organizations• The leader and advocate in

facilitating supportive services and opportunities that enable older citizens to be able to live more independently and productive

• One of 28 Area Agencies in Texas

• The region covers over 16,000 miles and approximately 112,000 citizens

• Locally sponsored by the Concho Valley Council of Governments

Collaborating Organizations• 409-bed safety net hospital• Over 225 providers• Locally owned non-for profit

medical center and clinic• With more than 20 locations,

Shannon provides a range of services for Tom Green and 18 surrounding counties

• The lead Level III Trauma Center and Air Med 1 air ambulance serving a 200-mile radius

• The primary stroke center for the region

Collaborating Organizations• Serves older adults, frail elders,

caregivers, and all people providing care to others

• The main focus is helping those providing care to others and education of nurses specifically taking care of the elderly or working in long-term care settings

• The mission of CRI is to ensure that we have caregivers, both formal and informal, who are well-equipped to care for this distinctive group. CRI draws from many campus resources, and a variety of nursing specialties, to help caregivers and nurses provide exceptional care to older adults

Core Partners

Assets Resilience Sustainability

Teach a man to fish.

Partnering Organizations

Intrepid Home Health Odyssey Hospice Meals for the Elderly Myer’s Drug Disability

Connections Relative Marketing &

Design

Sam’s Club San Angelo Standard

Times KIXY radio KKCN radio KLST/KSAN news

Collective Impact: Rules of Engagement Framework for Success

Common Agenda All participants have a shared vision for change including a common understanding of the problem and a joint approach to solving it through agreed upon actions.

Shared Measurement Collecting data and measuring results consistently across all participants ensures efforts remain aligned and participants hold each other accountable.

Mutually Reinforcing Activities

Participant Activities must be differentiated while still being coordinated through a mutually reinforcing plan of action.

Continuous Communication

Consistent and open communication is needed across the many players to build trust, assure mutual objectives, and create common motivation.

Backbone Support Creating and managing collective impact requires a separate organization(s) with staff and a specific set of skills to serve as the backbone for the entire initiative and coordinate participating organizations and agencies.

Common Agenda

Not a transfer of costs Savings to one organization is savings to all

Organizations serve similar populations Collaboration of efforts

Support from organizational leaders Relationships based on shared objectives

Commitment to improving health in Tom Green County

Shared Measurement

DSHS Data brought it to our attention DSHS defined the data sets Allowed for comparisons among the

community DSHS defined accountability

(interventions are evidence-based efforts are targeted)

Mutually Reinforcing Activities

Differentiated interventions with coordinated efforts

Public events, provider conferences, immunization clinics

Print Ads Billboards Online Media (Website, Facebook, Patient

Channel)

April 2012 Public Event October 2012 Provider Event October 2012 Heloise Public

Event Heart of Texas Conference on

Aging Speakers Bureau Health Fairs/Events

Interventions: Events

Education Events

Area Agency on Aging Station 618 Senior

Center Diabetes Update Seminar Sunset Mall Health Fair Friday Immunization

Clinics

Interventions: Immunization Clinics

Hand Sanitizer Hydration Cups Hydration card (urine) Rack Cards in Spanish & English Immunization Records (lifetime & adult) Walking booklet COPD Consult, Harvard Health Publications COPD Manuals, UT Tyler

Interventions: Education Materials

Television, radio, newspaper, classifieds coverage and print ads

Stethoscoop & Heartbeat, hospital newsletters Health Beat Hospital Magazine Direct mail www.tgcpartnershipforbetterhealth.org Patient Channel, The Wellness Network Facebook Page

Interventions: Media

Billboards

Continuous Communication

DSHS Roadmap Required monthly meetings; planning and

status updates Monthly Technical Assistance calls with DSHS

and 16 participating counties Two face-to-face meetings with 16 Counties in

Austin and DSHS experts/staff Sub-committee meetings Intervention Ad Hoc group meetings as needed,

PRN

Backbone SupportOrganization Support Valuable Impact

Educational/Clinical expertise; Educational Provider/Community outreach

Perceived neutrality; Public interest; Health education expertise

Education/Community Advocacy; Direct access to target population

Public interest; Community Outreach; Local governmental entity.

Direct access to target population; Strong understanding of the issue

Public sector “seal of approval”; Credibility

Backbone SupportOrganization Support Valuable Impact

Financial resources;Educational expertise;Logistical support; Direct access to target population.

Represent Private, For-profit health care corporation and providers; Credibility

Financial resources;Educational expertise;Logistical support; Direct access to target population; Grant coordination expertise.

Safety-net hospital; Private, non-profit local provider. Marketing/media expertise. Internal communication; Credibility.

Direct access to target population; Strong understanding of the issue; Start-up funding; Logistical support

Public sector/ local governmental entity “seal of approval”; Credibility; Perceived neutrality.

Where are we now?

Provider/Public Education Collateral materials Website Mobilized immunization resources Center of educational expertise and resources

5,459 high risk adults vaccinated for Bacterial Pneumonia

17,228 high risk adults vaccinated for Influenza 564 high risk adults educated on Bacterial

Pneumonia and ways to possibly avoid it 12 education opportunities provided 505 healthcare providers educated 1,895 smoking cessation services provided

to high risk adults

Bacterial Pneumonia Interventions

305 high risk adults educated on UTI and ways to possibly avoid it

12 education opportunities provided to the general population

505 healthcare providers educated

Urinary Tract Infection (UTI) Interventions

1,594 adults diagnosed with COPD vaccinated for Bacterial Pneumonia

1,169 adults diagnosed with COPD vaccinated for Influenza

1,998 adults diagnosed with COPD educated on the condition and ways to manage it

2652 adults educated on COPD and ways to manage it

505 healthcare providers educated 2,260 diagnosed with or at risk for COPD

provided with smoking cessation services

Chronic Obstructive Pulmonary Disease (COPD) Interventions

Success begets MORE success

Sustainability + Assets = Resilience

Resilience = Effectual Change

Effectual Change Improved

Community Health

“Train the Trainer” program for long-term care & assisted living facilities

Collaborate with existing events and organizations

Promote the website and Facebook page October 18, 2013: Provider Education Look for additional funding/support

Opportunities/Future Efforts

The Status is not Quo.

Contact Information

Mimi Baugh, MSN, RN-BC, RAC-CTDirector, Caregiver Research Institute, Angelo State University

325.486.6607 mimi.baugh@angelo.edu

Crystal Conner, MARegional Health Coordinator, Shannon Health & Wellness

Shannon Medical Center325.657.5677 crystalconner@shannonhealth.org