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Clinical-Community Relationships as a Pathway to Improve Health: Tools for Research and Evaluation August 7, 2013 1:00-2:00 PM ET. TODAY’S EVENT MODERATOR. Janice Genevro, PhD, MSW. AHRQ Prevention and Chronic Care Program. AHRQ and Clinical-Community Relationships. - PowerPoint PPT PresentationTRANSCRIPT
Clinical-Community Relationships as a Clinical-Community Relationships as a Pathway to Improve Health: Pathway to Improve Health:
Tools for Research and EvaluationTools for Research and Evaluation
August 7, 2013August 7, 20131:00-2:00 PM ET1:00-2:00 PM ET
TODAY’S EVENT MODERATORTODAY’S EVENT MODERATOR
Janice Genevro, PhD, MSW
AHRQ Prevention and Chronic Care Program
AHRQ and Clinical-AHRQ and Clinical-Community RelationshipsCommunity RelationshipsBuilding the Evidence Base:
What Do We Know? What Do We Need to Know?
How are partnerships among primary care and medical specialty providers, the community, and public health organizations developed, strengthened, and sustained to improve care and meet the needs of patients and families?
AHRQ and Clinical-AHRQ and Clinical-Community RelationshipsCommunity Relationships
The Promise of Clinical-Community Relationships
Form partnerships among clinical, community, and public health organizations to fill gaps in needed services.
Coordinate health care delivery, public health, and community-based activities to promote healthy behavior.
Promote patient, family, and community involvement in preventive health care.
Learning ObjectivesLearning Objectives Understand the concept of clinical-community Understand the concept of clinical-community
relationships and the rationale and need for relationships and the rationale and need for further investigation of measuresfurther investigation of measures
Learn about the processes used to develop the Learn about the processes used to develop the Clinical-Community Relationships Measures Clinical-Community Relationships Measures Atlas and RoadmapAtlas and Roadmap
Hear about the application of these products to Hear about the application of these products to research, evaluation, and public health research, evaluation, and public health practicepractice
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TODAY’S PRESENTERSTODAY’S PRESENTERS
Robert M. Pestronk, MPHRobert M. Pestronk, MPHRebecca Etz, PhDRebecca Etz, PhD
Virginia Commonwealth University
National Association of County and City Health
Officials (NACCHO)
Clinical-Community Relationship Measures (CCRM)Clinical-Community Relationship Measures (CCRM)
Rebecca Etz, PhDVirginia Commonwealth University
Department of Family Medicine and Population Health
The CCRM Project - PurposeThe CCRM Project - Purpose What is the purpose of this project?
Focus on clinical-community partnerships Develop measures to assess clinical-community
relationships Improve care and ability to meet patient needs Promote integrated approach to preventive services Overcome persistent obstacles to delivery
Fragmentation experienced by providers Fragmentation experienced by patients Fragmented medical neighborhoods ‘Decentering’ of relationships in medicine
The CCRM Project - MethodsThe CCRM Project - Methods What did we do?
Literature review to identify state of the art as well as gaps
Conceptual framework to facilitate learning Expert panel to assist with literature findings,
conceptual framework, identification of measures and creation of candidate measures
Set priority questions suggested by framework Develop recommendations for future directions
The CCRM Project - ParametersThe CCRM Project - Parameters
What were the assumptions informing our work?
Prevention that originates in primary care Community resources provide non-clinical services USPSTF recommendations Centering on relationships between clinical settings and
community settings meant that outcomes were not our focus
Conceptual FrameworkConceptual Framework Building our framework
Himmelman and relationships1
4 levels of linkage, collaboration as our target Donabedian and structure-process-outcome2
Enveloping context, action and engagement Etz and bridging3
Anchors on which connecting strategies rely1Himmelman A. Collaboration for a change: definitions, decision-making models, roles, and collaboration process guide.
Unpublished work. 2002. Partnership Continuum Inc., Minneapolis (MN).2Donabedian A. Explorations in quality assessment and monitoring: the definition of quality and approaches to its assessment.
Ann Arbor: Health Administration Press; 1980.3 Etz R, Cohen D, Woolf S, et al. Bridging primary care practices and communities to promote healthy behaviors. Am J Prev Med.
2008; 35(5S):S390-S397.
Conceptual FrameworkConceptual Framework
Rebecca S. Etz, Deborah J. Cohen, Steven H. Woolf, Jodi Summers Holtrop, Katrina E. Donahue, Nicole F. Isaacson, Kurt C. Stange, Robert L. Ferrer, Ardis L. Olson, Bridging Primary Care Practices and Communities to Promote Healthy Behaviors, American Journal of Preventive Medicine, Volume 35, Issue 5, Supplement, November 2008, Pages S390-S397, ISSN 0749-3797, http://dx.doi.org/10.1016/j.amepre.2008.08.008.
Conceptual FrameworkConceptual Framework
Elements: patients, Elements: patients, clinics/clinicians, and clinics/clinicians, and community resourcescommunity resources
Domains: structure, process, Domains: structure, process, outcomesoutcomes
Relationships among themRelationships among them
Conceptual FrameworkConceptual Framework
Expert Panel Expert Panel • Lynda Anderson, PhD - Centers for Disease Control and Prevention (CDC)
• Cheryl Aspy, MEd, PhD - Oklahoma Physicians Resource/Research Network (OKPRN), University of Oklahoma Health Sciences Center
• Carol Cahill, MLS - Center for Community Health and Evaluation, Group Health Research Institute (GHRI)
• Rebecca Etz, PhD - Ambulatory Care Outcomes Research Network (ACORN), Virginia Commonwealth University
• Russell E. Glasgow, PhD - National Cancer Institute (NCI)
• Cheryl Irmiter, PhD - Easter Seals (formerly AMA)
• Bobby Pestronk, MPH - National Association of County and City Health Officials
• Ruta Valaitis, RN, PhD - McMaster University; City of Hamilton, Public Health Department
Clinical-Community Clinical-Community Relationships Measures Atlas Relationships Measures Atlas
Published March 2013Published March 2013 Includes 22 measuresIncludes 22 measures Measurement framework Measurement framework
and rationaleand rationale Aligns measures to Aligns measures to
frameworkframework 10 of 56 categories 10 of 56 categories
include at least one include at least one measuremeasure
http://www.ahrq.gov/professionals/prevention-chronic-care/resources/clinical-community-relationships-measures-atlas/index.html
Clinical-Community Relationships Clinical-Community Relationships Measures Atlas Measures Atlas
Existing MeasuresExisting Measures
Existing MeasuresExisting Measures
Existing MeasuresExisting Measures
Existing MeasuresExisting Measures
Clinical-Community Relationships Clinical-Community Relationships Evaluation RoadmapEvaluation Roadmap
Focus on clinical Focus on clinical interactions and interactions and integrating servicesintegrating services
Capture the context Capture the context of care deliveryof care delivery
Inform research Inform research development and development and designdesign
http://www.ahrq.gov/professionals/prevention-chronic-care/resources/clinical-community-relationships-eval-roadmap/index.html#
Clinical-Community Relationships Clinical-Community Relationships Evaluation RoadmapEvaluation Roadmap
Priority Areas of Study1.1.Influence of element characteristicsInfluence of element characteristics2.2.Influence of relationships between the elementsInfluence of relationships between the elements3.3.Relative importance of elements and relationships Relative importance of elements and relationships in contextin context4.4.Best methods, strategies, and settings for studying and Best methods, strategies, and settings for studying and improving clinical-community relationshipsimproving clinical-community relationships5.5.Best measures for evaluating effectiveness of Best measures for evaluating effectiveness of clinical-community relationships clinical-community relationships
Clinical-Community Relationships Clinical-Community Relationships Evaluation RoadmapEvaluation Roadmap
Seven Recommendations1.1.Use complex systems approachesUse complex systems approaches2.2.Accommodate/tailor for variability in designAccommodate/tailor for variability in design3.3.Develop standard measuresDevelop standard measures4.4.Conduct rigorous, mixed methods approachesConduct rigorous, mixed methods approaches5.5.Report findings more thoroughly in useful formatsReport findings more thoroughly in useful formats6.6.Assess feasibility and sustainability of interventions for Assess feasibility and sustainability of interventions for clinics, patients, and clinical-community relationshipsclinics, patients, and clinical-community relationships7.7.Consider conceptual Consider conceptual framework as a starting pointframework as a starting point
Clinical-Community Relationship Measures (CCRM)Clinical-Community Relationship Measures (CCRM)
Robert M. (Bobby) Pestronk, MPHNational Association of County and
City Health Officials (NACCHO)
Clinical-Community Clinical-Community Relationships and NACCHORelationships and NACCHO
Recognition of the local health department playing a role in preventive health
Provides framework for understanding relationships among local health departments and practitioners
Provides guidance for young public health services and systems researchers
Contributions of the CCRM Project to Contributions of the CCRM Project to the Public Health Communitythe Public Health Community
Guidance to local health departments Understand roles in evolving
health care system Promote connection with
primary care practices Working with various
stakeholders Develop effective relationships Reduce barriers to encourage
relationships
MCOs
Parks
Mass TransitNursing Homes
Mental HealthDrug
Treatment
Civic GroupsCHCs
Laboratory Facilities
Hospitals
EMS
Health Department
Elected Officials
Tribal Health
Schools
Police
Fire
Jails
Environmental Health
ChurchesHome Health
Economic DevelopmentEmployers
PhilanthropistDoctors
Community Centers
Evaluation Roadmap provides a “context” for delivery of clinical preventive services: Outside of traditional primary care setting Clinicians and clinical practices are embedded
in a larger health care system
Public Health Implications of the Evaluation Roadmap
Public Health Implications of the Evaluation Roadmap
The Roadmap is a “through the looking glass” approach to population/public health: Greater access to clinical
preventive services More coordinated and
team-based care Potential cost savings Better health quality Better health outcomes
How to use the power of public health tools and clinical prevention services to make life and health easier and less risky for everyone?
What mix of financial incentives, technology, stories, politics, and training are necessary to achieve those goals?
Key Research Concerns for Key Research Concerns for Public HealthPublic Health
How can the cost savings from the practice of community-clinical relationships be reinvested in efforts to improve social equity?
What are the best qualitative and quantitative methods for evaluating clinical-community relationships?
How can we best scale up and adapt what’s working best in some locations so that it working best in all places?
Key Research Concerns for Key Research Concerns for Public HealthPublic Health
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For More InformationFor More Informationhttp://www.ahrq.gov/professionals/prevention-chronic-care/index.html
For More InformationFor More Informationhttp://www.innovations.ahrq.gov/linkingClinicalPractices.aspx
This project was funded under contract # HHSA290-2010-000021 This project was funded under contract # HHSA290-2010-000021 from the Agency for Healthcare Research and Quality (AHRQ), from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The opinions U.S. Department of Health and Human Services. The opinions expressed in this presentation are those of the presenters and do expressed in this presentation are those of the presenters and do not reflect the official position of AHRQ or the U.S. Department of not reflect the official position of AHRQ or the U.S. Department of Health and Human Services.Health and Human Services.
For more information about AHRQ’s work in this area, visit For more information about AHRQ’s work in this area, visit http://www.ahrq.gov/professionals/prevention-chronic-care/index.http://www.ahrq.gov/professionals/prevention-chronic-care/index.htmlhtmlor contact:or contact:Janice Genevro, PhDJanice Genevro, [email protected]@ahrq.hhs.gov