Stronger Together: A Successful Model of Health System-Community Collective Action During the COVID-19 Pandemic.

Background: Discontinuity between health care delivery systems and community-based organizations is a significant barrier to improving population health.

Objective: To describe the facilitators and barriers experienced by a health system-community partnership 15 months after implementation.

Methods: Coalition members who led committees within the coalition or had active, sustained participation in coalition activities were invited to participate.

Advancing action on the political determinants of health in the United States.

In an era of political polarization, growing anti-science sentiment, and pervasive inequities in the social drivers of health, a rising tide of potentially harmful state policy proposals in the United States threaten to undermine the health of the public. In response, our health system's population health and government relations offices partnered with key health advocacy organizations in our state of New Hampshire to offer an interactive virtual learning series aimed at preparing diverse professionals and citizens to effectively advocate for sound health policies. Two hundred forty-seven individuals registered for the six-session series.

The role of comorbidities, medications, and social determinants of health in understanding urban-rural outcome differences among patients with heart failure.

Purpose: There is now a 20% disparity in all-cause, excess deaths between urban and rural areas, much of which is driven by disparities in cardiovascular death. We sought to explain the sources of these disparities for Medicare beneficiaries with heart failure with reduced ejection fraction (HFrEF).

Methods: Using a sample of Medicare Parts A, B, and D, we created a cohort of 389,528 fee-for-service beneficiaries with at least 1 heart failure hospitalization from 2008 to 2017.

Cancer Epidemiology in the Northeastern United States (2013-2017).

Unlabelled: We tested the hypotheses that adult cancer incidence and mortality in the Northeast region and in Northern New England (NNE) were different than the rest of the United States, and described other related cancer metrics and risk factor prevalence. Using national, publicly available cancer registry data, we compared cancer incidence and mortality in the Northeast region with the United States and NNE with the United States overall and by race/ethnicity, using age-standardized cancer incidence and rate ratios (RR). Compared with the United States, age-adjusted cancer incidence in adults of all races combined was higher in the Northeast (RR, 1.

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease.

Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care.

International, national and local trends in the spread of COVID-19: a geographic view of COVID-19 spread and the role to be played by coproduction.

Background: COVID-19, a respiratory disease caused by the SARS-CoV-2 virus, emerged in 2019 and led to a worldwide pandemic in 2020. The COVID-19 pandemic has been a massive natural experiment in the formation of mitigation strategies to prevent cases and to provide effective healthcare for those afflicted. Regional differences in the impact of the pandemic on morbidity and mortality have been driven by political and regional differences in the coproduction of public health and social policy.

A 'COVID Compass' for navigating the pandemic.

Introduction: The greatest challenge confronting political, public health, business, education and social welfare leaders in the COVID pandemic era is to restore the economy, businesses and schools without further risking public health. The 'COVID Compass' project aims to provide helpful information to guide local decisions by tracking state and local policies over time and their impact on a balanced set of outcomes-health metrics, economic trends and social hardship indicators.

Methods: We selected a parsimonious set of 'local level' health, economic and hardship outcomes and linked them to 'local level' actions aimed to decrease COVID-19 health effects and to mitigate hardship for people, businesses and the economy.

International, national and local trends in the spread of COVID-19: a geographic view of COVID-19 spread and the role to be played by coproduction.

Background: COVID-19, a respiratory disease caused by the SARS-CoV-2 virus, emerged in 2019 and led to a worldwide pandemic in 2020. The COVID-19 pandemic has been a massive natural experiment in the formation of mitigation strategies to prevent cases and to provide effective healthcare for those afflicted. Regional differences in the impact of the pandemic on morbidity and mortality have been driven by political and regional differences in the coproduction of public health and social policy.

Multidisciplinary treatment of opioid use disorder in primary care using the collaborative care model.

: Treatment of opioid use disorder (OUD) is highly effective, but access is limited and care is often fragmented. Treatment in primary care can improve access to treatment and address psychiatric and physical co-morbidities in a holistic, efficient, and non-stigmatizing way. The Collaborative Care Model (CCM) of behavioral health integration into primary care has been widely disseminated and shown to improve outcomes and lower costs when studied for depression, but its use in treating substance use disorders has not been well documented.

Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach.

Background: Health systems in the United States are increasingly required to become leaders in quality to compete successfully in a value-conscious purchasing market. Doing so involves developing effective clinical teams using approaches like the clinical microsystems framework. However, there has been limited assessment of this approach within United States primary care settings.

Dissemination and Implementation of Evidence Based Best Practice Across the High Value Healthcare Collaborative (HVHC) Using Sepsis as a Prototype - Rapidly Learning from Others.

The dissemination of evidence-based best practice through the entire health care system remains an elusive goal, despite public pressure and regulatory guidance. Many patients do not receive the same quality of care at different hospitals across the same health care system. We describe the role of a data driven learning collaborative, the High Value Healthcare Collaborative (HVHC), in the dissemination of best practice using adherence to the 3-hour-bundle for sepsis care.

Primary care colorectal cancer screening correlates with breast cancer screening: implications for colorectal cancer screening improvement interventions.

Objective: National colorectal cancer (CRC) screening rates have plateaued. To optimize interventions targeting those unscreened, a better understanding is needed of how this preventive service fits in with multiple preventive and chronic care needs managed by primary care providers (PCPs). This study examines whether PCP practices of other preventive and chronic care needs correlate with CRC screening.

Building the learning health system: Describing an organizational infrastructure to support continuous learning.

Introduction: Academic health centers are reorganizing in response to dramatic changes in the health-care environment. To improve value, they and other health systems must become a learning health system, specifically one that has the capacity to understand performance across the continuum of care and use that information to achieve continuous improvements in efficiency and effectiveness. While learning health system concepts have been well described, the practical steps to create such a system are not well defined.

Across the divide: "Primary care departments working together to redesign care to achieve the Triple Aim".

Background: Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim.

Methods: As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care.

Strange Bedfellows: A Local Insurer/Physician Practice Partnership to Fund Innovation.

Despite an unprecedented urgency to control healthcare costs while simultaneously improving quality, there are many barriers to investing in quality improvement. Traditional fee-for-service reimbursement models fail to reward providers whose improved processes lead to decreases in billable clinical activity. In addition, providers may lack the necessary skills for improvement, or the organizational infrastructure to conduct these activities.

A simple framework for complex system improvement.

The need to rapidly improve health care value is unquestioned, but the means to accomplish this task is unknown. Improving performance at the level of the health care organization frequently involves multiple interventions, which must be coordinated and sequenced to fit the specific context. Those responsible for achieving large-scale improvements are challenged by the lack of a framework to describe and organize improvement strategies.

Engaging Patients at the Front Lines of Primary Care Redesign: Operational Lessons for an Effective Program.

Unlabelled: Article-at-a-Glance Background: The lack of patient engagement in quality improvement is concerning. As part of an enterprisewide initiative to redesign primary care at UW Health, interdisciplinary primary care teams received training in patient engagement.

Methods: Organizational stakeholders held a structured discussion and used nominal group technique to identify the key components critical to fostering a culture of patient engagement and critical lessons learned.

Predictors of colorectal cancer screening variation among primary-care providers and clinics.

Objectives: Colorectal cancer (CRC) screening is underutilized. To effect change, we must understand reasons for underuse at multiple levels of the health-care system. We evaluated patient, provider, and clinic factors that predict variation in CRC screening among primary-care clinics and primary-care providers (PCPs).

Optical colonoscopy and virtual colonoscopy numbers after initiation of a CT colonography program: long term data.

Background And Aims: The effect of CT colonography (CTC) screening on colonoscopy is unknown. The objective of this study is to determine the effect of a CTC screening program on the number of screening, therapeutic and total colonoscopies performed.

Methods: We compared the quarterly mean numbers of colonoscopic examinations performed for 50-79 year olds undergoing colorectal cancer screening in 2003, before initiation of a CTC program, to 2011, seven years after the CTC program began at our academic tertiary care facility.

Effect of patient selection method on provider group performance estimates.

Background: Performance measurement at the provider group level is increasingly advocated, but different methods for selecting patients when calculating provider group performance have received little evaluation.

Objective: We compared 2 currently used methods according to characteristics of the patients selected and impact on performance estimates.

Research Design, Subjects, And Measures: We analyzed Medicare claims data for fee-for-service beneficiaries with diabetes ever seen at an academic multispeciality physician group in 2003 to 2004.

Minority status and diabetes screening in an ambulatory population.

Objective: Ethnicity has been identified as a risk factor not only for having type 2 diabetes but for increased morbidity and mortality with the disease. Current American Diabetes Association (ADA) guidelines advocate screening high-risk minorities for diabetes. This study investigates the effect of minority status on diabetes screening practices in an ambulatory, insured population presenting for yearly health care.