The bedrock of WCHQ’s measurement system was laid in the early 2000s with the development of several key metrics that health system leaders knew were fundamental to tracking quality improvement. One of the earliest measures was A1c control.

As the rate of diabetes continues to climb, WCHQ members remain focused on diagnosing and treating patients with diabetes. While the pandemic impacted how and when care could be delivered, health care teams across Wisconsin rallied to ensure patients had access to care, whether it was virtual or inpatient visits. The importance of Diabetes Self-Management Education and Support DSMES) programs has never been more important than now. To learn more about how WCHQ can support you and your team as you help your patients who are diabetic live a healthy life, contact Sheryl Pierce.

The following graphs are pulled from WCHQ diabetes measurement data.

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Diabetes A1c Control Over Time December 2021:
‍This graph shows how WCHQ members performed over time on the Diabetes A1c Control measure, ending in December 2021. It includes four lines: the overall WCHQ member performance (blue), the top performing member (green), the bottom performer (red), and the goal set for this measure by the IAC (black dashes). As you can see, there was a significant drop in A1c control in the first year of the COVID-19 pandemic. However, in 2021 we saw a rebound on this measure, with performance returning to nearly pre-pandemic levels.

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Diabetes 2021 Race:
‍This graph shows Diabetes A1c Control for 2021 stratified by race. While the overall population rates have stabilized, there are still large racial disparities in A1c control. The lowest performing group is Hispanic/Latino, and the highest performing group is white. Approximately 1300 more Hispanic/Latino patients with diabetes would need to be identified to achieve A1c control to close that gap. The Black population also faces a significant disparity for A1c control, with a 11.4 percentage point difference when compared to white patients. Approximately 1722 more Black patients with diabetes would need to achieve A1c control and close the gap.

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Diabetes 2021 Geography:
The Diabetes A1c control disparities are not as large when we examine them by geography, but when we compare the lowest performing group (Urban Underserved) to the top performing group (Rural Advantaged), there is a significant difference between them. About 2,065 Urban underserved patients with diabetes would need to achieve A1c control to eliminate this difference.

For nearly two years, WCHQ has led a statewide effort to improve the care for those with the disease of obesity. With support from Novo Nordisk, WCHQ hosted an Obesity Summit October 13 with more than 150 in attendance. The Summit provided an opportunity for WCHQ members and stakeholders to ask thoughtful and pertinent questions following presentations, but more importantly, with one another during breaks.

Weight loss can have a profound impact on chronic disease, according to Tony Hampton, MD, a Board -Certified Obesity and Family Medicine physician for Advocate Aurora’s South Region in Chicago. In his keynote address, Dr. Hampton emphasized the importance of being mindful of the benefit of any physical activity, even if it is only for 10 minutes a day.

“We have to meet people where they are,” according to Dr. Hampton. “We need evidence-based science in our obesity discussions with patients. We cannot alienate people. As clinicians, we need to help lead that, to work together collaboratively and engage everyone in the community.”

Lisa Cadmus-Bertram, PhD, director of the Wisconsin Physical Activity Epidemiology Lab at UW-Madison, studies how physical and sedentary behaviors influence health. Specifically, she looks at the association between physical activity and cancer survival rates.

Cancer screening and treatment continue to improve 5-year survival rates for an increasingly large population of cancer survivors. Dr. Cadmus-Bertram said how physical activity is measured matters. Self-reported activity rates tend to be higher than actual.

She explained that people sometimes mistake exhaustion for physical activity. While caring for kids seems like you are doing a lot, it is not getting your heart rate up. Childcare must be entirely disentangled from physical exercise, according to Dr. Cadmus-Bertram.

The patient’s perspective on the care they receive when they have the disease of obesity was clearly communicated by Novo Nordisk Ambassador Patty Nece. A successful attorney, Patty described the bias she has experienced in school and the community. But as she told the audience of health care professionals her often shocking interactions from physicians who did not understand the disease and made her feel even more stigmatized and isolated, it was a clear signal to everyone that “we can do better.”

An important part of caring for patients, especially on the topic of weight, diet or exercise, is having the right conversation. Mia Croyle is a behavioral health specialist at MetaStar with considerable experience teaching motivational interviewing. Motivational interviewing is an intentional way of structuring a conversation, using an empathic listening system to increase motivation and confidence.

Two volunteers, Dirk Steinert, MD, Ascension Wisconsin and Jan Simonson, RN, Marshfield Clinic Health System, demonstrated how motivational interviewing can be more effective than other methods to help patients decide what steps they need to take to be healthy. The key, according to Croyle, is compassionate curiosity, not “gotcha” questions.

In closing, Joe Blatz from Novo Nordisk, shared the personal story of losing his mother at age 56 to congestive heart failure. She struggled with weight her entire adult life, she lost weight but struggled with weight gain.

“I hope today, through the presentations, that you found one thing you can take back and share with a family member or a patient that can change the path that they are on,” Blatz concluded.

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The fourth annual WCHQ Oral Health Collaborative Summit brought the members of the one-of-a-kind group together October 7 to network on topics ranging from value-based oral health and oral health disparities.

Gabrielle Rude, PhD, WCHQ President and CEO, started the day with Wisconsin history noting the great opportunities for collaboration to make advancements within oral health beyond just Wisconsin. Well positioned to innovate within valued-based oral health and oral health disparities, WCHQ brought in local and national speakers that filled the day with ambition.

The keynote speaker, Erica Colangelo, MPH from the Dental Quality Alliance shared a reflection from the “Gardener’s Tale.”

“We need to consider who has the power to decide? To act? To control resources?” Colangelo said. “We have the power to start with measurement and utilize the data paired with improvement models that support meaningful change.”

Dr. Kaz Rafia, DDS, MBA, MPH, Chief Health Equity Officer from CareQuest Institute, followed Colangelo with a reminder that “oral health care wasn’t built for everyone” – there are great disparities. Many improvement models put data before culture, but Dr. Rafia believes understanding cultural differences first is foundational to understanding the story of the data.

“You cannot find, what you cannot see, it requires data," according to Dr. Patrick Courneya, Health Plan Medical Director of HealthPartners. He encouraged the possibility of smaller organizations having the ability to make a profound impact on value by looking for practice variations and finding opportunities to do better. He used examples from his small practice in the early days of quality improvement and made valuable suggestions on how to take small steps to make a significant difference.

An impressive panel of leaders from HealthPartners, CareQuest Institute, Delta Dental of Wisconsin, and WCHQ agreed on the importance of beginning with the end in mind. Greg Theis, DDS, MBA, from Delta Dental of Wisconsin, provided a terrific overview of the vision of value-based oral health contracting. David Gesko, DDS, followed with real life examples in use today at HealthPartners. Dr. Rafia built on the morning lessons about value and disparities. There are great opportunities ahead, Dr. Rude summarized, “Aim for the moon, even if you miss, you’ll be among the stars.”

All remarkable things are supported with great teams, Cliff Hartmann, DDS, President of the Wisconsin Dental Association, followed the panel discussion by identifying opportunities within policy and training to support workforce issues. Workforce issues are pivotal in oral health and the WDA is approaching this issue head on.

As the Summit came to a close, the group enjoyed learning and discussing the topic of oral health disparities with Abbey Harburn, MPH, WCHQ Analytics Manager who also leads WCHQ Disparities initiatives. Harburn stressed the importance of identifying opportunities within the measurement side of oral health well beyond just meeting the measure. Harburn emphasized the importance of utilizing WCHQ data to better understand where disparities exist and building up the capacity to reduce disparities and advance health equity through statewide partnerships.

Oral health systems are not built for everyone – we need to identify practice variation and work towards improvement. Collectively, WCHQ Oral Health Collaborative members and partners can make a difference with data collection, shared learning, and evidence-based solutions.

The WCHQ Oral Health Collaborative appreciates the support of Haleon (formerly GSK) and Delta Dental of Wisconsin for supporting the oral health collaborative in this exciting work.

The WCHQ Oral Health Collaborative meets regularly to discuss issues of common interest, develop dental measures and collaborate on improvement work and publicly report results. To learn more contact Jen Koberstein.

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The first of its kind for WCHQ, the Disparities Summit will focus on sharing interventions that have worked to ensure all people in our communities have access to the care they need to lead their healthiest life. The speakers are all well-versed in issues related to equity and inclusion; many are directly involved in community actions with a goal of improving health by addressing the social determinants of health.

This event is offered both virtually and in person. We hope you can join us in person to participate in round table discussions on key areas where disparities have been identified to share and learn as we work together to eliminate health disparities in Wisconsin.

The complete schedule of education events and registration links follow. Contact Mary Kay Fahey for more information on any event.‍

‍WCHQ Disparities Summit

‍November 10

9 AM – 4 PM

Brookfield Conference Center, Brookfield, WI

Register

Agenda

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Disparities

Improvement Team Sets Plans for 2023

The Disparities Improvement Team met in October to discuss plans for 2023. The Team reviewed disparities data related to behavioral health and shared feedback on how this data could be made actionable for health systems throughout the state. In 2023, WCHQ and the HealthyMetric project team will publish a statewide report on disparities in behavioral health. The Disparities Improvement Team’s feedback will be incorporated into these reports to ensure that they are useful to health systems and other stakeholders.

The Team also spent time brainstorming methods for collecting and disseminating best practices, successful interventions, and strategies to improve health equity. In the coming year, the Team will develop a toolkit of strategies, which will be available to WCHQ members and other stakeholders.

For more information, contact Abbey Harburn.

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Chronic Kidney Disease

A Costly, Debilitating Disease: Help Identify and Slow the Progression

As one of the WCHQ priority areas, diabetes is a focus for the Chronic Kidney Disease Advisory Group. Over the last few months, the advisory group, consisting of primary care physicians, nephrologists, dietitians, pharmacists, quality improvement and clinical staff, have focused on developing two new measures to support early detection and treatment of chronic kidney disease (CKD) in patients with diabetes.

With nearly 40 percent of patients with diabetes showing evidence of chronic kidney disease, it becomes even more important for early detection and treatment options to slow the progression of CKD. A costly, debilitating disease - if caught early, CKD can be slowed and, in some instances, reversed.

The CKD Advisory Group is excited to continue this very important work and to see how data can inform their work. Over the next year, the Advisory Group anticipates developing educational opportunities for WCHQ members and formulating improvement strategies.

Contact Sheryl Pierce if you would like to learn more about the CKD Advisory Group and the supporting metrics.

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Chronic Disease Learning Collaborative, Diabetes Work Group

November is Diabetes Awareness Month

Throughout the year, about nine health systems have actively engaged in the WCHQ Chronic Disease Learning Collaborative (CDLC), Diabetes Workgroup. Many have committed to specific SMART goals to support improvement efforts within their own health system. The workgroup meetings focus on sharing best practices and exploring solutions to overcome common barriers. Topics vary from ways to improve optimal testing, staffing challenges, priority populations, and how to strengthen Diabetes Self-Management Programs.

At the upcoming January meeting, the CDLC workgroup participants will share individual poster presentations focusing on improvement strategies and results achieved. For additional information, please contact Sheryl Pierce at spierce@wchq.org.

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Obesity Advisory Team

The obesity advisory team had an engaging conversation in October providing feedback on the Obesity Summit, appreciating the virtual and in person options for attendees, reviewing the presenters and the impact of their messages. The Team brainstormed ideas for the next summit or educational events in the spring to focus on payment and obesity medication issues. An Obesity Toolkit is under development and will be sent to the Team for review in the upcoming weeks.

If you are interested in learning more about obesity, contact Jen Koberstein.

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Adolescent and Child Health Team Identifies Health Disparities

The Adolescent and Child Health Improvement Team met in October to review data and identify existing pediatric health disparities. The Team examined four measures: Childhood Immunization Status, Adolescent Immunization Status, Well Child Visits in the First 15 Months of Life, and HPV Vaccination. Each measure was stratified by race and ethnicity, insurance type, and geography to identify specific populations facing health disparities in access and utilization. The Childhood Immunization measure shows particularly stark disparities by race and ethnicity. Approximately 79.6% of white children are up to date on their childhood vaccines. On the other hand, only 59.3% of Native American children and 62.2% of Black children have completed the required childhood vaccines on time. The Improvement Team discussed strategies for addressing health disparities in their own patient populations, including education and outreach campaigns, proactive scheduling, and building trust between health systems and populations experiencing disparities.

For more information or to participate in the Adolescent and Child Health Improvement Team, contact Sheryl Pierce.

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