October 2024
President's Report
WCHQ Fundamental: Assume Positive Intent
The September WCHQ Board of Directors meeting began with our tradition of reviewing one of our Fundamentals. (We have 30 Fundamentals that define the behaviors we expect of our team and collaborative participants; actions that will take our collaborative from good to great). This month, we reviewed: Assume Positive Intent: Work from the assumption that people are good and that the intent behind their actions is positive.
This particular fundamental has a significant connection to the impetus for WCHQ. In the early 2000s, a group of health systems committed to sharing their strategies for improvement in the spirit of “raising all boats.” I later heard one of those leaders, Jeff Thompson, MD, describing this as analogous to when a physician answers the phone call of a colleague looking for help caring for a difficult patient. In medical school, physicians are taught that they should help each other take better care of patients; there is nothing proprietary about high quality care.
Today, in our fast-paced and often impersonal/virtual world, it is easy to focus more on the urgent task at hand, forgetting the human sitting across the (virtual) table. When solving complex problems, we need to have all voices heard, which means that we must start with a commitment to Listening Generously (another WCHQ fundamental). By assuming positive intent, we foster a culture of trust and collaboration, essential for achieving our shared goal of delivering exceptional care and improving health outcomes for all.
Data Spotlight
Breast Cancer Screenings Increase, Saving Lives
Breast cancer is the second most common cancer in the US in women and the second-leading cause of cancer-related deaths. In 2022, nearly 273,000 new breast cancers were reported, with 42,211 deaths from breast cancer (CDC - US Cancer Statistics). Regular screenings are the best method for catching breast cancer early and reducing related deaths, with seven deaths averted for every 1,000 patients screened (CDC).
Wisconsin ranks in the top 5 states for breast cancer screenings (NIH), consistently surpassing the national average. Since 2005, there has been a significant rise in screenings and an increase in eligible patients:
- In 2005, 71% of around 300,000 patients were screened, preventing nearly 1,500 deaths.
- Today, after a minor drop during the COVID-19 pandemic, more than 78% of 469,000 eligible patients were screened.
- Since 2005, WCHQ members have conducted at least 3 million screenings, preventing 21,000 deaths.
There is still work to be done. In 2023, 103,000 patients need screening, potentially preventing 721 deaths. The recommended age for breast cancer screenings is moving from 50 to 40, raising the number of eligible patients. We're dedicated to helping our members adapt, knowing that preparation and collaboration, as seen with colorectal cancer screening age changes, will ensure we're ready for this shift.
MercyHealth Increases Breast Cancer Awareness
Mercyhealth shared with us that several of their clinics in McHenry County have a special way of showing support. Mercyhealth clinics in Harvard, McHenry, and Woodstock set up a Remembrance Tree for Breast Cancer Awareness Month. Each clinic displays a tree in their lobby for the month of October with pink paper ribbons next to the tree. Patients and visitors are encouraged to write a message on the ribbon to honor a loved one and hang it on the tree.
Mercyhealth Woodstock has been collecting ribbons since the beginning of the project four years ago. The team is exploring new ways to display them each year. Pictured is the Mercyhealth Woodstock Primary Care Team and an example of just one of the ribbon trees honoring and supporting those who have bravely fought this disease.
Sneak Peek: Wisconsin Ahead of National Rates of High Blood Pressure Control
As we prepare to publish some of our statewide quality improvement findings over the last 20 years in our November newsletter, we thought we would share a sneak peek of the great results we are seeing.
Improved Blood Pressure Control – A Success Story
Over the last 20 years, the percentage of patients achieving good blood pressure control has risen significantly. Starting out in 2005, only 60% of patients in Wisconsin had good blood pressure control. Today, our control rate is an impressive 82% of patients.
Most notable of all within this progress is Wisconsin’s comparison to national rates. In 2022, the American Medical Association report, "Years of progress undone" shared that the percentage of US adults with hypertension, who had controlled blood pressure, steadily fell from 53% in 2009 to 48% in 2020. In contrast, our rates for controlled blood pressure improved during that same time period.
UnityPoint-Meriter reports one of the highest rates of high blood pressure control, at 87%. Derek Clevidence, MD, PhD, Regional VP/Medical Director, said, “There are many chronic disease metrics to attend to, and we have maintained a focus on hypertension measurements and follow ups engaging our patients and providers,” said Dr. Clevidence. “We recently refocused on healthcare disparities as part of our Community Health Needs Assessment action plan with additional outreach. These gaps have to be closed for optimum population health and it’s great to see some improvement.”
Wisconsin’s Growing Obesity Challenge: A Comparison of Wisconsinites in 2016 and 2023
New WCHQ data shows that obesity rates in Wisconsin are continuing to rise, creating a serious public health challenge. In 2016, 41.2% of Wisconsin’s adult population was living with obesity. By 2023, nearly half of the state's adults are obese (47.7).
This rise in obesity rates highlights the need for action, especially as obesity is a known risk factor for chronic diseases like diabetes, heart disease, and hypertension. Dr. Benjamin Duffy, an obesity medicine specialist with ThedaCare, stresses the medical importance of treating obesity.
“It is essential to recognize obesity as a disease to help manage the potential medical complications connected to it,” he said. “Treating obesity early and effectively with a comprehensive weight management program allows us to help reduce the risk of diabetes, cardiovascular disease, and other life-threatening conditions. Getting ahead of obesity, through a variety of strategies, at an early stage, can help improve patient outcomes.”
Concerning Trends Among Younger Adults
Our data shows an increase in obesity rates among younger adults, particularly those aged 18 to 34. Early-onset obesity is linked to more severe health complications later in life, including earlier onset of chronic diseases. Addressing obesity early can help prevent the development of these conditions, reducing the overall impact on individual health and long-term healthcare needs.
Geographic Disparities
We noted significant geographic disparities in obesity rates across Wisconsin. Certain areas report much higher rates of obesity, particularly in communities facing socio-economic challenges. These disparities highlight the need for localized, targeted interventions that address the unique social and environmental factors in each community.
The Growing Impact on Healthcare
As obesity rates rise, we will face increasing challenges helping patients manage obesity-related conditions such as type 2 diabetes, heart disease, and certain cancers. The prevalence of these conditions is expected to rise parallel with the growing obesity rates, making effective treatment strategies essential.
Collaborative Efforts to Tackle Obesity
In 2021, we formed an improvement team to combat the rising rates of obesity in Wisconsin. This team is focused on expanding education for healthcare providers and offering resources like an obesity toolkit. Additionally, we are embarking on a project with the Medical College of Wisconsin to train medical students on best practices for obesity care and prevention.
If you’re interested in joining WCHQ’s efforts to combat obesity, please contact Jen Koberstein at JKoberstein@wchq.org. Together, we can work to address this growing health challenge in Wisconsin.
Member Profile
In recognition of the WCHQ 20th anniversary in 2024, we are planning a member profile each month.
Member Name: Sixteenth Street Community Health Centers
Member Background: Sixteenth Street is a Federally Qualified Health Center (FQHC) serving 43,000 patients in Milwaukee and Waukesha Counties. Twenty-five percent of Sixteenth Street patients are uninsured and 69% are best served in a language other than English.
Providing high quality care for 55 years, Sixteenth Street was the first community health center in the state and is the first to publish quality data with WCHQ.
Sixteenth Street was recently recognized by the Health Resource and Services Administration (HRSA) as a 2024 Silver Awardee, Health Center Quality Leader, which represents achieving top 20% performance in clinical quality among health centers nationally.
Number of Providers: 120 providers, medical and behavioral health
Member of WCHQ Since: 2013
Current Quality Goals: For 2024, the Quality Improvement Plan initiatives include Controlling A1c, Controlling High Blood Pressure, Achieving HRSA National Quality Leader Recognition in Maternal and Child Health and Scaling Social Determinants of Health Screening.
Sixteenth Street develops tiered goals for key quality indicators, both process and outcome, in alignment with national, regional and state benchmarks. These data are analyzed and shared organizationally to identify opportunities or indicate sustained performance. Annually, the Quality, Risk and Safey Team assesses performance and identifies a select number of mission-centric initiatives that are the focus of robust multidisciplinary improvement teams.
WCHQ Engagement: Sixteenth Street has been represented on the WCHQ Board of Directors by Dr. Julie Schuller since 2016. Employees and providers of Sixteenth Street have participated in several of the assemblies and educational offerings. This past year, Sixteenth Street began submitting data aligned with the WCHQ data definitions - a journey that is just beginning.
How Participation in WCHQ has Impacted Healthcare at Sixteenth Street: “It’s been important to have the ability to collaborate with other high performing organizations with the focus of driving improved health outcomes for our community,” said Dr. Julie Schuller, Sixteenth Street President and CEO. “The ability to benchmark our results with these organizations also enables us to keep raising the bar.”
Breaking Down Barriers to Colorectal Cancer Screening
Colorectal cancer is the second-leading cause of cancer death in the United States and often symptoms do not appear until cancer has progressed to stage three or four (nccrt.org). Screening for colorectal cancer, with a stool-based test and/or colonoscopy, before symptoms appear, is the best way to find treatable cancer and prevent cancer from developing in the first place (fightcolorectalcancer.org). In Wisconsin, the American Cancer Society reports that one in every twenty-one people have a lifetime risk of developing colorectal cancer. Nationally, they report one in every twenty-three men and one in every twenty-five women will go on to develop colorectal cancer.
In a recent WCHQ webinar, “Colon Cancer Screening Demystified,” Dr. Jennifer Weiss, gastroenterologist with UW Health and the University of Wisconsin-Madison, outlined strategies for overcoming barriers to colorectal cancer screening:
- Patient Concerns about Prep:
- Share the many options for bowel prep. Dr. Weis recommended using a resource with images and clear instructions for many different bowel prep options such as this resource out of UCLA.
- Patient Questions:
- Provide clear instructions regarding who a patient should call with questions, and/or anxiety about the test, particularly noting if they should call their primary care clinic or the gastroenterology department.
- Ensure your clinic has a clear workflow on who answers questions and there is a warm hand off if patients call the wrong number.
- Give patients information about who to call with questions before they leave their primary care appointment.
- There is not enough time during appointments to have an adequate discussion about colorectal cancer screening options:
- Start the conversation about cancer screening early in the appointment. Medical assistants can inform patients about colorectal cancer screening. Share why this screening is important, ask the patient about any questions or concerns they may have.
Dr. Weiss reminds us that the bowel prep is the most important step in the procedure. In fact, the procedure cannot occur without it. “We need the colon to be clean so that we can find the pre-cancerous polyps and remove them during the colonoscopy,” Dr. Weiss said.
Through the course of our 20 years monitoring colorectal cancer screening, 3200 Wisconsinites have had a colorectal cancer detected through a screening. The national screening average in 2021 was 72%, before the recommended age to begin screening was moved from 50 to 45. In 2023, our rate was 74%. This rate even includes the additional patients in the new age recommendation. Our screening rates in Wisconsin are good, and by working together we can keep improving.
