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This page presents an overview of the Collaboratives. You can scroll down the page or jump to a specific item on the menu below:

Background

Fundamental changes are underway in American medicine. Health care systems are replacing independent small practices. Managed care and integrated delivery systems are leading an aggressive pursuit for lower costs and greater efficiency. Greater emphasis is being placed on the value of services, receiving high quality services for a competitive price. Measurement systems and "report cards" are a common feature of today's marketplace. There is also a growing gap in health disparities among the diverse U.S. population.

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The Collaboratives

The Bureau of Primary Health Care (BPHC), in collaboration with health centers, and public and private agencies, has launched an aggressive, innovative program to address health disparities, access to care and a changing marketplace. This effort, the Health Disparities Collaborative, seeks to 1) generate and document improved health outcomes for the underserved populations; 2) transfer knowledge about how to promote positive breakthrough changes; and 3) develop infrastructure, expertise, and leadership to support and drive improved health, access, and cost outcomes. Attainment of these goals depends upon continual learning, improvement, and change.

This multi-year Health Disparities Collaborative initiative began with Diabetes I, October 1998. Diabetes II began October 1999; Asthma and Depression started in January 2000 as part of the Institute of Healthcare Improvement (IHI) Breakthrough Series. Diabetes III and Cardiovascular began April 2001; Asthma II began in August 2001. In 2002, multi-condition Collaborative cycles began with Asthma, Cardiovascular Disease, Diabetes and Depression; in 2003, the conditions of focus and other related topics were Cancer, Cardiovascular Disease, Depression and Diabetes, with national pilots on Prevention, Diabetes Prevention and Finance/Redesign.

The California Quality Improvement Collaborative initiative began with Asthma and Diabetes in 2003, with clinics and health centers from the state of California not participating in the BPHC National Health Disparities Collaboratives. It uses the same models and measures as the national collaboratives.

The goals of the Collaboratives are to decrease or delay the complications of the disease, decrease the economic burden for patients and the community, and improve access to quality chronic disease care for underserved populations. Although participant organizations will pursue goals matched to local and state needs, all participants in the Collaborative will work to accomplish national goals as well.

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Collaborative Structure

The BPHC Health Disparities Collaboratives are guided at the national level by a Faculty/Planning Group comprised of individuals experienced in all of the conditions of focus: cancer, cardiovascular disease, depression, diabetes, diabetes prevention, prevention, etc. As well as health center operations, process improvement/redesign and evaluation strategies. National Collaborative Directors oversee all collaborative operations, logistics, and evaluation. Each of the five lead Cluster primary care associations (PCA) and clinical networks provide regional oversight and management within their respective region. A Cluster Director employed by the lead PCA in each Cluster, works in concert with a lead clinical network, and other national, regional, and local partners. Each Cluster has a Steering Committee with membership representative of health centers, primary care associations, clinical networks and major partners, drawing on their disciplines and expertise.

The California Quality Improvement Collaborative is structured very much in the same manner; focusing on California clinics and health centers. Its staff is housed at the California Primary Care Association in Sacramento and has its own Steering Committee, with a similar membership representation as the BPHC HDC Steering Committee.

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Collaborative Model

The model for the Collaboratives combines an interactive process improvement approach with rapid change using a Care Model. This model draws from the experience of the Bureau of Primary Health Care's (BPHC) National Health Disparities Collaboratives. The model has been successfully implemented in over 500 health centers nationwide to improve the care of patients with Asthma, Cancer, Cardiovascular Disease, Diabetes, Depression, as well as working to improve Diabetes Prevention and General Prevention. Another distinctive feature of this Collaborative is the focus on patients' needs and self-management abilities as drivers of heath change efforts. By taking a redesign approach, results are achieved organization-wide as opposed to within one department or area. This strategy assumes that health centers are not bound by the current system, that they can effect changes identified as useful, and that they desire a system that is efficient, effective, and satisfying for both patient and staff.

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What Is Required For A Clinic/Health Center To Participate?

Eligible health centers and clinics include Federally Qualified Health Centers (FQHCs) and other BPHC-funded health centers for the BPHC National Health Disparities Collaboratives, and non-BPHC-funded clinics/health centers for the California Quality Improvement Collaborative. Executive Directors and Medical Directors of centers interested in participating in this collaborative must commit to:

Engage the staff in efforts to improve care for patients as set forth by the Collaborative through well-defined measures and testing.

• Connect the goals of the Collaborative to strategic plans and initiatives in the organization.
• Provide a senior leader (must be CEO or Medical Director) to:
  • serve as sponsor for the Health Care Improvement Team;
  • serve as champion for spread of positive changes.
• Have their collaborative team attend all four Learning Sessions.
• Have their senior leader attend the first and third Learning Sessions.
• To attend a minimum of one Collaborative team meeting per month in the center.
• Complete all prework requirements prior to the Kickoff & Learning Session.
• Ensure monthly reports are submitted to the Collaborative Staff on the due date.
• Participate in the full duration of the initiative. Work with the Collaborative Staff to select a team to participate in this initiative (at least one physician must participate on the team).
• Provide team members' time devoted to improvement activities. For each team member a minimum of 3-4 hours per week and at least twice monthly team meetings are required. The site will not in any manner penalize team members for time spent working on the Collaborative.
• Provide resources to support the team including resources necessary for Collaborative Learning Sessions and other activities, and time to implement and test changes in the practice.
• Collect data as defined by the Collaborative at least monthly, and plot the data over time as part of the monthly report for the duration of the initiative.
• Provide team members with clinic electronic mail and access to a computer daily in the clinic. E-mail is the primary communication tool for the Collaborative.
• Share experiences and data openly so that knowledge and learning can be summarized.
• Maintain a project notebook that documents data, progress and experience of the participating health center.
• Assure that at least one team member participates in each team conference call as scheduled by the Collaborative Director.
• Collaborate with appropriate state and local programs, such as the state Diabetes Prevention & Control Programs (DPCP), American Heart Association, and American Lung Association.

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What Can My Health Center Expect From Participation In This Collaborative?

Over the life of the Collaborative, Clinics/Health Centers can expect a competitive advantage to result from:

• Enhanced quality of interaction, between patients and staff focused on their chronic disease.
• Enhanced productivity of providers and staff by reducing redundant work, eliminating waste, and simplifying the system.
• Reduced costs by increasing provider and staff productivity.
• Receipt of extensive technical assistance in the area of quality management and disease management.

The Collaborative agrees to:

• Pay for travel and lodging for 3 team members and Senior Leader to learning sessions.
• Provide curriculum and faculty for all learning sessions.
• Provide ongoing technical assistance to the teams.
• Provide coaching and feedback on monthly reports to the teams.
• Facilitate partnerships with local, state, and national organizations and government agencies.

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How Much Does This Cost My Health Center?

There is no application fee to participate in the Collaborative. The health center will allow administrative time for team members to meet for 3-4 hours weekly to work on the Collaborative and to attend all four learning sessions for the duration of the Collaborative.

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Is Our Organization Ready To Participate In A Collaborative?

If your organization shares the following characteristics, then the methodology will probably work for you:

• A CEO who sincerely desires streamlined processes.
• A learning organization, with excellence in patient care and services.
• A cadre of top management staff who can live with/work with a self-directed team.
• A CEO who understands that quality improvement is an investment in the bottom line.
• The ability to provide team-members 3-4 hours weekly to improve the system of care.
• A clinical person who understands the need for chronic disease management and fervently believes in its applicability to your center.

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What Commitment Must Management Make?

Management support of the Collaborative must be unwavering. It is important for management to understand that the Collaborative is a destabilizing force (since systems cannot remain as they are) but the team can be successful. It is therefore normal that some staff will resist initial efforts to redesign the systems. These same people are likely to become your key champions and enthusiastic supporters. The success of the team is directly proportional to the support they receive from senior leadership.

For more information about the application proccess, please contact Amy O'Donnell, Collaborative Program Assistant, at (503) 227-3343.

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