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Beyond the Status Quo: Building Effective Coalitions Mimi Baugh, MSN Angelo State CareGiver Research Institute Crystal Conner, MA Shannon Medical Center Population 110,224 13.9% population 65 years old or older 57% White, non-Hispanic 36.3% Hispanic 6.7 % Other 24.3% Uninsured 75.7% Insured 20.4% Medicaid 13.6% Medicare Source: US Census, 2010, Small Area Health Insurance Estimates; Department of State Health Services, County Health Facts; Texas HHSC Medicaid Enrollment by County, November 2012. Population 110,224 From 2006-2011, adult residents (18+) of Tom Green County received $214,677,910 in charges for hospitalizations that were potentially preventable. Source: US Census, 2010; Department of State Health Services Preventable Hospitalizations Hospitalizations for the conditions selected are called “potentially preventable,” because if the individual had access to and cooperated with appropriate outpatient healthcare, the hospitalization would likely not have occurred. Source: Center for Health Statistics, Texas Department of State Health Services Selected Conditions Condition Definition Bacterial Pneumonia A serious inflammation of the lungs caused by an infection. Bacterial pneumonia primarily impacts older adults. Urinary Tract Infection (UTI) Usually caused when bacteria enter the bladder and cause inflammation and infection. It is a common condition, with older adults at highest risk. In most cases, an uncomplicated UTI can be treated with proper antibiotics. Chronic Obstructive Pulmonary Disease (COPD) Characterized by decreased flow in the airways of the lungs. It consists of three related diseases: asthma, chronic bronchitis and emphysema. Because existing medications cannot change the progressive decline in lung function, the goal of medications is to lessen symptoms and/or decrease complications. Source: Center for Health Statistics, Texas Department of State Health Services Financial Impact 2005-2010 Potentially Preventable Hospitalizations for Adult Residents of Tom Green County, Texas Number of Average Total Hospitalizations Hospital Hospital 2005-2010. Charge Charges Hospital Charges Divided by 2010 Adult County Population Bacterial Pneumonia 2,666 $21,876 $58,322,558 $692 Urinary Tract Infections 1,445 $15,182 $21,938,091 $260 Chronic Obstructive Pulmonary Disease 1,396 $21,226 $29,631,897 $352 Source: Center for Health Statistics, Texas Department of State Health Services • Administrative agency for County Indigent Program, serving approx. 1,400 clients • Provides case management • Agreement with local providers for indigent health services • Fiscal agent for Preventable Hospitalizations project • • • • • Full Continuum of Care—Independent Living, Memory Care, Long Term Care, Skilled Nursing, Home Health, Hospice, Peace of Mind Program, Rotary House of Hope, and Outpatient Therapy Unique concept of Continuum of Care found nowhere else in this area 100 acres, 600 residents, 300+ employees Has served the Concho Valley area since 1951 A leader in innovation with many different options in various Senior Living areas • 171-bed acute care hospital • Designated Level III Trauma Center • Concho Valley's only accredited Chest Pain Center • Concho Valley’s only accredited Congestive Heart Failure facility • Comprehensive Heart and Vascular program, including open heart surgery • Robotic-assisted surgery • Level III-A Neonatal Intensive Care Unit • The leader and advocate in facilitating supportive services and opportunities that enable older citizens to be able to live more independently and productive • One of 28 Area Agencies in Texas • The region covers over 16,000 miles and approximately 112,000 citizens • Locally sponsored by the Concho Valley Council of Governments • • • • • • 409-bed safety net hospital Over 225 providers Locally owned non-for profit medical center and clinic With more than 20 locations, Shannon provides a range of services for Tom Green and 18 surrounding counties The lead Level III Trauma Center and Air Med 1 air ambulance serving a 200-mile radius The primary stroke center for the region • • • Serves older adults, frail elders, caregivers, and all people providing care to others The main focus is helping those providing care to others and education of nurses specifically taking care of the elderly or working in long-term care settings The mission of CRI is to ensure that we have caregivers, both formal and informal, who are well-equipped to care for this distinctive group. CRI draws from many campus resources, and a variety of nursing specialties, to help caregivers and nurses provide exceptional care to older adults Teach a man to fish. Assets Resilience Sustainability Partnering Organizations Intrepid Home Health Odyssey Hospice Meals for the Elderly Myer’s Drug Disability Connections Relative Marketing & Design Sam’s Club San Angelo Standard Times KIXY radio KKCN radio KLST/KSAN news Collective Impact: Rules of Engagement Framework for Success Common Agenda All participants have a shared vision for change including a common understanding of the problem and a joint approach to solving it through agreed upon actions. Shared Measurement Collecting data and measuring results consistently across all participants ensures efforts remain aligned and participants hold each other accountable. Mutually Reinforcing Activities Participant Activities must be differentiated while still being coordinated through a mutually reinforcing plan of action. Continuous Communication Consistent and open communication is needed across the many players to build trust, assure mutual objectives, and create common motivation. Backbone Support Creating and managing collective impact requires a separate organization(s) with staff and a specific set of skills to serve as the backbone for the entire initiative and coordinate participating organizations and agencies. Common Agenda Not a transfer of costs Savings to one organization is savings to all Organizations serve similar populations Collaboration of efforts Support from organizational leaders Relationships based on shared objectives Commitment to improving health in Tom Green County Shared Measurement DSHS Data brought it to our attention DSHS defined the data sets Allowed for comparisons among the community DSHS defined accountability (interventions are evidence-based efforts are targeted) Mutually Reinforcing Activities Differentiated interventions with coordinated efforts Public events, provider conferences, immunization clinics Print Ads Billboards Online Media (Website, Facebook, Patient Channel) Interventions: Events April 2012 Public Event October 2012 Provider Event October 2012 Heloise Public Event Heart of Texas Conference on Aging Speakers Bureau Health Fairs/Events Education Events Interventions: Immunization Clinics Area Agency on Aging Station 618 Senior Center Diabetes Update Seminar Sunset Mall Health Fair Friday Immunization Clinics Interventions: Education Materials Hand Sanitizer Hydration Cups Hydration card (urine) Rack Cards in Spanish & English Immunization Records (lifetime & adult) Walking booklet COPD Consult, Harvard Health Publications COPD Manuals, UT Tyler Interventions: Media Television, radio, newspaper, classifieds coverage and print ads Stethoscoop & Heartbeat, hospital newsletters Health Beat Hospital Magazine Direct mail www.tgcpartnershipforbetterhealth.org Patient Channel, The Wellness Network Facebook Page Continuous Communication DSHS Roadmap Required monthly meetings; planning and status updates Monthly Technical Assistance calls with DSHS and 16 participating counties Two face-to-face meetings with 16 Counties in Austin and DSHS experts/staff Sub-committee meetings Intervention Ad Hoc group meetings as needed, PRN Backbone Support Organization Support Valuable Impact Educational/Clinical expertise; Educational Provider/Community outreach Perceived neutrality; Public interest; Health education expertise Education/Community Advocacy; Direct access to target population Public interest; Community Outreach; Local governmental entity. Direct access to target population; Strong understanding of the issue Public sector “seal of approval”; Credibility Backbone Support Organization Support Valuable Impact Financial resources; Educational expertise; Logistical support; Direct access to target population. Represent Private, Forprofit health care corporation and providers; Credibility Financial resources; Educational expertise; Logistical support; Direct access to target population; Grant coordination expertise. Safety-net hospital; Private, non-profit local provider. Marketing/media expertise. Internal communication; Credibility. Direct access to target population; Strong understanding of the issue; Start-up funding; Logistical support Public sector/ local governmental entity “seal of approval”; Credibility; Perceived neutrality. Where are we now? Provider/Public Education Collateral materials Website Mobilized immunization resources Center of educational expertise and resources Bacterial Pneumonia Interventions 5,459 high risk adults vaccinated for Bacterial Pneumonia 17,228 high risk adults vaccinated for Influenza 564 high risk adults educated on Bacterial Pneumonia and ways to possibly avoid it 12 education opportunities provided 505 healthcare providers educated 1,895 smoking cessation services provided to high risk adults Urinary Tract Infection (UTI) Interventions 305 high risk adults educated on UTI and ways to possibly avoid it 12 education opportunities provided to the general population 505 healthcare providers educated Chronic Obstructive Pulmonary Disease (COPD) Interventions 1,594 adults diagnosed with COPD vaccinated for Bacterial Pneumonia 1,169 adults diagnosed with COPD vaccinated for Influenza 1,998 adults diagnosed with COPD educated on the condition and ways to manage it 2652 adults educated on COPD and ways to manage it 505 healthcare providers educated 2,260 diagnosed with or at risk for COPD provided with smoking cessation services Success begets MORE success Sustainability + Assets = Resilience Resilience = Effectual Change Effectual Change Improved Community Health Opportunities/Future Efforts “Train the Trainer” program for long-term care & assisted living facilities Collaborate with existing events and organizations Promote the website and Facebook page October 18, 2013: Provider Education Look for additional funding/support The Status is not Quo. Contact Information Mimi Baugh, MSN, RN-BC, RAC-CT Director, Caregiver Research Institute, Angelo State University 325.486.6607 [email protected] Crystal Conner, MA Regional Health Coordinator, Shannon Health & Wellness Shannon Medical Center 325.657.5677 [email protected]