Understanding and Addressing Disparities in Wisconsin through Statewide Partnerships

Current as of June 2022

Goal: This project will work to understand where health disparities exist and build the capacity to reduce disparities and advance health equity through statewide partnerships.

Rationale: Recent experiences of both racial injustice and COVID-19 have highlighted the critical need to address disparities in healthcare. COVID-19 worsened both economic and health inequities in the short term, and there is evidence that these inequities may persist in the long term and negatively reinforce each other. With these rising inequalities, it is critical to understand where health disparities exist and develop targeted interventions to eliminate them. Solutions are not one-size-fits-all; race and ethnicity, rural and urban geography, health insurance, and socioeconomic status can all influence health.

Progress: During the first year of this project, the team has led participatory design sessions with a variety of stakeholders across the state to receive input and guidance on future reports; developed five brief disparity reports that will be publicly released in the summer of 2022; conducted focus group interviews with health systems and interviews with health plans to understand how their organization designs, plans, and implements interventions to improve healthcare quality and improve disparities; and launched a disparities improvement team for WCHQ health systems members.

Plan: WCHQ is partnering with HIP, the Medical College of Wisconsin, Marshfield Clinic Research Institute, and the Wisconsin Health Information Organization on this three-year grant to expand on previous disparity reports by adding new data, new subpopulations new geographic levels, new metrics, and new methods. This project will leverage the existing statewide WCHQ and WHIO infrastructure to create sustainable strategies to reduce disparities. Lastly, the project will facilitate new academic partnerships and grant applications across Wisconsin faculty focused on disparities across the state, working with WCHQ and WHIO to create a pipeline for the sustainable implementation of successful projects.

Funder: Funding for this project was obtained from the Wisconsin Partnership Program and the Advancing a Healthier Wisconsin Endowment.

Neighborhood Health Partnership Program

Goal: To provide local, timely, and actionable health data and tools to communities and organizations, government entities, and researchers to support and inform strategies and build proposals and plans that advance health and health equity in Wisconsin communities.
Rationale: Actionable insight requires data, but neighborhood data on health measures are often delayed, inaccurate, expensive, incomplete, and unavailable at the local level where successful interventions often occur.

Progress: In 2019, NHP developed a neighborhood health report based on WCHQ quality metrics at the ZIP code level. In October 2020, a pilot test of the program was launched to test and learn. WCHQ health system members were provided access to a secure site with maps visualizing the ZIP code level data for all WCHQ publicly report measures. In addition, health systems can request reports through the NHP website.

Plan: The program will incorporate the learnings from the pilot and fully launch in the fall of 2021.

Funder: Funding for this project was obtained from the Wisconsin Partnership Program.

Identifying Colorectal Cancer Screening Strategies in Rural Communities

Goal: This project will evaluate differences between high-performing and low-performing rural clinics with respect to colorectal cancer screening.

Rationale: Across the Midwest, variation in CRC screening rates among rural clinics is wide, ranging from 32% to 85%. Learning how high-performing clinics have been successful and translating this knowledge into concrete strategies in lower-performing rural clinics are critical steps in developing effective tailored approaches to increasing CRC screening in rural areas.

Progress: This project is in the initial stages.

Plan: System and clinic factors related to receipt of CRC screening among patients in rural clinics will be identified through surveying rural clinics and linking survey results to WCHQ data. High-and low-performing clinics will be invited to participate in semi-structured interviews to understand each clinic’s CRC screening processes. This project will result in new knowledge about critical factors necessary to support CRC screening in rural communities. Results will be shared with WCHQ members.

Funder: Funding for this project was obtained from the Wisconsin Partnership Program.

Accelerating research on multiple chronic conditions with rural and African-American communities and health-care providers

Goal: To create clinic-level reports, providing data visualizations of patients with multiple chronic conditions that can be used to help researchers, community organizations, and health systems and clinics understand the prevalence of comorbidities and related health outcomes in their communities. This project will increase the number and reach of self-management interventions available to improve the health of older adults with multiple chronic conditions (MCCs).

Rationale: Three out of four older adults live with multiple chronic conditions and this burden disproportionately affects African Americans. Despite the need for interventions to help older patients with MCCs improve self-management, existing programs have limited reach and effectiveness in underserved communities.

Progress: Clinic level reports have been prototyped and feedback has been received from WCHQ members as a part of co-design sessions.

Plan: We will incorporate feedback from co-design sessions and plan to make clinic level reports available to WCHQ member health systems and affiliated clinics in spring 2021.

Funder: Funding for this project was obtained from the NIH – National Institute on Aging.

Systems consultation to improve opioid prescribing practices in primary care

Goal: This project will develop a multi-level, adaptive, and scalable implementation strategy to improve opioid prescribing practices in primary care.

Rationale: Drug overdose is the leading cause of accidental death in the U.S. More than half of overdose deaths involve an opioid and about half of opioid deaths involve a prescription opioid, half of which are prescribed in primary care. Thus, primary care should be a focal point to improve opioid prescribing.

Progress: Data from select WCHQ member clinics will be analyzed to determine the average morphine milligram equivalent dose.

Plan: We will compare the effect of an adaptive systems consultation implementation strategy vs. academic detailing alone on average morphine milligram equivalent dose. Next, we will develop a tool that decision-makers can use to predict which implementation strategies will be most effective in different settings and to weigh the costs and effects of using different implementation strategies.

Funder: Funding for this project was obtained through the NIH – National Institute on Drug Abuse.

Completed Projects

Enhancing Chronic Condition Management and Preventive Screening

Goal: This project will examine how differences among populations relate to the quality of health care for chronic conditions and preventive screening across the state.

Rationale: Wisconsin faces numerous challenges in delivering the highest quality healthcare to its citizens, which mirror those seen across the nation. It is critical to understand the extent to which differences among populations are a major source of variation in healthcare quality and to identify and characterize the populations most affected.

Progress: Data on healthcare quality from WCHQ will be analyzed with respect to sociodemographic characteristics, chronic conditions, and healthcare utilization.

Plan: Reports and publications will be available to WCHQ members.

Funder: Funding for this project was obtained from the Wisconsin Partnership Program.

Measuring Disparities in Healthcare Quality

Goal: This project will examine disparities in the quality of healthcare in Wisconsin.

Rationale: Even though Wisconsin ranks among the best states in overall health care quality, we rank among the worst states for differences in health care quality. These differences in quality contribute to the poor health outcomes noted for diverse populations.

Progress: Over the course of the grant, WCHQ has enhanced the WCHQ data through quality checks and updates of key fields such as insurance (e.g., Medicaid), ZIP code (e.g., rural/urban), and race/ethnicity and produced two statewide disparities reports, the 2019 Wisconsin Health Disparities Report and the 2020 Wisconsin Health Disparities Report: Rural and Urban Populations. The WCHQ Measurement Advisory Committee has also approved measurement and public reporting of at least one measure of disparity (e.g. race/ethnicity, payer, rural/urban) in healthcare quality at the health system level.

Plan: WCHQ is partnering with HIP and the Medical College of Wisconsin to apply for funding to continue and expand upon this project to examine the impact of COVID-19 on health disparities in the state of Wisconsin.

Funder: Funding for this project was obtained from the Wisconsin Partnership Program.

Wisconsin Obesity Prevention Initiative, Phase II

Goal: This project will track obesity rates among children and adults in the state of Wisconsin.

Rationale: Obesity and obesity-related diseases place a massive burden on health systems. Data on obesity rates within small geographic regions are critical to effectively monitor and reduce obesity.

Outcome: In 2015, the Health Innovation Program and Wisconsin Collaborative for Healthcare Quality launched the Wisconsin Obesity Surveillance Partnership. Through this partnership, WCHQ provided obesity data to the Wisconsin Health Atlas. The Atlas maps obesity across Wisconsin by ZIP code (Figure 1) on a public web site (https://www.wihealthatlas.org/).