Content Comparison

11/15/23

1. AAPCHO status with discussions health center site

2. Link to Confluence (Jonathan and Sarah)

3. Atlanta meeting

4. Next steps

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1. Project Description and Workplan--process map to understand closed loop process. CHC is moving over to Athena 1, so good time to build it better. Trying to think about Case Study as well…what kind of info to include up front. Challenges/Solutions to Test/Proposed steps and strategies/measures, Impact Measures, etc…

   1. What data is actually accessible from outside the org? Alohacare. Perhaps look at top 50 patients who have not followed up?

      1. Sources: examples specialists visits not completed, Rx not picked up---already looking at language barriers/childcare/transportation (language barriers = language justice)

      2. Narrow it…Rosy will suggest looking at specific clinical, age, , look at top 25 etc…, who Alohacare says is at highest risk

2. Confluence--Jonathan “owns” site, can trouble shoot, subtract/add, maintain. Will add file upload pages per project. Subfolders as needed.

3. AAPCHO attending design meeting in Atlanta, representing SDOH, etc.. Meg (MH), Ron 2, Kathy, Julia and AllianceChicago will also be in attendance.

4. Next steps: (see Action Items)

• Kathy overseeing contracting process

• Rosy to share Workplan once completed.

• Jonathan Uy (Deactivated) to add on to Confluence

• Jonathan Uy (Deactivated) and Sarah Price Link Rosy with Informatics team on how to pull immunization data

11/1/23

Discussion Points:   AAPCHO and CareQuest

• Introductions

  • AAPCHO

  • NACHC  (name, roles, and responsibilities)

• Review of scope of work

• Open Discussion

• Next Steps

• Oral Health

  • SOW Review

    • 1c - data will be collected directly from HRSA/UDS+?

      • Will request de-identified data after it is available; we shouldn’t rely on UDS+ data

      • Potential to influence ONC categories

• Opportunity to publish

• PHIT to create Confluence (populate with files from other work)

10/18/23

• Welcome and Introductions  (3 minutes)

• Adult Immunization Overview (5 minutes)  5 years in the making…

• Data Overview (5 minutes)  the what the where the mess

• Publications Plan

• Next

• Transportation - originally planning to exploring linkages to diabetes

  • Also adult immunization? Other comorbidities?

  • Working with one health plan, would have adult immunization rates but would not have transportation measure (Aloha Care)

  • How do we get referral incorporated into system?

• Consistency of data over the years? Partners, data elements, etc. - NACHC team would need to dig in further

• Who are the teams involved, will partners be leading?

• Publishing models and looking at initial evaluation results

• Liked the idea - Best practices for payment, roadmap

  • Collaborate with partners to make sure we have stakeholder perspective

• Idea - If we standardize measure and workflow, this is what can happen in 3, 6 months

  • Who have we asked?

• AAPCHO did paper on PRAPARE on screening rates

• “Closing the loop” - we asked HCs what vaccines they keep on site and which they refer, asked if they closed the loop

  • Of the patients referred out, how many were also asked about transportation issues, were they addressed, and if so, what was the immunization outcome?

  • A lot of patients can be lost to follow up, want to make sure that loop is closed - what percent of patients actually went by the recommendation, didn’t? A lot of different scenarios

  • We have tools on self-inventory and referral

• Narrow it to prototype we can scale after - by disease, age group?

  • Focus by payer?

• NACHC will send publication list to Rosy once

• Jen will update data and share dashboards

10/11/23

Discussion Points:

• Welcome and Introductions

• Overview of CareQuest     Katja  (See attached) 

• Overview of current Status of Transportation Measure   (Julia)

• Discussion on next steps:

  • Define roles and responsibilities moving forward  AAPCHO-NACHC.

    • Carequest

    • Transportation

  • Meeting dates and times

  • Next steps

• Focus on publishing

• CareQuest

• Universal screen to test for transportation

  • Element optionally requested by UDS

• Contract would go through 6/30/24

  • One contract for 2 SOWs

  • Conference - could do CHI 2024, open to other options

    • Travel should be included but separate for auditing purposes

• SDOH Closed Loop Pilot Proposal

  • Products

    • Compiled recommendations from health centers and stakeholders on design of closed loop referral system for Transportation or other SDOH

    • Data collection implementation resources including workflow diagram(s), data template, data reporting/tracking templates, and screenshots

    • Developed and tested Implementation Readiness Assessment Tool

    • Narrative Report that describes key findings, promising practices, and lessons learned as well as recommendations for next steps

  • Closed loop protocol - work with transportation providers and providees to ensure patient received transportation recommended by HC or other social service provider and be able to state what the outcome for the patient was

    • Hopefully will be able to work with vendors to collaboratively test as well

  • Some groundwork has been done, Informatics will check in with Julia

  • What measure(s) would be most meaningful to track implementation, impact?

    • Could add additional data elements to EMR

• Roles

  • NACHC will handle environmental scan, Informatics side

  • AAPCHO handle research side

• Meetings

  • 2 pm EST on Wednesdays works for AAPCHO, most of NACHC team - bimonthly

• Katja/Kathy will begin working on SOW and executing contract

• NACHC will take care of environmental scan

• Figure out meeting cadence, Rosy will send times

• Determine main NACHC point of contact for Transportation