Previewed final report that will be submitted next week
CareQuest
Up to date with deliverables
7/10/24
Emailed update:
AAPCHO has submitted CareQuest Data Disaggregation Project deliverables
Closed Loop Transportation Project Update
AAPCHO is working on deliverable 4, Case Study Report
Report is titled Closing the Loop on Transportation Services: A Hawaii Health Center Pilot
Headings include: Purpose and Background; Introduction to the Closed Loop Project; Project Aims; Solutions Tested; Processes for Data Collection, Strategies, and Measures; KPHC Evaluation of Implementation; and Promising Practices for Future Implementation; Lessons Learned and Reflections
Followup SDOH template implementation survey has been programmed, and KPHC staff will help disseminate at their staff meeting.
6/12/24
Workforce team & Julia unable to attend
SDOH
Webinar went well, good turnout & active engagement
Last stages of deliverables
HC use case coming together, currently under review & revision
Data collection training resource is under review
Closed loop transportation
Met with KPHC, last part of data collection and including into report
Outline set, rest of it in progress or under review (includes readiness assessment, follow up survey)
Will meet with them end of June
Potential future plans
Intention to check in with other health centers to see how feasible pilot may be, further spread
Work with larger group (PCAs, HCCNs) for train the trainer approach to disseminate pilot results more broadly
Improve IT component by working with vendors
Have been asked by Hawaii PCA to conduct additional trainings (more general social interventions)
Working with Pacific Islander healthcare association, started work with eClinical Works
5/29/24
CareQuest
June 6th webinar: Christine will submit slides May 31st and await feedback.
AAPCHO webinars on SDOH went well---
Slow and steady process for collecting SDOH---applying template going well. No needs for change.
What keeps coming up---how to train staff…why this is important to collect. Often questions are being collected at different points.
“Housing” and “language” access questions are tricky.
Scripts will be included in final products for spread/scale.
Readiness assessment tool is almost ready…KPHC is testing 1st. PRAPARE form adapted to test the readiness of staff to use. Finalized mid-June.
Outline for final report in development.
5/15/24
Meeting cancelled, emailed updates
CareQuest Data Disaggregation Project Update
AAPCHO met with the webinar collaborators (CareQuest, NNOHA, NACHC) to further plan the webinar and is making recommended changes to our content and slide deck. We also submitted required information to CareQuest in prep for the webinar (including recommended title, objectives, and potential webinar questions)
AAPCHO received and is reviewing a draft of Dr. Le’s webinar slides to integrate with our content and slides.
AAPCHO and KPHC completed one of two webinars to discuss KPHC experiences, promising practices, and lessons learned. The webinar was a success in understanding KPHC and other stakeholders’ perspectives about closed loop protocols.
AAPCHO developed an outline and will work on building out the final report
Upcoming Meeting
Next meeting is 5/29 – Rosy will be out this week; Christine will provide updates during our scheduled meeting
5/1/24
Meeting cancelled, emailed updates
Emailed updates:
CareQuest Data Disaggregation Project Update
AAPCHO signed Joint Provider Agreement with CareQuest
AAPCHO held a meeting with Dr. Huong Le to discuss the group’s webinar ideas, and developed the webinar outline which we will discuss further with the larger group in our meeting next Monday.
Currently working on PPT slide deck and reviewing initial template received from Dr. Le
RCW and CK both out 5/15 – can we send email updates for that week?
4/18/24
Emailed updates:
Closed Loop Transportation Project Update
AAPCHO met with KPHC today and discussed the progress of the closed loop tracking system. They shared their draft reports targeting diabetes and hypertension measures. They are working on additional revisions to include not only transportation (the focus of this project) but other SDOH measures.
To better understand KPHC staff implementation experiences, KPHC completed their staff process evaluation after making suggestions to shorten AAPCHO’s original survey. Results were generally positive (details below).
There were 20 total responses, and 60% of respondents identified as "Clinical Support Staff."
Mostly all the participants felt that it was "very easy" and "somewhat easy" to complete the SDOH Template
Mostly all the participants felt that it was "very comfortable" and "somewhat comfortable" for the patients to answer questions in the SDOH Template
65% or 13 participants answered that it was "somewhat easy" for the patients to understand the questions -- 3 participants said "very easy"; 3 participants said "somewhat difficult"
On average, 45% of participants reported that patient's "some of the time" refuse to answer a question on the SDOH Template; 50% of the participants said "rarely/never"
As for analyzing some of the comments, some respondents shared that some patients may misinterpret questions due to language barriers, and sometimes they're more open to answer these questions with their providers. In some cases, with explanations of the questions for patients with language barriers, it may take longer to get through the SDOH Template questions.
We are prepping for the webinar in May to get input from other stakeholders. We’ve sent KPHC a ppt template for them to complete and they are working on their draft.
CareQuest Oral Health Data Disaggregation Project Update
We have scheduled to meet with Dr. Huong Le tomorrow to start planning our June 6 webinar
We have drafted ideas for the webinar and have created outlines for our report deliverables
Presentation outline
Webinar template
PPT deck
We have drafted data disaggregation training resources for data collection
We have drafted concept paper ideas for the next phase of this project and will aim to send it out in the next week
4/3/24
Oral Health
Joint provider agreement for June webinar - June 6 date finalized
Will schedule calls to discuss content of webinar
Training resource on importance of data disaggregation - still in progress
Closed Loop Transportation
Meeting regularly with KPHC
Centering in on diabetes measures
Report template
Shortened # of questions - finalized and working on implementation
Readiness assessment
Made one pager
Plan is to get feedback from other stakeholders for further refinement & scaling
Julia received questions from a colleague at Optum about updates to PRAPARE to support the new race/ethnicity OMB standards and SOGI, and that she is looking forward to connecting with Rosy about it
AAPCHO to work on concept for CareQuest, due date TBD
Rough draft at earliest convenience
Next call 4/17
3/20/24 - Meeting cancelled, updates via email
Katja’s team met separately, on track with all updates and action items
Email updates from AAPCHO:
Closed Loop Transportation Project Update
AAPCHO met with KPHC and discussed the progress of the closed loop tracking system and worked together to incorporate other potential measures but they are likely to target the diabetes measures.
# Primary care visits added to guideline infographic as another possible measure KPHC will look into.
Shared with KPHC a Staff Implementation Process Survey they can use to track adoption of the closed loop implementation. They are currently making suggested revisions.
We’ve been receiving monthly reports for the new data being tracked with the new closed loop implementation, and are discussing potential changes.
Oral Health Webinar Update
Confirmed June 6 webinar date w/ team
We have drafted ideas for the webinar and have created outlines for our report deliverables
Webinar presentation outline: draft in progress
3/6/24
Met previously with Katja’s team on Oral Health last week
Closed Loop Transportation Project
Meeting regularly with KPHC
Solidifying measures to track (diagnoses code, evaluation measures)
Received preliminary report, will be discussing later today
Working on readiness assessment
Webinar coming up in a month - came up with PDSA slide deck to populate
Have created Project Guideline Infographic, sent to KPHC team for preliminary data capture
Have heard from others interested in this work as well for future opportunities and testing
Hawaii PCA
Hoping to continue work after July 31
2/20/24 - Email Update
1/21 project updates in lieu of meeting:
Closed Loop Transportation Project
AAPCHO met with KPHC and discussed the progress of the closed loop tracking system and worked together to incorporate measures.
AAPCHO created a guideline document for KPHC with project outline, measures, and diagnoses codes
KPHC met with their IT team on 2/15 to implement measures
Will meet with them today
AAPCHO working on readiness assessment
Oral Health Project Update
Continuing reviewing the literature from the environmental scan, and adding onto existing resources with updated national guidelines and newer articles from various journals
Incorporated new oral health data including numbers, percentages, and data visualization into Webinar PPT slides
Incorporated new oral health recent publications and findings section into Webinar PPT slides
2/7/24
CareQuest Oral Health
Environmental scan underway, have collected 20+ entries
Will be updating the presentation deck shortly
Survey
Testing in SurveyMonkey - second review in process
What are the disaggregated categories that HCs are collecting?
Asking HCs to submit reg forms, will do cross tabulation of what they are collecting, what are the most prominent categories they are using
Any planning needed for educational activities?
Aiming for May
Will begin NACHC internal process
CHI abstract submission open, due March 1
Blogs
Who will be writing the blogs?
Need to be in the queue for NACHC ones, also can link to one of AAPCHO’s posts
SDOH Closed Loop Pilot
Working with KPHC to incorporate measures - discussing what measures they will be tracking (just transitioned to Athena)
Added question for patients “have you been able to access the resources you need to address your social needs” to track closed loop referral
Testing with MAs and getting their feedback
Beginning implementation at multiple sites
Meeting with them later today
AAPCHO may need assistance with data, ONC later on; dissemination of survey
1/10/24
Closed Loop Transportation Project Update in lieu of meeting: Activity 1 and 2
Activity 1 Update 1/10/24: AAPCHO met with KPHC and discussed the progress of the closed loop tracking system. KPHC reviewed the newly developed EHR form with their MAs and made some refinements based on their feedback. KPHC will next plan to test with providers for feedback. AAPCHO also sent the drafted subcontract to KPHC for feedback.
Activity 2 Update 1/10/24: KPHC and AAPCHO reviewed the SDOH Closed Loop workflow and discussed the evaluation tracking measures. AAPCHO sent these tracking measures to KPHC to discuss with their IT staff to include in reporting.
1/10/24
Oral Health Project Update in lieu of meeting: Activities 1a and 1b
Activity 1a Update 1/10/24: Currently reviewing literature from the Environmental Scan for relevance.
Activity 1b Update 1/10/24: Addressed IRB application reviewer suggestions and IRB application was approved.
1/3/24
Closed Loop Transportation Project Update in lieu of meeting: Activity 1
Activity 1 Update 1/3/24: AAPCHO has been meeting regularly with the project site at Kalihi-Palama Health Center (KPHC). We have discussed and developed a project description, scope of work, and work plan and have also discussed the design of the case study report with proposed project strategies and evaluation measures. In our meetings, we have been focusing on learning about their closed loop protocol and workflow, especially since they are transitioning to AthenaOne. Also, now that the contract with NACHC has been issued to AAPCHO, we are also developing the subcontract for KPHC.
1/3/24
Oral Health Project Update in lieu of meeting:
Activity 1a and 1b
Activity 1a Update 1/3/24: Completed Environmental Scan methodology and began literature reviews with over 50 entries but need to review studies for relevance
Activity 1b Update 1/3/24: Developed survey to include questions about data disaggregation collection practices at health centers serving AA, NH/PI Communities. Submitted survey for approval with AAPCHO Community IRB.
11/15/23
AAPCHO status with discussions health center site
Link to Confluence (Jonathan and Sarah)
Atlanta meeting
Next steps
add text
CareQuest Project: Activity 1b. Assessment of key informant current oral health population data resources used at health centers serving AA, NH/PI communities.
1/30/24
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
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