The Partnership for Innovation:
2008 Grant Projects
Improving Care for Young Healthy Options Families
Project Lead: Nan Smith MD, MPH, Riverfront Medical Center, Spokane
Award: $263,319 (Fall 2008)
The Medical Home model holds great potential to improve care for pregnant women and children in the Healthy Options program. Using medical home principles, the primary care teams at Riverfront Medical Center will pilot a program to connect patients with a personal care physician and use a team-based approach to provide the full range of care for their obstetric and pediatric needs.
This patient-centered approach will help care teams link families to a wide array of specialists and services within the Group Health system and the community. This includes contacting families and directly connecting them with the care team’s registered nurse who will coordinate their care. The team will use EPIC tools such as after visit summaries to support families between scheduled clinic visits, reinforce patient care goals and coordinate with community resources to ensure access to the appropriate resources.
Enhancing Medication Safety for Patients with Complex Medication Regimens
Project Leads: Lee Allen and Lorraine D’Alessandro, Pharmacy Division
Award: $89,325 (Fall 2008)
Patients who take multiple medications can face a confusing and often variable schedule that includes taking different combinations of pills multiple times a day. This is a particular concern for the elderly and patients with conditions such as HIV, heart disease, diabetes or high cholesterol. The Group Health pharmacy team will pilot test a system within the Group Health HIV population to help patients take the right medications at the right time. The pilot will explore the system’s potential for increased safety and health outcomes for HIV patients.
The system will use a combination of innovative packaging and automated voice mails to organize medications and remind patients of refill needs and any changes to their regimen. Compliance packaging will be used to organize medication in sealed packets with the correct prescribed dosages that are clearly marked with the date and time they should be taken. To provide additional support, a patient’s medical team will leave secure voicemail messages that will provide information to help them adhere to their medication regimen.
Painless Nasal Flu Vaccine for Children
Project Lead: John Dunn, MD, Pediatrics
Award: $75,542
Challenge: Children who get the flu are at a high risk for severe symptoms, hospitalization, and even death. However, only about 30 percent of children nationwide get annual flu vaccinations.
Many families place a low priority on flu shots for children for a variety of reasons. Some choose not to add yet another injection to a perceived long series of childhood vaccinations. Others don't see the flu as a serious health risk for kids or simply don't want to subject their children to another painful shot. An alternative, injectionless nasal vaccine is available but providers have been slow to adopt it.
Innovation: A new flu vaccine offers a pain-free alternative to injections for kids. The live-attenuated flu vaccine is delivered in mist form through the nose, eliminating needles and pain. The nasal vaccine is being promoted by the Centers for Disease Control and Prevention and the Washington State Department of Health as a more convenient vaccine. Evidence suggests that it may be more effective than the injectable forms.
Physician teams within the Pediatric and Infectious Diseases departments would work in collaboration to administer the nasal flu vaccine in the Group Health pediatric population.
Pilot program: The nasal vaccine would be made available and promoted in select Group Health medical centers. Medical staff would work with parents to encourage them to have their children vaccinated with this painless and effective vaccine.
Potential benefits: Availability of a painless nasal vaccine could increase the number of parents that choose to vaccinate their children for the flu. With more kids vaccinated there would be fewer severe flu cases, keeping kids out of the hospital and keeping them healthier.
Online Chronic Disease Self-Management Program
Project Lead: Kimberly Wicklund, Health Information and Promotion
Award: $151,450
Challenge: Chronic diseases are a major cause of disability and reduced quality of life. They also account for between 70 and 80 percent of national health care expenditures.
In a recent survey of adult Group Health members, more than 60 percent indicated they had one or more chronic conditions. Nearly half had two or three chronic conditions. Many Group Health members with chronic diseases such as diabetes, heart failure, and depression report that they have difficulty keeping their conditions under control.
Self-management is a widely recognized strategy for helping people control their chronic conditions. Group Health's Living Well with Chronic Conditions program helps patients manage their conditions by building self management skills through problem solving, action plans, social support, and confidence building.
Innovation: An Internet-based chronic disease self-management program will provide a new way for people to participate in disease management programs from the comfort of their homes. Using cutting-edge, online social-networking technology, the program will eliminate the need for patients to attend self-management programs in person. Over the Internet, patients will participate in moderated online discussions and learning sessions, and could download materials. They can participate in these programs where and when it's most convenient for them.
Pilot program: The online workshops will be offered beginning in 2009. The pilot will include integration of the social networking technology into MyGroupHealth, a recruitment plan, a training plan for moderators, evaluation tools and processes, and linkage with other self-management and patient activation resources at Group Health, such as the Health Profile.
Potential benefits: Enhanced patient/provider interactions could lead to more effective and appropriate care. Patients would strengthen their confidence and skills to better manage their conditions and symptoms. And those who are homebound, have small children, or have scheduling difficulties would be able to participate in the program at their own convenience.
Optimal Eye Care for Diabetic Patients to Prevent Blindness
Project Lead: Chris Diehl, MD, Ophthalmology
Award: $78,766
Challenge: Diabetes is a significant contributor to vision loss. The chronic, elevated blood sugar levels associated with diabetes can cause a number of disorders in the eye that lead to partial or total blindness.
Routine eye exams that evaluate retinal blood vessels help prevent blindness through early detection and treatment. While nearly all patients with diabetes receive routine blood sugar screening, many do not receive eye exams even when encouraged to do so by their doctors.
Fewer than 70 percent of Group Health members with diabetes participate in retinal screening. Because of the low participation rate, many diabetes patients do not realize that they have eye problems until they experience vision loss.
Innovation: Currently diabetes patients must make a separate appointment for an eye screening with an optometrist or ophthalmologist. The Group Health Eye Care team has identified a strategy to increase access to retinal screenings for diabetics. Integrating eye exams into routine lab visits removes barriers to screenings.
Pilot program: When a doctor or nurse orders a routine blood sugar screening for a diabetic patient at the Tacoma or Northgate medical centers, they will also automatically order an eye exam. Both of the medical centers will receive advanced retinal cameras in the lab areas. Lab technicians will receive training in photographing the patient's retina, eliminating the need for an additional appointment. The images will then be electronically sent for evaluation by optometrists who will immediately alert the patient and their care team if any irregularities or causes for concern are detected.
Potential benefits: The program could provide Group Health diabetic patients with the best eye care available. Screening and early treatment could reduce vision loss in diabetic patients. Members could avoid hospitalization and surgeries through early detection and treatment, making health care more convenient and accessible.
Infectious Disease in Long-Term Care Facilities
Project Lead: Amy Schlight, Occupational Health
Award: $52,100
Challenge: Every flu season poses a potential crisis for long-term care and skilled nursing facilities because elderly and sick patients who get the flu are at higher risk for severe symptoms, hospitalization, or death. Staff at these facilities are also at higher risk of contracting the flu while caring for this population.
If multiple staff get sick during the flu season it becomes even harder to provide care for patients when they need it most. Studies suggest that the only way to decrease influenza in these settings is to immunize both residents and staff.
Most nursing facilities do not have the necessary resources and expertise to fully immunize staff and patients, nor are procedures in place to respond to an outbreak should one occur.
Innovation: A team comprised of representatives from Group Health Permanente, Infectious Disease and Infection Control, Pharmacy, Nursing Home Services, Employee Health Services, and Occupational Health Services will develop a service to administer flu shots for residents and staff at care facilities and establish procedures to respond to flu outbreaks. By offering a service on site, the program will be convenient for both residents and staff who now must travel off-site for a flu shot. Nearly 100 percent of staff and residents will be immunized.
Pilot program: The team would make this service available to a small number of facilities during the 2008-09 flu season. Group Health will immunize patients and staff regardless of Group Health membership status. It will provide medical, nursing, pharmaceutical, and occupational health services to help nursing homes deal with the complexities of managing a comprehensive influenza campaign in their facility — a mix of capabilities that few other care providers have.
Potential benefits: The on-site service would make it possible to immunize almost all staff and residents. Immunizing the entire population of a care facility would greatly reduce the probability of an outbreak. The service will equip facilities will to quickly respond to influenza outbreaks.
