Background: US birth outcomes differ by race/ethnicity with black women experiencing a two-fold higher risk of preterm birth (PTB, birth<37 weeks) compared to white women. Evidence suggests place-based social determinants of health, such as racism, drive disparities in PTB-- determinants that public health can’t tackle alone. Here, we compare two California-based multi-sector coalitions focused on advancing birth equity, sponsored by the UCSF California Preterm Birth Initiative.

Methods: We catalyzed two efforts in Fresno County (2014) and San Francisco (SF) City and County (2017) that established broad public/private, multi-sector coalitions operating under the principles of collective impact (CI). Each developed unique common agendas, systems of shared measurement, mutually reinforcing activities, continuous communication plans, and organizational backbones. Thematic analyses of documents and 32 in-depth interviews with system leaders and community stakeholders were conducted in Dedoose.

Results: Fresno selected interventions to reduce overall PTB rates and close racial/ethnic gaps in PTB, whereas SF prioritized interventions specifically for black and Pacific Islander (PI) families where disparities were greatest. Backbones based at a local academic institution (Fresno State) and health department (SF) had distinct spheres of influence with differential impacts on racial equity and policy change efforts. However, both coalitions integrated individuals with lived experience into all committees and working groups and leveraged community-academic partnerships to implement unique strategies including strengthening birth data collection and scaling group prenatal care (Fresno) and launching demonstration projects of community-based doula support and an income supplement for black/PI pregnant persons (SF). Stakeholders from both coalitions highlighted challenges with communication and ensuring sustainability.

Conclusions: While adopting common principles of CI, each cross-sector coalition operationalized equity differently. Long term investment in coalition infrastructure is required to drive policy and service delivery changes. Community-academic partnerships can generate evidence on promising interventions while upholding local processes and community involvement in decision making.

Background: Integrated care models in clinical settings have been shown effective at managing a variety of medical conditions. Recently, a provider-sponsored health plan transformed from a siloed care management approach to a comprehensive model that integrates services. This new model involves multidisciplinary care teams and leverages disparate data sources (e.g., clinical, behavioral, attitudinal) to more effectively deliver services and manage patients’ healthcare needs. In doing so, the organization has designed an innovative multidisciplinary care management model focused on risk levels and social determinants to successfully promote wellness among its patient population.

Methods: Multiple qualitative and quantitative techniques, which were guided by public health theory and best practices, were used to assess the previous healthcare management functions and design a new operating model. Methods including: workshops and interviews with stakeholders and organizational leaders, secondary data analyses, and key informant interviews to better understand organizational challenges and best practices. Based on the evidence, we developed a new model of care that was designed during interactive sessions with staff and adjusted as needed based on patient, provider, and caregiver feedback.

Results: This project piloted an innovative, collaborative, and scalable population health care management model to improve healthcare delivery and outcomes for patients. The initial phase includes about 30,000 shared patients (health plan member with an attributed system PCP), with the intent to expand to the remaining shared population, totaling nearly 48,000 lives.

Conclusions: Early qualitative results have shown improved care coordination, patient/staff interaction, and patient experience. Additionally, we estimate $2.5 to 3.5 million in cost savings are possible from this approach. Demonstrating that such comprehensive, interdisciplinary care delivery models lead to both improved healthcare metrics for patients and cost savings for organizations is important for care management systems.

Adults with diabetes are two to four times more likely to die from some form of heart disease (AHA) and so it is imperative that comorbid diabetes and cardiovascular disease conditions are managed well. As a health plan, we sought partnerships with leading non-profit health organizations to help members with these comorbidities custom health education materials.

Methods: In July 2019, a sample population of 1,599 members from 3,062 with comorbid diabetes and cardiovascular conditions received a customized health education toolkit produced with a national diabetes organization. The toolkit was full of tips and tools to help recipients manage these comorbid conditions. Included was a custom blood pressure guide from a national heart health organization. It contained information to help recipients understand their blood pressure, learn about the dangers of high blood pressure, and create a plan to help control it. Members that provided permission were surveyed via an electronic questionnaire that included Likert Scale questions and open-ended questions about their usage of and satisfaction with the toolkit.

Results: Qualitative evaluation: 43.7% (699/1599) of the members sent the toolkit were surveyed with a 6.5% (N=46) response rate. Of those, 93.5% (N=43) stated that they used one or more of the items and 50% (N=23) found the blood pressure guide to be “very useful” or “extremely useful.” The quantitative analysis on care gap closures impacted by the delivery of the custom toolkits will be conducted by August 2020 for 2019 claims.

Discussion: Identifying populations with comorbidities is a crucial step. Implementing an innovative intervention with recognized non-profit partners was generally very well received by members. Qualitative results were very encouraging. Barriers for the qualitative evaluation included some members restricting this type of communication from being sent to them, a lack of an email address for many members, and a moderate response rate.

Background: Practice facilitation (PF) is an evidence-based approach to help primary care practices develop strategies for quality improvement (QI). However, types of PF tasks and how they relate to goal setting/prioritization have rarely been articulated. This study examines goal setting/prioritization and PF support at each encounter, providing insights into what makes PF effective.

Methods: Twenty-three practice facilitators assisted 263 primary care practices in improving aspirin therapy, blood pressure control, cholesterol management, and smoking cessation counseling (ABCS) metrics. Facilitators documented, via electronic practice records, goal setting, strategies aligning to lean six-sigma process (DMAIC:define-measure-analyze-improve-control), and tasks/activities applied during each PF visit. Descriptive statistics were compiled on PF activities. Iterative approach was applied to categorize QI strategies implemented into the 5 DMAIC stages.

Results: Overall, after setting ABCS targets, practices prioritized additional goals on financial stability, community engagement, joy in practice, and other QI activities. Across goals, facilitators performed on average 35% of PF activities such as goal setting, change management, streamlined work flow, and information technology assistance. Another 20% were spent on reviewing charts, dashboards, and other data to enhance quality and 17% of the efforts were dedicated on identifying and providing needed resources. About 70% of strategies implemented to achieving these goals focused on D-M-I phases.

Conclusions: Our findings showed that working with practices in selecting specific QI targets and providing customize PF to support those goals are crucial to PF success. Effects of PF can be sustained as practices increase their QI capacity and technical know-how through the PF process.