# Presentation: 505961

## Collaboration and Integration at Work in Colorado

**Collaboration and Integration ****at Work in Colorado**

**Presented by:**
**Mary Paulsen, MSN RN**
**QI Director ~ Colorado**
**American Heart Association**
**American Stroke Association**

## Presentation Objectives

- Brief Overview of Cancer, Cardiovascular and Pulmonary Disease Program in state of Colorado
- Key Components / Competitive grants program
- Examples of collaboration and integration through the grants program with multiple partner participation in state of Colorado
- Project Titles:
- 1) Colorado State Stroke Registry:  *A Quality & Process Improvement Initiative*
*2) Get With The Guidelines Hospital Based Quality Improvement Program** *

## Colorado Legislature: Amendment 35 Funding

- House bill passed 05-1262 passed in 2005 (Implementation of tobacco taxes for Health-related purposes)
- Appropriated funds to establish “Cancer, Cardiovascular Disease and Pulmonary Prevention Early Detection and Treatment (CCPD)
- Program administered by the Colorado Department of Public Health and Environment (CDPHE) Prevention Services Division

## Key Components: Amendment 35 Funding

- Focuses on prevention, early detection, and treatment for cancer, cardiovascular disease, and chronic pulmonary disease
- Assists in the implementation of the state’s strategic plans for cardiovascular disease
- Establishes review committee
- Requires evaluation of the effectiveness of program
- Establishes a competitive grants program for cancer, cardiovascular disease, and pulmonary disease.

## Amendment 35:Grants Program Criteria

- Grants application shall address at least one of the following
- Program criteria:
**Translating evidence-based strategies into practical application in healthcare, workplace, and community settings**
- Provide appropriate diagnosis and treatment services for persons with abnormalities discovered in screening and early detection programs funded though this initiative
- Implementing education programs for public and providers
- Providing evidence-based strategies to overcome health disparities

## Example One:Colorado Stroke Registry: A quality & process improvement initiative

- 2002 Colorado State Legislature Created Stroke Advisory Board (COSAB)
- COSAB members include: volunteer group of over 20 hospitals and local/national heart disease/stroke organizations
- The Group published: *Stroke in Colorado: A Report to the Colorado Legislature from the Colorado Stroke Advisory Board (Nov 2003)*
*One of the recommendations of this report was to establish stroke registry in Colorado*

## Colorado Stroke Registry

- CCPD Competitive RFA’s releases in November 2004
- Colorado Stroke Advisory Board, consisting of statewide volunteers applied for grant funding under CCPD program for the implementation of state-wide stroke registry
- Grant was awarded and program implementation began in January 2005 and to run through June 2008 (Continuation application must be submitted every year for continued funding)
- COSAB group chose Get With The Guidelines Stroke program as Colorado State Stroke Registry program (this is a ‘voluntary’ stroke registry)

## Goal Summary:Stroke Registry

- Development/implementation of state-level Stroke Registry to implement stroke treatment guidelines in actual hospital practice
- Stroke registry will collect data on acute stroke care to design, implement, and evaluate interventions based on collected data to improve the quality of care for acute stroke patients in alignment with the goals and objectives of the State of Colorado Health Disease and Stroke Prevention Plan
- The foundation for the registry is the American Heart Association/American Stroke Association Get With the Guidelines Stroke Program.
- Encourage participation from all hospitals across state of Colorado; hospitals must agree too:
**Enter into agreement with Outcome, vendor for American Heart Association/American Stroke Association GWTG program**
**Sign “Letter of Intent” to participate**
**Agree to have de-identified data submitted to COSAB via a ‘super-user’ account **
**Actively participate in QI projects/programs to improve quality indicators within individual hospital system as well as statewide **
**Participate in statewide webex conference call / stroke mentoring program / best practice sharing and educational stroke workshops**

## Status to date:Stroke Registry

- 29 hospitals throughout Colorado participating in stroke registry
- Participating hospital accounts for 65% stroke discharges across the state *(Based on 2006 Discharge Data)*
- Over 2300 records in database
- Preliminary reports show increase in compliance with all 7 core stroke indicators over last 12 months.

## Example Two:Get With The Guidelines Quality Improvement Program (CAD/HF)

- CCPD Competitive RFA’s releases in March 2006
- Grant application was completed / submitted / awarded to Colorado Foundation for Medical Care
- Grant implementation began July 2006 and to run through June 2009 (competitive application required each year for continuation)
- Colorado Foundation for Medical Care collaborated with American Heart Association to implement Get With The Guidelines CAD/HF programs throughout the state of Colorado.
- Other collaborative partners:
- Colorado Hospital Association
- Colorado Clinical Guideline Coalition
- Department of Health
- Hospitals

## Program Goals:GWTG Quality Improvement Program CAD/HF

- Increase number of hospitals using GWTG quality improvement  program throughout state of Colorado
- Increased compliance with guideline-based medicine, which will lead to improved patient outcomes, reduced length of stays and unnecessary re-admits.
- Evaluate/track quality indicators using CFMC Grant ‘super-user’ account in alignment with strategic goals of the Colorado Heart Disease and Stroke State Health Plan
- Support to hospitals by working with them to implement an ‘organization culture of quality” approach, in an effort to increase likelihood of sustainability beyond the three year grant period
- Participating hospitals must agree:
- Sign Participating Hospital Agreement form with Outcome Sciences
- Agree to have de-identified aggregate data transmitted to Grant Project Coordinator
- Enter patients into the Patient Management tool
- Participate in monthly webex / conference calls
- Attend GWTG workshop and CFMC Regional Meetings
- Participate in best practice sharing
- Work with AHA to review quality indicators and/or identify areas that can be improved upon and put processes in place to make those improvements

## Status to date:Get With The Guidelines Quality Improvement Program (CAD/HF)

- 17 hospitals participating in GWTG CAD program: representing 37% CAD discharges in state of Colorado
- 17 hospitals participating in GWTG HF program; represent 33% of HF discharges in state of Colorado
- Approximate number records in database (Nov 06 – Sept 07)
- 	 	1300 Records in CAD database
- 	             700 Records in HF database
- Not competing programs; but collaborative programs:
- Efforts put into collecting data and making process change support hospital involvement with JCAHO and CMS.  All quality indicators for CAD and HF are the same as JCAHO's, CMSs and 100k Lives project.
- 8 Colorado hospitals recognized in US News and World Report, July 07 as achieving 85% greater on core indicators for greater than 90 days / 1 year / 2 years or greater: all grant participants
- .

## Conclusion.....

- Multiple groups/organizations can successfully collaborate and integrate
- by following these guiding principles:
- Be creative when developing partnerships; engage a variety of stakeholders
- Identify common goals
- Use resources efficiently and effectively
- Be focused on health outcomes
- Keep your ‘eye’ on the prize