A Statewide Approach to Reducing Re-excision Rates for Women With Breast-conserving Surgery.

OBJECTIVE: Test the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates. BACKGROUND: Breast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target. METHODS: Wisconsin Hospital Association discharge data (2017-2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change preintervention to postintervention between Surgical Collaborative of Wisconsin (SCW) and nonparticipating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included 5 collaborative meetings in 2018 to 2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided. RESULTS: In 2017, there were 3692 breast procedures in SCW and 1279 in nonparticipating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and nonparticipating hospitals (16.1% vs. 17.1%, P =0.47). Re-excision significantly decreased for SCW but not for nonparticipating hospitals (odds ratio=0.69, 95% confidence interval=0.52-0.91). CONCLUSIONS: Benchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for statewide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.

The role of disease management in the treatment and prevention of obesity with associated comorbidities.

Nearly two thirds of the US population is overweight or obese and those numbers are climbing. Many organizations are beginning to recognize overweight and obesity as severe health threats and to acknowledge that treatment can serve as an important first step in addressing this epidemic. Through its Obesity with Co-morbidities Initiative, the Disease Management Association of America (DMAA) seeks to raise awareness and improve understanding of the role disease management (DM) can play in the treatment and management of obesity with comorbidities. Among the objectives of the Obesity with Co-morbidities Initiative was to develop standard definitions of obesity and obesity with comorbidities and to conduct qualitative research among key DM stakeholders. The first project undertaken and completed by the Obesity with Associated Co-morbidities Steering Committee and work group was to define the term "obesity" for consistent usage within the DM community for the purposes of population-based interventions. As part of this initiative, DMAA partnered with Synovate, a global market research firm, to conduct focus groups and in-depth interviews in order to collect qualitative data on attitudes and practices related to obesity treatment and coverage among key industry stakeholders, including health plans, disease management organizations, employers, and the business community. The findings indicated that obesity was widely recognized as a serious issue, but there remained varying opinions regarding responsibility, health and productivity costs, coverage, and best treatment methods among the participants. DMAA will continue this initiative through 2007 and will continue to develop a knowledge base of obesity guidelines and management practices, create valuable tools and resources including an online resource center, and facilitate partnerships with other organizations involved in the management and prevention of obesity.

Assessment and management of obesity and comorbid conditions.

To better understand obesity, its related conditions and risk factors, and the best assessment and management approaches for the adult population, the Disease Management Association of America and the National Committee for Quality Assurance partnered to conduct a literature review that could inform future initiatives of both organizations as well as others. The goals of the literature review were to: (1) describe the prevalence of obesity and related conditions and their health and financial impacts; (2) illustrate the clinical importance and interrelatedness of the conditions; and, the focus of this article, (3) describe the evidence supporting the different assessment and management options for obesity and comorbid conditions.

Exploration Into the Business Priorities Related to Corporate Engagement in Community Health Improvement Partnerships.

OBJECTIVE: To explore factors that matter to business in making decisions regarding engagement in community health improvement efforts. METHODS: Using qualitative methods, domains of interest were identified through literature reviews and expert interviews. Relevance of the domains in terms of potential priorities for action was tested through employer and community stakeholder interviews. RESULTS: Factors that employers considered important to sustained community collaboration as a business priority included (1) credibility of the convener, (2) broad representation of the community, (3) strong mission and goals, (4) individual commitment to health, (5) organizational commitment to health, and (6) demonstrated commitment from leadership. CONCLUSIONS: Priorities have been identified for engaging business in community health efforts. Implications for research, practice, and policy include the need for measurement, transparency in reporting, and agreement on principles for public-private partnership in this area.

Measuring medication adherence.

Several studies have shown that poor adherence to pharmaceutical treatment regimens increases health condition severity, mortality rates, and overall health care costs. The dimension of medication adherence in health management outcomes has been deficient of a comprehensive yet practical standardized measurement methodology. DMAA: The Care Continuum Alliance, along with its industry partners, noted this absence and assembled a clinical workgroup to undertake an appropriate standardization effort. The medication adherence clinical workgroup within DMAA's outcomes measurement and methodology steering committee convened in February 2008 to review literature, incorporate subject matter expertise, gain consensus on measurement techniques, and discuss known limitations. This workgroup has successfully completed a standardized methodology to measure medication adherence rates via medication possession ratio (MPR). The guidelines for this method were approved for inclusion in Volume III of DMAA's Outcomes Guidelines Report. Accordant Health Services, as a member of this workgroup, volunteered to test the recommended specification and measure. These tests would encompass not only measurement calculations but also feasibility considerations. The measurement period for these tests was the 2007 calendar year. Results showed that condition-specific MPRs for a health plan population ranged between 78.9% and 83.6%. The same methods applied to an employer group population revealed a condition-specific MPR range of 75.4% to 76.5%. Based on 2007 book of business data for CVS Caremark's Adherence to Drug Therapy program, those results are within the 95% confidence interval for employer group and health plan populations.