Community Rx: Prescribing Quality in Health Management Design

Welcome back to the Community Health Management Design Podcast. I'm Dr. Tami Moser, and today we embark on a crucial journey to design a Community Health Management service that aligns with the core objectives we set out in Week 1. We'll explore how the Institute of Medicine's seminal "Crossing the Quality Chasm" report guides us in shaping a modern, effective healthcare system. This influential report outlines six key aims—Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity—that serve as the foundation for delivering exceptional health services.

Let’s delve into these aims and examine their practical application in service design, using a community-based diabetes prevention program as our case study. We'll discuss ensuring safety through culturally sensitive dietary guidance, effectiveness using evidence-based models, and patient-centeredness by offering personalized session options. We'll also touch on the importance of timeliness with prompt service access, efficiency through intelligent resource use, and equity by ensuring all materials are accessible to diverse populations.

Join us as we dissect these aims, discover how to implement them within our designs, and understand how they translate into robust community health programs. We’ll conclude by discussing the importance of measuring success across these dimensions to continuously improve and meet the needs of our communities. Stay tuned for insights that will help you create a comprehensive and impactful health management service.

Tami Moser [00:00:00]:
Welcome back to the community health management design podcast. I'm doctor Tami Moser. And today, we're diving deep into designing a community health management service that truly addresses the needs we identified in week 1. We'll be drawing heavily from the Institute of Medicine's landmark report crossing the quality chasm, which has shaped health care improvement efforts for over 2 decades. The crossing the quality chasm report published in 2,001 laid out a vision for a 21st century health system that's vastly different from what we had at the turn of the millennium. And I would even say at this point in time, It identifies 6 aims for improvement that should be at the core of every health service design. Let's break these down and see how they apply to our community health management service. The 6 aims that health care should see that allows us to know we have a quality program are safety, effectiveness, patient centeredness, timeliness, efficiency, and equitable service.

Tami Moser [00:01:03]:
These aims often abbreviated as steep, provide a framework for excellence in health care service design. Let's start with safety. The home report states that patients should not be harmed by the care that is intended to help them. In community health management, this might mean ensuring that our interventions don't inadvertently increase risk in other areas of health. So think of those balancing measures again. Effectiveness is about providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit. This aim challenges us to base our community health programs on solid evidence and to continually evaluate their impact. Patient centeredness is about providing care that is respectful of and responsive to individual patient preferences, needs, and values.

Tami Moser [00:01:53]:
In community health, this might mean tailoring our programs to the cultural norms and preferences are of our target population. And this is an area where no matter how often it's discussed and a point of education of providers, this still is sorely lacking in most areas areas of health care, that continuum of both from the community side all the way through hospital stays and aftercare. So something to consider very closely and really think about what do our patients really need, want, or will participate in, and what fits within the cultural norms of that population. The next is timeliness in the IOM framework, and this refers to reducing weights and sometimes harmful delays for both those who receive and those who give care. In our community health services, this could mean ensuring prompt access to preventative services or quick follow ups after health screenings. Efficiency is about avoiding waste including waste of equipment, supplies, ideas, and energy. This aims challenges us to design lean resource Right? It is an area of concern for IOM, but it is not the pursuit of efficiency at the or in a way that penalizes everything else that needs to be done. So efficiency and quality still have that kind of struggle between them.

Tami Moser [00:03:44]:
But addressing these 6 areas that the IOM identifies and the Institute of Health Care Improvement identifies as key components of quality as a total package helps us mitigate that desire for efficiency at the cost of everything else. And finally, equity. And this means providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, or socioeconomic status. This aim is particularly crucial in community health where we often work with diverse and underserved population. And this can be everything from in terms of equity that because someone identifies as a certain gender, they're still provided equitable care. Right? Or because someone may be poor versus rich, they still are provided quality care and that it's equitable in in serving those populations. So now you might be wondering how do these aims translate into concrete, So now you might be wondering how do these aims translate into concrete service design. So let's walk through an example keeping these aims in mind.

Tami Moser [00:04:52]:
And also keep in mind, the PDF of this report is provided so that you can dig into it deeper. Granted, it is a longer report, but it is something I think that you should save to access or refer back to as you work your way through these 6 areas in our particular program. Right? So, we're looking back at the community based diabetes prevention program. So, here's how we might apply this deep framework. Safety. We ensure our dietary recommendations are culturally appropriate and don't inadvertently promote eating disorders. And so everything from our recommendations to the education we provide, we would be thinking about that. Effectiveness.

Tami Moser [00:05:50]:
We base our program on proven diabetes prevention models like the CDC's National Diabetes Prevention Program. Patient centeredness. We offer both group and individual sessions allowing participants to choose based on their personal preferences. Timeliness. We provide same week appointments for initial assessments and immediate access to online education resources. Efficiency. We use a mix of in person and telehealth services to reduce costs while maintaining quality. Equity.

Tami Moser [00:06:22]:
We offer materials in multiple languages and provide services in various community locations to ensure equal access. Alright. So while in each of these areas, what I've mentioned may not be the only thing we think about in terms of each in in each of those areas. We may have multiple things that we're listing out within our program that will address those six components of quality. Just know that you may only have 1 or you may have many. And if you're looking at something like efficiency and we're like, we don't know how to deal with this, then you need to look at all aspects of your service. Right? There should be in order to have a quality service, all 6 of these areas have to be addressed. So the crossing the quality chasm report also emphasizes the importance of redesigning care processes.

Tami Moser [00:07:16]:
It suggests that effective care is based on continuous healing relationships, customization based on patient needs and values, the patient as the source of control, shared knowledge and free flow of information, evidence based decision making, safety as a system property, transparency, and anticipation of needs. So you can see there's a quite a lot that goes into effective care. In our diabetes prevention program, this might look like establishing ongoing relationships between participants and health coaches, customizing meal plans based on individual preferences and cultural backgrounds, empowering empowering participants to set their own health goals, providing open access to personal health data and educational resources, and using predictive analytics to identify participants at highest risk for developing diabetes. Now, let's talk about how we measure excellence in our service design. The IOM report emphasizes the importance of building organizational supports for change, including using information technology, aligning payment policies with quality improvement, and preparing the workforce. For our diabetes prevention program, we might measure it in this way. Safety, rate of adverse events related to program interventions, effectiveness, percentage of participants who maintain or reduce their h a one c levels, patient centeredness, patient satisfaction scores and retention rates, Timeliness, average wait time for initial assessment and ongoing appointments. So there'd be 2 there.

Tami Moser [00:08:58]:
Efficiency, cost per participant per percentage point reduction in h a one c. Equity, comparison of outcomes across different demographic groups. So remember the goal is to design a service that excels across all these dimensions. It's challenging, but it's what our communities deserve. So your assignment this week is to draft a service design for your community health management program that explicitly addresses each of the 6 IOM aims. For each aim, describe a specific measure of your program and how you'll measure its success in relationship to that measure. In our next episode, we'll discuss how to implement your service design including strategies for overcoming common barriers Keep designing, keep measuring, and keep striving to cross that quality chasm in your community's health. Until next time, this is doctor Tami Moser signing off.