City of El Paso Department of Public Health



City of El Paso Department of Public HealthDSRIP Project: Border Public Health Interest GroupIdentifying Project and Provider Information:Title of Project: Border Public Health Interest GroupRHP Project Identification #: 065086301.1.1Project Option: 1.5.2 Implement intervention that involves collaborating/partnering/instituting data sharing agreements with Medicaid agencies, public health departments, academic research centers, other agencies, etc. to better assess patient populations and aid the evaluation of health disparities.Performing Provider Name: City of El Paso Department of Public Health/065086301Project Description:The City of El Paso Department of Public Health proposes a three academic institution collaborative research interest group which will collect and analyze REAL data to describe regional/local health problems and prescribe appropriate policy/program interventions.Currently, the three academic institutions in the El Paso area (University of Texas El Paso, University of Texas Houston School of Public Health, and Texas Tech University) are engaged in population-based research activity. This regional research involves the collection and analysis of valid and reliable race, ethnicity, and language data with the intent to reduce disparities. However, there is no venue for exchange of information; strategizing on research direction; broadening the stakeholders beyond academia. The health department is proposing to establish a Border Public Health Interest Group comprised of researchers from the three major El Paso area academic institutions supplemented by epidemiology support from the health department. Representatives from all three institutions have agreed to participate in the public health interest group. Once the group is fully operational, planners envision extending the invitation to New Mexico State University and academic institutions in Juarez, Mexico to form a truly regional public health research body. Purpose of the group will be to conduct collaborative research on pressing border health concerns, e.g., diabetes, select communicable/chronic diseases. As a neutral convener, the health department can facilitate sharing of information among participating institutions; help the institutions identify and articulate common interests; and broker resolution of problems attendant to inter-academic institution collaboration. Once operational, the Border Public Health Interest Group (BPHIG) will inventory research projects currently underway at three affiliated academic institutions, e.g., study of relationship of insurance status to accessing preventive health/early detection services for breast and cervical cancer for low income Hispanic women along the border. Status/findings will be shared with the group to identify synergies and opportunities for collaborative research. The group will then strategize on continuation of current or development of new research initiatives; inclusion of additional stakeholders; and identifying/accessing private and/or public funding for current/new investigations. In addition to facilitating interaction among the three academic institutions, the health department, as a local governmental entity, can foster development of appropriate public policy to assure that research findings are translated into programs/action. Policy influence will occur through strategic dissemination of research findings and engagement of academic and non-academic partners in advocacy with public, private, and non-profit sectors.Finally, the Border Public Health Interest Group’s interaction and collaborative research activities will help educate academic institutions, hospitals, private providers, public officials, and the broader community along the border of the value of collecting/analyzing/using REAL data for informed decision-making. Goals and Relationship to Regional Goals:The goal of this project is to express to the broader El Paso region the synergistic value of collaborative research on health topics relevant to border populations. The relationship building attendant to full participation in BPHIG will result in the application of skills, expertise and passion of area researchers (irrespective of institutional affiliation) on health problems of common interest/concern. This sharing of REAL data collection, analysis, interpretation, and findings will improve local capacity for understanding border health problems/conditions and will help sensitize the community to the need/means for action. Project Goals: Form a Border Public Health Interest Group with researcher/policy maker representation from City of El Paso Department of Public Health, University of Texas El Paso, University of Texas Houston School of Public Health, and Texas Tech University Paul Foster School of Medicine. Inventory current research activity to identify synergies of interest; identify research gapsDevelop/fund/conduct pilot collaborative research project Apply findings from pilot project to policy/program initiativesExpand participation on BPHIG to other regional academic institutions Expand participation on BPHIG to non-research related businesses, non-profits, local governmentsReposition BPHIG as the El Paso area “think tank’ for REAL data analysis; health policy development; and program/service intervention advocacyThis project meets the following regional goals:The BPHIG project will enhance regional capacity to understand the macro and micro differences of border health issues. Further, the project will help prescribe culturally-driven, evidence-based interventions. The BPHIG initiative relates to the following regional goal:Overcome language, socio-economic, and monetary barriers to accessing healthcare resources in the regionChallenges:The major challenge for BPHIG will be to extend the collaborative sentiment of the participating researchers to upper level administration of the respective academic institutions, i.e., getting full buy-in from the administrative hierarchy of each university. Fortunately, most funding sources now expect (demand) evidence of community collaboration, including inter-institutional for local academia. This fundamental shift in research funding philosophy from competitive to collaborative will help address the issue.5 Year Expected Outcome for Provider and Patients:Over a 5 year work period BPHIG will inspire a regional commitment to health improvement and demonstrate enhanced access to culturally-responsive health services. A regional expectation for improved health will follow:better awareness of border health issues and appropriate policy/service interventions; greater sensitivity to the full range of causal factors of disparities; change in belief structure about capacity to make a difference Improved knowledge, alone, does not yield change. Communities must be dissatisfied with current conditions and feel the capacity/power to improve circumstances. The work of BPHIG will facilitate that transition in thought, heart, and practice for residents of the El Paso region.Starting Point Baseline:This is a new initiative of the City of El Paso Department of Public Health; hence, baseline is zero (0).Rationale:The current demographic mix of El Paso is predictive for the nation (predominantly Hispanic with diverse socioeconomic status). As such, population-based research on prevalence and incidence of communicable and chronic diseases is especially relevant to healthcare providers and policy makers. Population-based research in the El Paso community will help describe/refine who’s at risk for select diseases by race, ethnicity, language, physiologic, behavioral, socioeconomic factors. Further, specific interventions (health and other) can be studied to identify best practices for health protection and disease prevention/management/control in a predominantly Hispanic population.Publicly funded research projects now require evidence of collaboration. Historically, the three academic institutions in the area pursued research tracts in isolation. The expectation for collaboration is a paradigm shift. However, this shift can be facilitated by the health department as a neutral convener. The key to successful collaborative research is trust among the institutions/researchers that the responsibilities/benefits of process and outcome will be equitably shared. That trust will need to earned, incrementally, over time and experience. It is critical that the initial group research project be strategically identified/designed to mitigate risk and afford all participating institutions opportunity for added value.Population-based research in the El Paso community will help describe/refine who’s at risk for select diseases by race, ethnicity, language, physiologic, behavioral, socioeconomic and other factors AND who may be protected by one or more of the above factors. Further, specific interventions (health and other) can be studied to identify best practices for disease prevention/management/control in a predominantly Hispanic population. Work of the Border Public Health Interest Group will inform/influence health planners, clinicians, and policy makers and, therefore, is translational to all DSRIP categories. Project Components:There are no specific project components to Project Option 1.5.2; however, the project option does require quality improvement activities including “lessons learned,” and identifying opportunities for scaling and replication of successful interventions. BPHIG will conduct an ongoing quality improvement process to address the requirements of this section.Unique community need identification number(s) the project addresses:CN.4 Obesity Prevention/Health PromotionCN.6 Other Community Need as Identified by the Performing ProviderHow the project represents a new initiative or significantly enhances an existing delivery system reform initiative:There is currently no coordinated approach to REAL data research; analysis/interpretation of findings; and translating research results into a policy and programs. BPHIG will demonstrate that academic institutions, public and private providers can collaborate on investigating border health issues and preparing/advocating effective interventions. Related Category 3 Outcome Measure(s):Outcome Domain (OD-11): Addressing Health Disparities in Minority PopulationsImprovement Targets IT-11.6 (DY 4-5): Other Outcome Improvement Target (TBD)Reasons/Rationale for selecting the outcome measures:The outcome of the proposed DSRIP project for a Border Public Health Interest Group will be improved collaboration among academic researchers from the three local universities; improved standardization of data collection per REAL methodology; improved translational results/findings due to consistency in collection methodology; and improved application of research findings to program/service intervention design; and, ultimately improved health status of minority populations in the El Paso border region. Relationship to Other Projects:The Border Public Health Interest Group complements another health department DSRIP submission: El Paso Community Health Atlas (065086301.1.2), which seeks to develop a comprehensive biomarker database which can be analyzed by zip code or other geo, demographic, or health-related criteria for research and targeted interventions to address health disparities in the border region. Relationship to Other Performing Providers’ Projects in the RHP:The Border Public Health Interest Group also complements other DSRIP initiatives in Region 15 including:UMC: Enhance Performance Improvement and Reporting Capacity at UMC Neighborhood Health CentersUMC: Chronic Care Model for Neighborhood Health CentersTexas Tech: Disease Management RegistryTenet: Enhance Interpretation Services and Culturally Competent CareHCA: Chronic Disease Management RegistryPlan for Learning Collaborative:Performing Providers, IGT entities, and the Anchor for Region 15 have held consistent monthly meetings throughout the development of the delivery system for the low-income Waiver. As noted by HHSC and CMS, meeting and discussing Waiver successes and challenges facilitates open communication and collaboration among the Region 15 participants. Meetings, calls, and webinars represent a way to share ideas, experiences, and work together to solve regional healthcare delivery issues and continue to work to address Region 15’s community needs. UMC, as the Region 15 Anchor anticipates continuing to facilitate a monthly meeting, and potentially breaking into workgroup Learning Collaboratives that meet more frequently to address specific DSRIP project areas that are common to Region 15, as determined to be necessary by the Performing Providers and IGT entities. UMC will continue to maintain the Region 15 website, which has updated information from HHSC, regional projects listed by Performing Provider, contact information for each participant, and minutes, notes and slides from each meeting for those parties that were unable to attend in-person. Region 15 participants look forward to the opportunity to gather annually with Performing Providers and IGT entities state-wide to share its experiences and challenges in implementing its DSRIP projects, but also recognizes the importance of continuing ongoing regional interactions to effectuate change locally. Through the use of both state-wide and regional Learning Collaborative components, Region 15 is confident that it will be successful in improving the local healthcare and indigent population.Project Valuation:The proposed value (community benefit) of the Border Public Health Interest Group (BPHIG) is $5,933,708 over the DSRIP funding period (DY 2-5). Of this amount $4,309,791 has been allocated for the value of Category 1 Infrastructure Development. The valuation takes into account direct staffing of the initiative (two epidemiologists and one support staff) adjusted for leave time use/staff turnover; supplies and materials; training and conference attendance for health department staff and BPHIG researchers; consultation for design of pilot collaborative research project; computers/tablets for field collection of data; stipends for field data collectors/researchers; technical consultation and software design/purchase for inputting and analysis of REAL data; back office functions (payables and receivables management, fiscal and program reporting, human resources); program management to troubleshoot scheduling/staffing/production issues; publication and other costs related to the dissemination of research findings; evaluative services for collection and analysis of activity and other performance data relative to DSRIP reporting requirements; and administrative oversight. 065086301.1.11.5.2 1.5.2 (Quality Improvement)Project Title: Border Public Health interest GroupPerforming Provider Name: City of El Paso Department of Public HealthTPI: 065086301OD-11 Addressing Health Disparities in Minority Populations 065086301.3.1IT-11.6Other Outcome Improvement Target (TBD)Year 2 (10/1/2012 – 9/30/2013)Year 3 (10/1/2013 – 9/30/2014)Year 4(10/1/2014 – 9/30/2015)Year 5(10/1/2015 – 9/30/2016)Process Milestone P-4Implement standardized policies and procedures to ensure the consistent and accurate collection of dataProcess Metric P-4.1Description of elements of the systemGoal: Inventory and assess data collection policies and procedures of respective institutions; identify opportunities for standardization policies and procedures relative to REAL data collectionData Source: Policies and proceduresEstimated Incentive Payment: $600,000Process MilestoneP-8Participate in face-to-face learning, i.e., meetings of seminars, at least twice per year with other providers and the RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting, all providers should identify and agree upon several improvements (simple initiatives that all providers can do to “raise the floor” for performance). Each participating provider should publicly commit to implementing these improvements.Process Metric P-8.1Participate in semi-annual face-to-face meetings organized by the RHPP-8.2Implement the “raise the floor” improvement initiatives established at the semi-annual meetingGoal: Participate in face-to-face learningData source: Documentation of semi-annual face-to-face meetings; evidence of “raise the floor” initiative.Estimated Incentive Payment: $600,000Process Milestone P-4Implement standardized policies and procedures to ensure the consistent and accurate collection of dataProcess MetricP-4.1Description of elements of the systemGoal: Continue to identify opportunities for standardization of policies and procedures relative to REAL data collection; coordinate inter-institutional response to assure development and adoption of standardized REAL data collection policies and proceduresData Source: Policies and proceduresEstimated Incentive Payment: $524,450Process MilestoneP-8Participate in face-to-face learning, i.e., meetings of seminars, at least twice per year with other providers and the RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting, all providers should identify and agree upon several improvements (simple initiatives that all providers can do to “raise the floor” for performance). Each participating provider should publicly commit to implementing these improvements.Process Metric P-8.1Participate in semi-annual face-to-face meetings organized by the RHPP-8.2Implement the “raise the floor” improvement initiatives established at the semi-annual meetingGoal: Participate in face-to-face learningData source: Documentation of semi-annual face-to-face meetings; evidence of “raise the floor” initiative.Estimated Incentive Payment: $524,450Improvement MilestoneI-12Implement intervention to make improvements in REAL data collection and useImprovement MetricI-12.1Documentation of increased number of unique patients with documented REAL data using innovative program option. Demonstrate improvement over prior reporting period (baseline for DY 2)Goal: Identification and initiation of collaborative research project using standardized REAL data collectionData Source: Documentation of research project ; demonstration of REAL data collectionEstimated Incentive Payment: $525,007Process MilestoneP-8Participate in face-to-face learning, i.e., meetings of seminars, at least twice per year with other providers and the RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting, all providers should identify and agree upon several improvements (simple initiatives that all providers can do to “raise the floor” for performance). Each participating provider should publicly commit to implementing these improvements.Process MetricP-8.1Participate in semi-annual face-to-face meetings organized by the RHPP-8.2Implement the “raise the floor” improvement initiatives established at the semi-annual meetingGoal: Participate in face-to-face learningData source: Documentation of semi-annual face-to-face meetings; evidence of “raise the floor” initiative.Estimated Incentive Payment: $525,008Improvement MilestoneI-12Implement intervention to make improvements in REAL data collection and useImprovement MetricI-12.1Documentation of increased number of unique patients with documented REAL data using innovative program option. Demonstrate improvement over prior reporting period (baseline for DY 2)Goal: Release of pilot research findings; discussion of value of REAL data collection relative to analysis, interpretation, and policy/program opportunitiesData Source: Documentation of release of research findingsEstimated Incentive Payment: $505,438Process MilestoneP-8Participate in face-to-face learning, i.e., meetings of seminars, at least twice per year with other providers and the RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting, all providers should identify and agree upon several improvements (simple initiatives that all providers can do to “raise the floor” for performance). Each participating provider should publicly commit to implementing these improvements.Process MetricP-8.1Participate in semi-annual face-to-face meetings organized by the RHPP-8.2Implement the “raise the floor” improvement initiatives established at the semi-annual meetingGoal: Participate in face-to-face learningData source: Documentation of semi-annual face-to-face meetings; evidence of “raise the floor” initiative.Estimated Incentive Payment: $505,438Year 2 Estimated Milestone Bundle Amount: $1,200,000Year 3 Estimated Milestone Bundle Amount: $1,048,900Year 4 Estimated Milestone Bundle Amount: $1,050,015Year 5 Estimated Milestone Bundle Amount: $1,010,876TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD (add milestone bundle amounts over Years 2-5): $4,309,791City of El Paso Department of Public HealthDSRIP Project: Border Public Health Interest GroupCategory 3 Quality ImprovementsTitle of Outcome Measure (Improvement Target): IT-11.6 Other Outcome Improvement Target (TBD)Unique RHP outcome identification number: 065086301.3.1 Outcome Measure Description:IT-11.6-Other Outcome Improvement Target (TBD)Goal: TBD by performing providerData Source: TBD by performing providerThe City of El Paso Department of Public Health is proposing a four year developmental effort to operationalize a Border Public Health Interest Group (BPHIG) around the theme of collection and analysis of REAL data. Currently, the three academic institutions in the El Paso area (University of Texas El Paso, University of Texas Houston School of Public Health, and Texas Tech University) are engaged in population-based research activity. This regional research involves the collection and analysis of race, ethnicity, and language data with the intent to identify and ameliorate health disparities. Though the three research institutions have embraced collection of REAL data, there has been no assessment of the use of REAL data systems among El Paso area institutional healthcare providers, community health centers or private physicians The Border Public Health Interest Group will conduct the community assessment on the use of REAL data systems; invite early adopters of REAL to be members of the Interest Group; and identify opportunities for development/implementation of standardized REAL data collection. Through community deployment of new epidemiology staff supported through the DSRIP project, the health department will play a pivotal (and neutral) role in advancing community discussion of the need for REAL data collection and its value in identifying disparities related to race, ethnicity, and language. In addition to encouraging community adoption of REAL data collection systems, BPHIG will identify one or more collaborative research opportunities where REAL data collection will be foundational to the research. Results of the research will inform the community on the value REAL data collection for problem description and aid the development of appropriate public policies and targeted interventions.Process Milestones:DY 2: P-1-Project Planning-engage stakeholders, identify current capacity and needed resources, determine timelines and document implementation plansDY 3: P-3-Develop and test data systemsOutcome Improvement Targets for each year:DY4:IT-11.6: Other Outcome Improvement Target (TBD)DY5:IT-11-6: Other Outcome Improvement Target (TBD)Rationale:Process Milestones P-1 and P-3 were chosen due to lack of an inventory of current population-based research activity being conducted by the three local universities. Further, it is unknown to what extent data collection underway is consistent with expectations for uniformity of REAL data. Assessment of scope of current activity and application of REAL data collection methodology will occur over the first two years of the project. Outcome of the assessment will drive the Outcome Improvement Target (s) for years DY4 and DY5.The current demographic mix of El Paso is predictive for the nation (predominantly Hispanic with diverse socioeconomic status). As such, population-based research on prevalence and incidence of communicable and chronic diseases is especially relevant to healthcare providers and policy makers. Population-based research in the El Paso community will help describe/refine who’s at risk for select diseases by race, ethnicity, language, physiologic, behavioral, socioeconomic factors. Further, specific interventions (health and other) can be studied to identify best practices for health protection and disease prevention/management/control in a predominantly Hispanic population.Publicly funded research projects now require evidence of collaboration. Historically, the three academic institutions in the area pursued research tracts in isolation. The expectation for collaboration is a paradigm shift. However, this shift can be facilitated by the health department as a neutral convener. Population-based research in the El Paso community will help describe/refine who’s at risk for select diseases by race, ethnicity, language, physiologic, behavioral, socioeconomic and other factors AND who may be protected by one or more of the above factors. Further, specific interventions (health and other) can be studied to identify best practices for disease prevention/management/control in a predominantly Hispanic population. Work of the Border Public Health Interest Group will inform/influence health planners, clinicians, and policy makers and, therefore, is translational to all DSRIP categories. Outcome Measure Valuation:The proposed value (community benefit) of the Border Public Health Interest Group (BPHIG) is $5,933,708 over the DSRIP funding period (DY 2-5). Of this amount $1,623,917 has been allocated for the value of Category 3 Quality Improvements. The valuation takes into account direct personnel and operational expenses to support Category 3 activities; costs associated with technical consultation and, as needed, REAL data software design/purchase; and the community benefit value of conducting REAL data research on area health problems with the intent of informing the community of findings and building community constituencies for policy change and program development. 065086301.3.13.IT-11.6Other Outcome Improvement Target (TBD)Performing Provider Name: City of El Paso Department of Public HealthTPI-065086301Collect Valid and Reliable Race, Ethnicity, and Language (REAL) Data to Reduce Disparities:Unique Category 1 identifier-065086301.1.1Starting Point/Baseline: 0OD-11: Addressing Health Disparities in Minority PopulationsYear 2 (10/1/2012 – 9/30/2013)Year 3 (10/1/2013 – 9/30/2014)Year 4(10/1/2014 – 9/30/2015)Year 5(10/1/2015 – 9/30/2016)Category 3Process Milestone P-1Project Planning-engage stakeholders, identify current capacity and needed resources, determine timelines and document implementation plans Process Milestone MetricGoal: Develop fully functional Border Public Health Interest Group (BPHIG) with full participation of three local universities; recruit and select two epidemiologists and one support staff to assist BPHIG in business planning and research design; develop and approve three year strategic plan for: inventorying existing research projects;determining extent of compliance with REAL data collection methodology;applying REAL data methods and expectations to data collection on existing research projects;expanding participation on BPHIG;identification of collaborative research opportunitiesData Source: Performing Provider Estimated Incentive Payment : $50,000Category 3Process Milestone P-3Develop and test data systems Process Milestone MetricGoal: Research/inventory existing REAL data collection systems being used by hospitals, community health centers, private providers within and outside El Paso. Identify and involve early adopters. If possible, modify existing REAL data collection systems to reflect local needs. Identify collaborative research opportunity for piloting of REAL data system.Data Source: Performing Provider Estimated Incentive Payment: $400,000Category 3Outcome Improvement Target IT-11.6 Other Improvement Target: Must be evidence-based, appropriate for the proposed project, and meet the definition of an outcome measureGoal: TBDData Source: Performing ProviderEstimated Incentive Payment: $500,000Category 3Outcome Improvement Target IT-11.6Other Improvement Target: Must be evidence-based, appropriate for the proposed project, and meet the definition of an outcome measureGoal: TBDData Source: Performing ProviderEstimated Incentive Payment: $673,917Year 2 Estimated Outcome Amount: $50,000Year 3 Estimated Outcome Amount: $400,000Year 4 Estimated Outcome Amount: $500,000Year 5 Estimated Outcome Amount: $673,917TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD (add outcome amounts over DYs 2-5): $1,623,917 ................
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