Transforming Healthcare Delivery Through Collaborative Data Collection and Analysis

“Transforming Healthcare Delivery Through Collaborative Data Collection and Analysis”

CAVU Foundation is a 501c.3 public charity whose mission is to identify and support innovative community programs and services that enhance the healthcare of underserved children. CAVU provides direct funding and technical assistance to community health centers (CHCs) across Massachusetts in an effort to address a variety of pediatric healthcare needs.

In 2008, CAVU launched the Healthy Weight Initiative (HWI) to tackle pediatric overweight/obesity in the community health center setting. Pediatric obesity is more prevalent in low-income and minority children, and the prevalence is rising at a faster pace in these vulnerable populations [1]. As increasing numbers of obese children develop co-morbid conditions such as type 2 diabetes and cardiovascular disease, this alarming trend will further exacerbate health disparities. To address this problem, and to target the children at highest risk, CAVU has supported the implementation of specialized Healthy Weight Clinics at CHCs across Massachusetts. The 8 CHCs currently participating in the HWI serve ~50,000 kids annually. At these health centers, the proportion of patients aged 3-18 with BMI >85th percentile ranges from 30% to 50%.

The HWI supports the replication of the Healthy Weight Clinic model first piloted in 2006 at Whittier Street Health Center by Dr. Shikha Anand, Whittier’s Director of Pediatrics and Assistant Professor of Pediatrics at Boston Medical Center. In addition to replicating this best practices based model, the Initiative fosters collaboration among community health centers around the issue of childhood overweight/obesity. Building on the success of the pilot program, the HWI has now expanded to a total of 8 CHCs across Massachusetts and CAVU is currently considering different ways to make the Healthy Weight Clinical Model available to all health centers that are seeking to address pediatric obesity, including web-based collaborative forums and/or downloadable toolkits.

The Healthy Weight Clinical Model

Patients are referred to the Healthy Weight Clinic by their primary care provider, and attend the clinic monthly for up to 6 months and as needed thereafter. During each visit, patients and their families meet with a specially trained CHC doctor, nutritionist, and case manager. Patients spend time goal-setting with the nutritionist and provider champion while the case manager assists patients in accessing resources that will help them to reach their goals. Depending on the patient’s needs, these resources may include referrals to local physical activity programs, exercise guides, farmer’s market coupons, and, through CAVU’s partnership with Good Sports, new sports equipment that will enable them to participate in physical activities. Much of this activity is billable, ensuring that the clinic can self-sustain at the health center in the long term.

Collaboration is a key element of the Healthy Weight Initiative, as health centers have not historically had a CHC-driven venue for collaboration around pediatric obesity. Through a combination of live meetings, conference calls, and online tools (i.e. the Healthy Weight Blog) health centers are able to learn from each other and from experts in the field to ensure high quality patient care. Participating health centers also receive quarterly site visits from the Healthy Weight Medical Director and Program Manager to ensure that clinic staff members receive any technical support they need.

In support of the Healthy Weight Initiative, CAVU has developed a versatile data collection tool using Microsoft software obtained through Techsoup (please see below for a list of Microsoft products used). The Data Collection & Information System (DCIS) is a web-based platform that centralizes data collection for all Healthy Weight Clinics. Comprehensive patient data is collected for a variety of health measures, including BMI (Body Mass Index), screen time, physical activity, sweetened beverage intake, and risk of co-morbidities. In addition to these health measures, the DCIS also collects data on patient goal-setting, progress in meeting goals, and referrals to physical activity and nutrition programs in their community. This system replaced previously cumbersome and inefficient methods of data collection for CAVU, fundamentally improving our ability to track and enhance the success of our programs.

Since the DCIS became operational in early 2009, the system has already proven to be a valuable tool for improving the quality of healthcare delivery. DCIS reports have successfully encouraged sites to be more thorough in their data collection, especially when recording vital information such as BMI, physical activity, and sweetened beverage intake. These data collection skills are critical in allowing health center staff to effectively track and report on the impacts of their work, assisting health centers in obtaining external support for their efforts. Additionally, with real-time reporting, the DCIS allows CAVU to immediately identify and track performance variations among Healthy Weight Clinic sites. The Healthy Weight Clinic Model allows for a degree of flexibility in the way clinics operate, so it is necessary for the collaborative to be able to identify the strategies that work and those which underperform. When variations are detected among clinic sites, the collaborative can then examine that information and determine what quality improvement measures are called for. This rapid feedback and information-sharing has both empowered healthcare professionals in the HWI and strengthened CAVU’s ability to provide high quality technical assistance.

The Data Collection & Information System has added significant value to the Healthy Weight Initiative and it has transformed the way the collaborative manages patient-tracking, data collection, real-time reporting, and healthcare quality improvement. To date, the Healthy Weight Initiative has served a total of over 400 children. Of the 275 kids that have had repeat visits, 35% have shown a decrease in BMI, 40% have increased their physical activity, 53% have reduced their daily screen time, and 56% have reduced their sweetened beverage intake. With these encouraging results, CAVU is eager to build upon our success and bring the Healthy Weight Initiative to even more communities. The DCIS will continue to be a critical tool in driving the success of the HWI and CAVU’s ability to improve healthcare for underserved children.

Microsoft Products Used in Developing the DCIS

Windows Server User Client Access License

Windows Server 2003 R2 Enterprise Edition English/Multilanguage

Visual Studio 2005 Professional with MSDN Professional

SQL Server 2005 Standard Edition, x64

Windows Server External Connector License

1. Strauss, R.S. and H.A. Pollack, Epidemic increase in childhood overweight, 1986-1998. JAMA, 2001. 286: p. 2845-2848.