Partnering with Nebraska HHS to Improve Client Health

This blog is written by the Nebraska Department of Health and Human Services Chronic Disease Prevention and Control Program.

Background
Community Alliance, located in Omaha, Nebraska, is a behavioral health organization with an integrated health care clinic. Community Alliance increased the clinic’s cholesterol management rate by 8% in 6 months. The clinic accomplished this after developing an electronic health record-based cholesterol dashboard. Community Alliance used the dashboard to identify clients with unmanaged cholesterol and to inform the development and implementation of cholesterol-focused quality improvement initiatives specific to these clients. The Nebraska Department of Health and Human Services’ Chronic Disease Prevention and Control Program (DHHS CDPCP) supported this work with grant funds received from the Centers for Disease Control and Prevention (CDC).

Approach
Community Alliance used the CAAPIE (Capture, Assess, Action Planning, Implement, and Evaluation) framework to guide cholesterol dashboard planning and development. The DHHS CDPCP created the CAAPIE framework and tools to guide grantees in implementing evidence-based activities. Community Alliance’s team first captured client population data by recording demographics and high cholesterol-related diagnoses in a data-collection tool. Next, the team completed a self-assessment of current practices, strengths, and areas for improvement. The Community Alliance team identified “use of clinical quality measures to track differences in health outcomes for high blood cholesterol” as a practice not currently in place at the clinic. The team noted that the clinic’s strengths included leadership buy-in and a provider with expertise in implementing disease dashboards. These findings led Community Alliance to include “build condition-specific dashboard” as an action step in their action plan for improving cholesterol management rates. They set a goal of improving the clinic’s cholesterol management rate by 3% in one year. With the action plan in place, Community Alliance is set to work on implementing the dashboard.

Intervention-Dashboard Development and Implementation
Community Alliance’s team met frequently with an IT staff member and identified metrics (e.g., lab numbers, client demographic info, smoking status, and risk categorization) to display in the cholesterol dashboard. The team also had discussions to define each metric (e.g., diagnosis codes, lab numbers for risk categories). The dashboard began as an Excel file. Over time, the team built the dashboard into the electronic health record (EHR) system, SmartCare, using a Microsoft add-on, Power BI. The Microsoft Power BI software uses data from the EHR to display graphs and tables. The graphs and tables allow users to select, analyze, and visualize one or more key metrics quickly and easily. The final dashboard allows users to filter and sort client records by diagnosis of hyperlipidemia, by low-density lipoprotein (LDL) lab results, by date of last clinic visit, smoking status, prescriptions, or a combination of these measures. The dashboard’s visual data points allow the primary care provider, nurse care coordinator, and medical assistant clinical team to have quick, easy access to client information and risk levels. They use the information to formulate a comprehensive care plan for each client.

Barriers/Challenges
Community Alliance staff dedicated significant time to developing and implementing the cholesterol dashboard. They met frequently to research dashboard-building technology, define and redefine metrics, and pilot the dashboard. Once they developed the dashboard, they dedicated time to planning how the dashboard would fit into the clinic’s workflow and to training staff in using the dashboard. Community Alliance provides dashboard training to each new clinical team member.

Results
Six months after implementing the dashboard, Community Alliance reviewed client data on high cholesterol diagnoses and observed an improvement in management rates. In this period, the clinic achieved an 8% increase in its high cholesterol management rate. This surpassed the twelve-month goal of 3%. Community Alliance began building dashboards for additional chronic conditions such as hypertension, obesity, diabetes, and comorbidities. The clinic’s dashboard and use of the dashboard information is an exemplar for how physicians use a clinical decision-making tool to improve client outcomes. Community Alliance intends to continue using and improving its dashboards to identify care gaps and inform clinical decisions.

This publication was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,897,290 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. Government.

Help is Within Reach

Community Alliance offers a full range of integrated health services, including primary and psychiatric care, mental health and substance use counseling, rehabilitation and employment services, supportive housing, community, family and peer support, and more.