Title of Outcome Improvement Project: IT-11
Title of outcome Improvement Project: IT-11.1 Improvement in Clinical Indicator in identified disparity group
Unique RHP outcome identification number: 84597603.3.5
RHP Performing Provider: TEXAS TECH HS CTR FAMILY MED
Outcome Measures Description:
IT-11.1 Improvement in Clinical Indicator in identified disparity group: Reduction in the re-occurrence rate of seizures in Hispanic patients with Epilepsy.
Process Milestones:
DY2
- P-1 Project planning - engage stakeholders, identify current capacity and needed resources, determine timelines and document implementation plans
DY3:
- P-3 Develop and test data systems to capture baseline rates
- P-2 Establish baseline rates
Improvement Milestones:
DY4:TBD
DY5:TBD
Rationale:
The management of epilepsy in Hispanics presents unique challenges. Accessing care for this population is difficult[i] for a variety of reasons to such an extent that the Institute of Medicine has noted the “unequal treatment” minorities are challenged with accessing care[ii]. Within the Hispanic community, there is considerable misinformation on this condition[iii]. For example, Hispanics are nearly 8 times more likely to believe that a patient with epilepsy cannot hold a steady job or will die at a younger age than non-Hispanics. Eight percent of Hispanics in this study believed epilepsy was contagious or related to some kind of evil spirit or sins.
Given these disparities, a multi-disciplinary approach to the care of these patients is critical. We propose to use a measure of the reoccurrences, or break through seizures in Hispanic patients as a clinical outcome indicator. We will be working with providers and others involved in the care of these patients over DY2-3 to develop an appropriate definition for this metric, and to propose reasonable improvement metrics.
Valuation: The Performing Provider considered a series of factors in establishing a valuation for each project. These included the amount of human resources required to meet the milestones of the project, through new hires as well as the assignment of existing support personnel such as Information Technology, EMR and administrative support. We considered what non personnel resources would be required, such as equipment specialized for a certain specialty, and what, if any, additional space would be required to house the initiative. We considered timing issues related to when we had to add resources compared to when a corresponding milestone could be achieved. We also considered the amounts of potential professional fee revenues the project may generate, and offset these against resource demands.
We made a risk assessment for each project, considering the complexity, the scope, the extent to which any single point failure in the milestones would jeopardize downstream success, the degree of inter-dependence on other projects within the waiver program as well as institutional initiatives outside the waiver, and the amount of time required to manage the project. We made an assessment of potential general community benefit.
Finally, we considered organizational priorities, and to what extent the Performing Provider was able to justify partial support of these efforts as meeting existing institutional requirements or objectives.
[i] Grisolia JS. Epilepsy of the borderlands: seizure disorders in US Latinos. Epilepsy Behav 2000;1:150–2.
[ii] Smedley BD, Stith AY, Nelson AR, editors, for the Institute of Medicine (IOM). Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington DC: National Academy Press; 2003.
[iii] Sirven J, et al; Que es la Epilepsia? Attitudes and knowledge of epilepsy by Spanish speaking adults in the United States. Epilepsy Behav 2005;7:259-65. .