Reducing Inequities and Building Trust: QI Outreach

UC Davis Health has traditionally provided primary and specialty care through academic clinics but, in the last few years, they aimed to increase partnership and trust across academic, community, and county clinics in the region to raise all boats in outpatient quality improvement and access. New leadership across the various settings, therefore, began to re-engage in partnership and build trust with a shared goal of reducing disparities and sharing trainings, tools, and resources.

The initiative involves:

• Regular leadership engagement to discuss disparities among over 30 quality metrics across three settings (community, academic, FQHCs);
• Learning collaborative that focuses on approaches to address quality improvement and to gain advice;
• Consult team of quality improvement, data, and equity experts to provide advising and adapted best practices for staff leading initiatives; and
• Shared resources for county clinics that lack resources for data analytics and centralized patient outreach.

A subgroup also was developed to incorporate input in development of a new prospective risk model to identify patients at high risk of hospitalization in the future 12 months. This risk model is used by care managers to proactively reach out to patients. This group focuses on understanding the history of bias in predictive risk models especially among underrepresented communities, engaging communities in the development, and training staff to use risk models to reduce bias.

The practice relies on:

• Actively utilizing community needs to guide priorities and resource allocation.
• Following the Toolkit to Advance Racial Health Equity in Primary Care Improvement by the California Improvement Network.
• Breaking down silos between practice leaders across community, academic, county, and public health to engage about outpatient quality with humility and a growth mindset.
• Engaging leadership who are willing to work together for the community and go beyond shared learning to sharing resources.

In the last few years, UC Davis Health has aimed to increase partnerships and trust between their academic, community, county, and public health entities. Their shared goal is to improve quality performance and access across all practice types. These clinics serve patients who are most often admitted to the hospital. Historically, there has been differences in resources and patient complexity as well as siloed quality improvement efforts leaving clinics on their own to create new workflows.

The practice had goals to develop shared leadership goals, openly discuss barriers, and offer shared resources to work jointly. Data analytics were shared across practice settings, shared priorities determined, and centralized staff are doing outreach to patients across practice types.

Having diverse input in the development of the risk model has helped to guide the understanding of potential bias directed at historically underrepresented communities and identification of patient communication strategies for proactive and culturally inclusive care management outreach.

We believe trust is improving as evidenced by the growing partnership between leaders who previously had not, and work together in a shared mission for the larger community.