Council on Health Care Quality and Population Health December 11, 2014

Transcription

1 DRAFT TOPIC SPEAKER PURPOSE/DISCUSSION ACTION/CONCLUSION General Administrative Call to Order Ms. Dayal Attendance taken and the meeting was called to order at 1:04 pm Council Members Present: Doctors Anderson, Colmenares, Ehrenthal, Hoffmann, Jones- Nosacek, Lee, Morris (part), Remington; Ms. Dayal and Mr. Jacoby. Non-voting Observers: Drs. Flood, McAvoy, Wagner; Mr. Brokopp. Staff: Mses. Coleman, Krueger; Mr. Rather, Nelson (part). Approval of Minutes Ms. Dayal Review, amend, approve minutes of September 18, The minutes were amended striking the second paragraph regarding 2014 Resolution 207: Unproven Mind-Body Treatments. Discussion occurred regarding alternative treatments and how they are paid for. It was suggested that insurance companies will determine what practices are used. It was noted that some long term practices such as acupuncture are used as a first effort instead of more invasive procedures. However, in most cases evidence based practices should be used unless the patient gives informed consent. Consensus was the first and third paragraphs adequately described the discussion and subsequent motion to not adopt. Health Care Quality and Population Health Lifecourse Presentation Dr. Ehrenthal Dr. Remington introduced Dr. Ehrenthal as a new member of the Council, mentioning her distinguished career and current position as Director of the Lifecourse Initiative for Healthy Families at the University of Wisconsin Department of Population Health Sciences. Dr. Ehrenthal presented a detailed report on the Lifecourse model as it relates to Infant Mortality. carried, the minutes were approved as amended, deleting a paragraph under 2014 Resolution 207: Unproven Mind-Body Treatments. as follows: Discussion occurred regarding alternative treatments and how they are paid for. It was suggested that insurance companies will determine what practices are used. It was noted that some long term practices such as acupuncture are used as a first effort instead of more invasive procedures. However, in most cases evidence based practices should be used unless the patient gives informed consent. Infant Mortality Policy Discussion Dr. Remington Reports The Council considered a policy on Infant Health and Wellness in Wisconsin. A copy of the policy with possible revisions was distributed at the meeting, and approved as follows: Upon motion, seconded, carried, the Council approved the policy as distributed: deleting the impact of in the first section, second 1

2 Infant Health and Wellness in Wisconsin The Wisconsin Medical Society (Society) recognizes the severity and significance of high infant mortality rates in the state and is concerned by the racial and socioeconomic disparities of infant and stillborn deaths and preterm birth rates. To address these issues, the Society supports reducing Wisconsin s infant mortality rate and improving birth outcomes via these strategies: bullet and adding and access to contraceptives at the end of the second bullet in the last section. Increase health equity and reduce disparities of birth outcomes through improving the social, economic, educational, and environmental determinants of health. The Society supports: Targeting social determinants of health through investments in high-risk, underresourced areas that emphasize the reduction of poverty on families during childbearing years. Addressing racial disparities by supporting culturally appropriate infant mortality programs and policies, focusing on Wisconsin s specific racial and ethnic composition. Adding a health equity perspective to approaching programs and policies that support healthier birth outcomes. Improve data collection and quality surveillance systems associated with birth outcomes measurement. The Society supports: Improving timely and accurate reporting of existing data collection programs and better facilitate the translation of real-time data. Prioritizing research into the causes and prevention of infant mortality and poor birth outcomes, including biological mechanisms, through local, state, and national agencies and organizations. Building interagency, public-private, and multi-disciplinary collaboration at the national, state, community, family, and individual levels with organizations surveying infant mortality, women s health, family health, and lifecourse wellbeing. Improving and build upon existing evidence-based quality measures for health care professionals. Improve the health of women across the lifespan. The Society encourages applying a lifecourse perspective to conceptualize birth outcomes as a product of the entire life of the mother in addition to the pregnancy. The Society supports: Encouraging lifecourse well-being at every age and every life stage, including pre-, inter-, and post-partum, through routine discussions between physician or health care professionals and patient that include: 2

3 o Risk factors leading to poor birth outcomes including STIs, tobacco and marijuana use, substance abuse, chronic conditions (such as diabetes, hypertension, and infection), domestic violence, and mental health. o The importance of identifying, screening, and monitoring women with pre-existing, high-risk medical conditions including previous preterm birth, mental health issues, and chronic diseases. o The maintenance of healthy weight, exercise, and nutrition throughout the lifespan. o Culturally competent care. Advocating for aligning pay structures and incentives that reward physicians and health care systems for lifecourse perspective care delivery. Advocating for improvements in the health system that allows physicians to provide high quality, continuous, patient-centered comprehensive care. Reducing the women s health care professional shortage and increase access to care by promoting collaborative practice. Support evidence-based preventive interventions at the community level to improve birth outcomes. The Society supports: Developing new and maintain already successful culturally appropriate health promotion and social marketing campaigns that encourage family planning, safe sleep, smoking cessation, seat belt use, and other infant mortality prevention interventions. Improving comprehensive and preventive reproductive health care for men and women of reproductive age through promoting education and use of family planning, including pregnancy preparedness, and optimal inter-pregnancy intervals, and access to contraceptives. Supporting active engagement of fathers across the lifespan. Advocating for programs and policies that are known to improve infant mortality rates and birth outcomes. The Council expressed possible interest in adding measures to the policy similar to the red, yellow, green process introduced by Karen Timberlake. It was mentioned that perhaps Karen Timberlake could be invited to an upcoming meeting of this Council to discuss process measures. Tobacco Policy Reorganization Ms. Dayal Ms. Dayal and Dr. Remington explained their work with Society staff to re-work existing Society tobacco policy into one comprehensive policy. The Council approved deleting policies SMK-001 and SMK-003, amending SMK-002 to read as listed below. The Council also reaffirmed SMK-005. carried, the Council approved the deletion of policies SMK-00l and SMK-003; the amended SMK-002 (as listed in the minutes); and reaffirmed SMK

4 SMK-002 Smoking and Tobacco: The Wisconsin Medical Society, recognizing the clear, scientific documentation of the threat that the use evidence of adverse effects of that tobacco use, addiction, and smoking poses to has on the health of Wisconsin residents, tobacco users and non-users alike, supports: Regulating tobacco products by the Food and Drug Administration under similar provisions and statutes as alcohol products. Recognition that tobacco products are have addictive drugs properties. Promotion of totally smoke-free indoor environments, including all businesses, all educational establishments, workplaces, and all places where the public may gather. Disclosure of tobacco ingredients and placement of appropriate injurious to health messages on the smokeless tobacco product packageing to enlighten society to the true dangers of tobacco. Outright ban on Banning of tobacco advertising. Restricting sales of tobacco products to minors and increasing the enforcement of punitive measures of such sales. Assessing, as a component of every new-patient examination, all patients for risk of tobacco-related illness during patient visits, regardless of whether a patient currently uses, formerly used or never used tobacco products. (HOD, 0410) Improving access to and availability of smoking cessation programs. Increasing the The Wisconsin cigarette excise tax to reduce consumption and to useing the funds generated to support a statewide comprehensive tobacco control program. SMK-003 Smoke Free Wisconsin: The Wisconsin Medical Society continues to support legislation for a smoke free Wisconsin, that includes all public and work places including provisions for support of smoking cessation programs, a legislative priority for the Society until such legislation is passed. (HOD, 0412) SMK-001 Promote Smoke-Free Workplaces: Based on evidence on the harmful effects of second-hand smoke, the Wisconsin Medical Society supports legislation promoting a smoke-free workplace. (HOD, 0410) SMK-005 Electronic Cigarettes and other Electronic Nicotine Delivery Devices: The Wisconsin Medical Society supports the classification of electronic cigarettes (ecigarettes) and other electronic nicotine delivery devices (ENDDs) as tobacco products and drug delivery devices and support that they be regulated by the U.S. Food and Drug Administration. Without substantial research and analyses of these devices regarding their safety and potential effectiveness as a smoking cessation tool, the effects of secondhand vapor exposure, and the impacts of the ingredients from such devices on the 4

5 body, the Society supports the inclusion of e-cigarettes in smoke-free and tobacco-free policies and that they not be approved for use in public places or for sale to or use by persons under age 18. (BOD, 0614) Five Year Policy Reviews Ms. Dayal The Council approved VIO-008 as amended below: VIO-008 Domestic Violence of Adults: The Wisconsin Medical Society believes it is the obligation of physicians andor their teams to: 1. Privately identify and screen patients for potential domestic abuse violence 2. Respond appropriately to abuse disclosures reporting in accordance to Wisconsin law 3. Assess safety issues 4. Appropriately address clinical effects of abuse violence in their patients 5. Refer patients to appropriate community and health care provider services 6. Carefully and discretely document disclosures in the patient s medical record carried, VIO-088 was approved as amended (as listed in minutes). carried, the Council approved the amendments to AID-007 (as listed in minutes) and reassignment into the Public Health section of the Society s policy compendium. The Society acknowledges the significant long term health consequences of domestic violence including death and injury to patients. Wisconsin physicians recognize the prevalence of domestic violence and acknowledge that it is a significant cause of death and injuries that has long term health consequences for their patients. It is therefore of the utmost importance important that for Wisconsin physicians to assess patients for signs or effects of domestic violence where indicated or appropriate. this abuse. In treating adult patients who are possible victims of domestic violence, the goal of intervention must be to help victims regain control of their lives. Because The Society also recognizes Research confirms that reporting to law enforcement, without the victim s consent, can may potentially further endanger the patient or others victims. Wisconsin law places obligations and restrictions on whether and when a physician can or must report incidences of or injuries caused by domestic violence to law enforcement. It is therefore vital that physicians become informed of their legal obligations and limitations on reporting incidences of or injuries caused by domestic violence. To the extent allowed by law, physicians should pay great respect the to a patient s right not to disclose domestic abuse or to refuse intervention when the patient believes such action is not in his or her best interest. The role of the physician in this process is to offer patients options and allow them to make the decisions in their lives. The patient s decision should be documented in the medical record. Physicians should ensure that all such assessments, conversations and decisions are documented in the patient s medical health record. Under Wisconsin law, physicians are required to report certain crimes and abuses that 5

6 may or may not be the result of domestic violence. Wisconsin law requires that physicians report to law enforcement gunshot wounds or any other wound or serious burns (greater than 5% of body affected) that are believed to have occurred as a result of a crime. In addition, abuse of children, and abuse of adults at risk and elder adults at risk in certain circumstances, requires reporting to appropriate county agencies. As of March 2008, there is no Wisconsin law mandating reporting, specifically for domestic violence of adults, including elders. (HOD, 0409 Staff explained the recommended amendments which broaden the scope of AID-007. The Council approved the policy as amended: AID-007 PUB- Testing of Foster Children for HIV Communicable Disease: The Wisconsin Medical Society supports legislation that would allow physicians and/or legal guardians of foster children to test them for communicable diseases including HIV. and inform foster parents of the complete health status of children placed in their care. (HOD, 0409) Public Health Preparedness Ms. Dayal The Council considered EPP-002 Emergency Preparedness. A motion was made to amend the policy and after discussion, the motion was withdrawn. The Council requested experts be consulted for appropriate, accurate wording when referring to health emergency preparedness with a report back to the Council. Wisconsin State & County Bacteria/Virus Resistance & Sensitivity Register Dr. Terry Neff Dr. Terry Neff was present to discuss his proposal for the establishment of an online registry of bacterial and viral sensitivity/resistance with pooled data from hospitals and clinics that would document patterns across county and state lines. The Council discussed the many types of information currently available via a computer app from Epocrates, the CDC, local and state health departments, etc. The Council thanked Dr. Neff, noting that the Society did not currently have a policy section on communicable diseases or a policy on the sharing of antibacterial resistant disease information by Wisconsin health systems, but will look into developing a policy on the subject. Reports Government Relations Report Mr. Rasch Mr. Rasch explained recent federal legislative activities which included no movement of SGR. He further explained the Society has reached out to Cong. Ryan for assistance with SGR and Medicare data legislation. Mr. Rasch reported state legislative work on Workers Compensation will continue into Mr. Rasch encouraged Council members to attend the Society s Doctor Day is March 11, 2015 at the Monona Terrace. 6

7 Council Updates Ms. Coleman Ms. Coleman updated the Council on the recent work of the Society s Strategic Councils. A written report was included with the agenda packet as Exhibit H. Other Business Old Business Ms. Dayal There were no items of old business. New Business Dr. Oliver Dr. Oliver was invited by the Council Chair to discuss the UW Capstone Certificate in Leadership for Population Health Improvement. Adjournment The next meeting is scheduled for February 19, carried, the meeting adjourned at 4:02 p.m. 7