Choosing Our Direction for 2019

Every year we have the chance to step back, look at our work, and choose our topics for the next year. We would also love to hear input from our community about our new direction. Typically we follow a two-step process, having a wide-ranging discussion at the end of which we narrow down our choices. At the May Bree Collaborative meeting we decided to move forward with two topics and continue the discussion at our July meeting. Our two selected topics are to:

• – Continue our opioid prescribing workgroup with a new focus on screening and management of patients on high-dose opioids. See our workgroup here.
• – Develop a new workgroup in response to the request from our Legislature to “identify best practices for mental health services regarding patient mental health treatment and patient management [including] best practices on patient confidentiality, discharging patients, treating patients with homicide ideation and suicide ideation, record-keeping to decrease variation in practice patterns in these areas, and other areas…” This last area builds on our work to develop standards around suicide care and our earlier work to integrate behavioral health into primary care. You can read a study that the UW did around these issues here.

We will be selecting our other topics at the July 17^th Bree Collaborative meeting, three from the list below coming out of the May conversation:

• – A maternity bundled payment model
  • * This will include many issues related to maternity care including long-acting reversible contraceptives; managing opioid, alcohol, and tobacco use; prenatal care, and others. We have been following the increasing coverage of inequities in maternity outcomes – see articles from the New York Times here and from Vox here. In our advanced country it should not be the case that black mothers are three to four times more likely to die in childbirth than white mothers.
• – Adapting the total joint bundle to outpatient sites
  • * Our bundled payment models have been directed toward hospital or inpatient care. The Centers for Medicare and Medicaid Services recently removed total knee replacement from only being for inpatient settings. Here we would adapt our 2017 total joint replacement bundle and warranty to an outpatient setting.
• – Palliative care
  • We have included palliative care in our oncology recommendations and touched on the topic in our end-of-life care recommendations. Here we would expand on that earlier work to develop standards around palliative care in general. You can read more about palliative care from the World Health Organization here.
• – Shared decision making
  • * Incorporating shared decision making using a patient decision aid when possible has been one of our priorities across many of our topics. You can see this incorporated into our bundled payment models, into recommendations around maternity and end-of-life care, and many others. The Health Care Authority also certifies patient decision aids. Here we would focus on disseminating shared decision making in clinical practice and best practices across topics.
• – Eye imaging
  • * The Washington Health Alliance found $282 million to be spent on “wasteful” health care in their February 2018 report First, Do No Harm: Calculating Health Care Waste in Washington State. 11 measures were found to make up 93% of the low-value services including unnecessary imaging for eye disease.

Do you have personal experience with any of these topics? Let us know at bree@qualityhealth.org

Ginny Weir, MPH
Program Director, Bree Collaborative