About Project

Objective:

To measurably improve clinical outcomes through enhancing the practice of patient-centered, evidence-based medicine.

Since 2007, The Right Care Initiative’s goal has been to apply scientific evidence and outcomes improvement strategies to reduce patient morbidity and mortality through a collaborative focus on achieving quality goals where performance metrics indicate that evidence-based, life-saving practices are not fully deployed. Data from the Integrated Health Care Association, the National Committee For Quality Assurance, the federal Agency for Health Care Quality and Research, the Commonwealth Foundation, CMS, and the Centers for Disease Control indicate two trouble spots where evidence-based patient management and clinical quality improvement will significantly enhance and save lives while preventing disability: cardiovascular disease, with particular emphasis on hypertension and lipid control; and diabetes, focused on heart attack and stroke prevention.

Our Demonstration Goals

• Heart attack and stroke prevention focused on heart disease, hypertension and diabetes patients through lipid, blood pressure, and blood sugar management.
• Support for medical, pharmacy and quality improvement directors via “University of Best Practices” colloquia.

California Statewide Goals – Achieve 90th Percentile for Cardiovascular Disease and Diabetes; National Healthcare Effectiveness Data and Information Set (HEDIS) 80% of hypertensive patients with blood pressure (BP) controlled: <140/90 mm Hg (Optimally <130/80 mm Hg per 2017 American College of Cardiology Guidelines, endorsed by ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA) 80% of diabetic patients with blood sugar controlled: Hemoglobin A1c<8 80% of patients with diabetes and/or cardiovascular conditions on appropriate cholesterol therapy (proxy, LDL controlled: LDL-C<100mg/dL or for very high risk ASCVD, LDL-C<70mg/dL or lower) Proactive Community Outreach to Screen & Identify Vulnerable Patients to Connect to Treatment & Support

Project Inspiration

California Department of Public Health (CDPH) estimates Californians suffer approximately 72,000 deaths from cardiovascular disease (including heart attack and stroke) and 8,000 deaths from diabetes each year, many of them preventable according to CDC. NCQA conservatively estimates that improving California’s cardiovascular disease and diabetes measures to the national HEDIS 90th percentile could save 1,694 to 2,818 lives each year, while avoiding $118 million in yearly hospital costs, 766,401 sick days and $125.56 million in lost productivity.

Heart disease, hypertension and diabetes are increasingly well understood scientifically, and ripe for best practices collaboration.  Over the course of this project, California has outpaced the nation in improving health system performance on control of blood pressure, cholesterol and blood sugar, building on the “100,000 Lives” campaign for reducing medical errors and the Million Hearts™ national initiative launched in 2011.  

Key Partners

Implementation Action and Goals

The Right Care Initiative, operated by the UC Berkeley School of Public Health, was publicly launched with encouragement from the Department of Manged Healthcare, NCQA and the Deans of UC Berkeley and UCLA Schools of Public Health in March 2008 at the 1st annual Clinical Quality Improvement Leadership Summit. Since then, more than a dozen Right Care summits have been held around the state. Each Right Care gathering is a collaborative effort to close the gap between science and practice to improve patient outcomes among medical, pharmacy and quality improvement directors, as well as thought leaders in evidence-based medicine.

Thanks to an NIH GO grant (2009-July 2012), the Right Care Initiative received a special opportunity to launch a community-focused effort to reach the Right Care Initiative goals of preventing heart attacks, strokes and diabetic complications and piloted the first University of Best Practices in San Diego. Since then, a Right Care University of Best Practices has been launched in three additional metro areas: Sacramento in 2012, Los Angeles in 2013 and Santa Clara in 2018. Each University of Best Practices is comprised of the major delivery systems of the region, including medical groups, health plans, community clinics, the V.A., Navy, and Air Force along with subject matter experts.

Research Questions

• What are the most promising interventions for quickly bringing patients into safe control?
• What barriers are preventing improvement, and what are the best strategies for overcoming them?
• What are the best strategies for California to expedite a focused re-engineering effort to refine the implementation of evidence-based medicine to quickly meet these goals that are estimated to save thousands of lives annually?
• What strategies are needed to improve clinical outcomes in light of health disparities in California’s diverse population?

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Last Revised: 8/5/19