Today HealthLandscape
is releasing the Geospatial Brief, “Where are “Bright Spots” for AppropriateDiabetes Preventive Care?” Using appropriate Diabetes preventive care as a case
study, Brief #3 provides an example of how geospatial methods can be used to
identify high-performing (“bright spot”) regions. This blog reviews “bright
spots” approaches that have been previously used in the healthcare field.
A recent Editorial by long-time primary care advocate Thomas
Bodenheimer advocates for finding the “bright spots” in primary care, so that
we can “learn from them, and arrange for the bright spots to illuminate the
dark corners,” (Bodenheimer, 2014). Bodenheimer
and his colleagues at Stanford’s Clinical Excellence and Research Center (CERC)
define “bright spots” as physician groups that are successful at providing high
quality care while keeping healthcare costs low. In-depth study of these
“bright spots” allowed CERC to identify ten features of primary care delivery
associated with higher quality care and lower spending (CERC, 2014). The work
of CERC builds from the positive deviance (PD) approach, which is an
asset-based framework for identifying organizations or individuals that are
successful despite facing more difficult or similar circumstances than others,
determining the features which make them successful, and applying the features
to other organizations or individuals (Pascale et al., 2010). The PD framework has been applied in several
different healthcare settings, including medical homes (Gabbay et al., 2013), hospitals
(Bradley et al., 2009), and local health departments (Klaiman et al., 2014). While
they are not referred to as PD or “bright spot” approaches, the Veterans
Affairs (VA) is also pushing forward with innovative strategies for improving
care for the Veteran population (Elnahal and Littlefield, 2016).
Positive deviance approaches offer great potential in the
healthcare field. By identifying successful strategies for improving care and
reducing costs, we can apply these strategies and target scarce resources to areas
of need. Using appropriate Diabetes preventive
care as a case study, Geospatial Brief #3 details geospatial approaches for identifying
“bright spot” regions. This research builds on the first two HealthLandscape
Geospatial Research Briefs, which explore the relationship between preventive
care, preventable hospitalizations, and spending, and identify priority regions
for improving preventive care (Topmiller, 2016a; Topmiller, 2016b). Future research can use the results of these
geospatial briefs for in-depth study of “bright spot” regions, and then apply
lessons learned to priority regions.
Michael Topmiller
GIS Strategist
HealthLandscape
References
Bodenheimer, Thomas S.,
(2014). Find the" bright spots." Joint Commission journal on
quality and patient safety/Joint Commission Resources, 40(4), pp.147-147.
Bradley, Elizabeth H.,
Leslie A. Curry, Shoba Ramanadhan, Laura Rowe, Ingrid M Nembhard, and Harlan M
Krumholz, 2009. Research in action: using positive deviance to improve quality
of health care. Implementation Science 4:25.
Clinical Excellence
Research Center (CERC), Stanford University, 2014. “America’s Most Valuable
Care: Primary Care.” Clinical Excellence Research Center at Stanford
University, Bright Spots Research.
Elnahal, Shereef, and Patrick Littlefield. “VA Diffision –
spreading and implementing best practices to improve care for our nation’s
Veterans.” (blog, March 2, 2016). Accessed at http://www.blogs.va.gov/VAntage/26205/va-diffusion-spreading-and-implementing-best-practices-to-improve-care-for-our-nations-veterans/.
Gabbay,
Robert A., Mark W. Friedberg, Michelle Miller-Day, Peter F. Cronholm, Alan
Adelman, and Eric C. Schneider, 2013. A Positive Deviance Approach to
Understanding Key Features to Improving Diabetes Care in the Medical Home. Annals of Family Medicine 11(S1):
S99-S107.
Klaiman,
Tamar A., Athena Pantazis, and Betty Bekemeier, 2014. A Method for Identifying
Positive Deviant Local Health Departments in Maternal and Child Health. Frontiers in Public Health Services and
Systems Research 3(2).
Pascale, Richard, Jerry Sternin, and Monique Sternin, 2010. The Power of Positive Deviance: How Unlikely
Innovators Solve the World’s Toughest Problems. Harvard Business Press,
United States of America.
Topmiller,
Michael, 2016a. “Do Regions with More Preventive Care Have Lower Spending and
Fewer Hospitalizations?” HealthLandscape
Geospatial Research Brief #1.
Accessed at http://www.healthlandscape.org/Geospatial-Analysis.cfm
Topmiller,
Michael, 2016b. “Where are “Hot Spots” of Medicare Spending and Preventable
Hospitalizations and “Cold Spots” for Preventive Care?” HealthLandscape Geospatial Research Brief #2.
Accessed at http://www.healthlandscape.org/Geospatial-Analysis.cfm
