Welcome!Your name + organization

Please type in the chat box:

February 12, 2019

Holly Howard, MPH Director, National Quality Improvement Center

Improving Chlamydia Screening Among Adolescents in Primary Care e-Learning Collaborative (CT eLC)

Clinical Support CoordinatorInformational Webinar

Today’s Objectives

• Discuss the background/history of the CT eLC

• Describe CT eLC key components, timeline

• Describe Clinical Support Coordinator/Team (CSC/CST) roles, responsibilities, timeline

• Describe next steps for applying to be a CSC/CST

• Q & A

Welcome + Introductions: The NQIC eLC Leadership Team

Welcome!Your name + organization

Any questions you have during the webinar

Please type in the chat box:

Holly Howard, MPHNQIC Director

The National Quality Improvement Center (NQIC)

*Vacant*NQIC Programs &

Training Coordinator

Jennifer Harmon, MPHData Lead + Project

Development/Evaluation

Laura Kovaleski, MPHCSC Coach + Project

Development/Evaluation

Melissa Reyna, MPHClinical Support

Coordinator, in-kind support from CA DPH

Population Health Improvement Partners (IP)

Meredith CarrollCT eLC QI Coach &

Program Support Coordinator

Amanda Cornett, MPHSenior Program Director, IP

CT eLC Lead QI Coach

The National Quality Improvement Center (NQIC)Our ChargeThe NNPTC NQIC is funded by CDC to build clinical quality improvement capacity among STD Prevention Training Centers, state and city STD programs, and their clinical partners nationwide in order to improve CDC-recommended STD screening, diagnosis, and treatment.

Our ApproachTeach the basics of Lean + Model for Improvement QI Methods

Identify indicators to measure improvements

Observe STD care delivery processes and identify opportunities for improvement

Partner with clinical practices to test + sustain improvements

Background + History: The CT eLC

CT eLC Project Overviewo A collaboration between NQIC and IP, and funded by CDC DSTDP

o Designed to support primary care practices in increasing chlamydia screening rates, with an emphasis on adolescent patients (ages 12-21 years)

o Accomplished by sharing adolescent sexual health + STD clinical care best practices and through the provision of technical assistance (TA) and coaching to participating primary care practices

o Sites implement best practices using QI methods + tools

o All training and support provided virtually

Practice Participation IncentivesFREE Credits for eLC Participants*

• In partnership with:

• The American Academy of Pediatrics (AAP)

• The American Board of Family Medicine (ABFM)

Maintenance of Certification Part 4

Program Improvement CMEs

* Applications pending for practices outside of CA

CT eLC Project Aim StatementAchieve >10% improvement within each of the following areas:

% of adolescents with an assessment of sexual activity documented within past 12 months

% of sexually active adolescents screened for chlamydia within past 12 months

Knowledge, activities, comfort, confidence of providers + staff related to adolescent sexual health and chlamydia screening best practices 

Knowledge, confidence of providers + staff in using QI methodologies + tools

Each practice identifies a QI Team to implement ProjectLeadership Champion

Primary Contact

Clinician Champion

Data Lead

Other Team Members

4 core categories of best practice interventions critical to improving adolescent chlamydia screening rates

Sexual ActivityAssessment

Chlamydia Screening

Welcoming Environment

Minor Consent & Confidentiality

Project Intervention: Monthly CT eLC Webinars + Practice QI Team Action

4 CT eLC Informational Webinars

Offer ideas for How To Implement

Disseminate webinar summary highlights to all staff

Brainstorm practice change ideas + solicit ideas from staff

Teach best practices + national recommendations

Practice QI Team

• Sexual activity assessment• Chlamydia screening• Consent + Confidentiality• Welcoming environment

Facilitate peer‐to‐peer practice discussion/TA

Implement PDSA cycles to test change ideas

The CT eLC - Cohort 1 The California Pilot

Sept 2018-Mar 2019

• Located in 7 local health jurisdictions across CA

• Variety of practice types: private pediatric practices, FQHCs, community health centers, school-based health centers

• 2 sites trained medical residents

• All sites provided care to >40 adolescents/month

• Wide range of experience with QI methods

The Pilot CT eLC:7 Practice Sites in California (Cohort 1)

45%

90%84%

90%95%

0%

25%

50%

75%

100%

Baseline October November December January

30% sexually active

48% sexually active

36% sexually active

52% sexually active

California preliminary results:Documentation of a sexual activity assessment (7 practices)

Median percent identified as

sexually active

Median sexual activity assessment rate

with ranges

38% sexually active

81%

70%

91%97% 98%

0%

25%

50%

75%

100%

Baseline October November December January

*1 practice is excluded from the chlamydia screening rate median because they were not able to identify more than 1 sexually active patient who was eligible for chlamydia screening in any given reporting period.

California preliminary results:Annual Chlamydia Screening Rate (6 practices*)

45% sexual activity

assessment rate

90% sexual activity

assessment rate

84% sexual activity

assessment rate

90% sexual activity

assessment rate

95% sexual activity

assessment rate

Median sexual activity assessment rate

Median chlamydia screening rate

among sexually active patients

The CT eLC - Cohort 2 Expansion to New States

CT eLC – Cohort 2: Expansion Goals

• Continue in CA + expand to 2 new states = 3 states

• Add up to 4 new PCHD-funded state or city project areas within the 3 participating states = 5 project areas

• Enroll 3-5 practices from within each participating project area = 15-20 practices

CT eLC Structure

NQIC

CSC CSC

P P

P P

P

NQIC will:• Lead + facilitate the eLearning Collaborative for all practices• Create all data + tracking systems; analyze all practice metric data• Provide training + coaching to CSCs/CSTs

Clinical Support Coordinators/Teams will:• Serve as liaisons between their local practices and NQIC• Provide monthly subject matter coaching to their practices

Primary Care Practices will:• Attend monthly webinar trainings• Use QI methods to test/implement practice changes • Gather + submit monthly practice data

P P

P P

P

The CT eLC Project Timeline

Phase 1 | late Apr. – Aug. 2019 | CSC training + practice enrollment

Apr‐May: CSC orientation + training 

Jun‐Aug: Project promotion + practice enrollment

Phase 2 | Sept. 2019 – Mar. 2020 | Active CT eLC QI project period

late Apr. - Aug. 2019 Sept. 2019 - Mar. 2020

Phase 1 Phase 2

CSC Responsibilities Phase 1

With robust support from the NQIC, each CSC will:

Receive an orientation from NQIC on the CT eLC curriculum, data systems, practice requirements, and tools to plan for eLC implementation in their project areas

Receive training on using QI methods and providing subject-matter coaching to clinical practices

Lead recruitment efforts for practices in their area by: (1) promoting the CT eLC to local healthcare stakeholders, (2) reviewing practice applications, and (3) selecting 3-5 practices for eLC participation

PLAN

NING

late Apr. - Aug. 2019 Sept. 2019 - Mar. 2020Phase 1 Phase 2

CSC Responsibilities Phase 2

With robust support, templates, and tools from the NQIC, each CSC will:

Serve as the primary communications point-person for their practices, including: (1) liaising between practices and NQIC, (2) disseminating project information, and (3) triaging clinical practice questions

Schedule and facilitate two touch-point calls with each of their practices: (1) an introductory call, and (2) a mid-project milestone call

Monitor practice + provider progress towards achieving Medical Board Maintenance of Certification (MOC) and Performance Improvement Continuing Medical Education (CME) credits

PROJ

ECT C

OORD

INAT

ION

late Apr. - Aug. 2019 Sept. 2019 - Mar. 2020Phase 1 Phase 2

CSC Responsibilities Phase 2

With support, templates, and tools from the NQIC, each CSC will:

Ensure accuracy and timeliness of data submissions, including: (1) answering questions from practices, (2) sending reminders about upcoming data deadlines, and (3) clarifying data errors

Draft tailored coaching notes for each practice, based on data submitted, as part of monthly progress reportsDA

TA SU

PPOR

T +

COAC

HING

late Apr. - Aug. 2019 Sept. 2019 - Mar. 2020Phase 1 Phase 2

Monthly Practice-Specific Progress Reports(x4 months)

Progress on Data Measures:

• Run charts based on small samples of charts abstracted by the practice and entered monthly online;

• Summary of recent PDSAs tested by practice, based on monthly logs submitted

• Progress Report templates with each practice’s data entered will be supplied by NQIC to CSCs monthly

Monthly Practice-Specific Progress Reports(x4 months)

Tailored Coaching Notes:

• Informed by data submitted, PDSA logs, practice inventory survey, any calls with the practice’s QI team, etc.

• NQIC will providing “coaching of the coaches”, and a compendium of sample notes by topic

Monthly Practice-Specific Progress Reports(x4 months)

Progress on Practice and

Individual Project Requirements:

• Webinar attendance

• Coaching calls

• Data submissions

• PDSA cycles

• Meaningful participation

The CT eLC Estimated Time Commitment

Phase 1 | late Apr. – Aug. 2019 | CSC training + practice enrollment

~4 hours/monthPhase 2 | Sept. 2019 – Mar. 2020 | Active CT eLC QI project period

~6‐12 hours/month

late Apr. - Aug. 2019 Sept. 2019 - Mar. 2020

Phase 1 Phase 2

NQIC Website:www.californiaptc.com/nqic

CT eLC ProjectWebpage

CT eLC ProjectWebpage

NQIC Website:

CT eLC Project Pagewww.californiaptc.com/eLC

The CSC Application Process

The CSC Application is now Open!

http://bit.ly/ClinicalSupportApplication

CS Coordinator or Team?

• While an individual Clinical Support Coordinator is welcome to apply to support their project area, there are many benefits to applying as a Team:• Shared responsibilities and time investment:

• Divide and conquer specific roles (communications, data tracking, clinical coaching)• Divvy up practice support

• Collective subject matter expertise, unique perspectives, strengths• Professional development opportunity for multiple people• Contingency plan in case of staff turn-over, emergencies – safety net for practices

Strategies for Identifying CST Partners

Reach out to possible partner organizations in your jurisdiction to inquire about their interest in joining a CST for this project in your area:

Your NNPTC regional Prevention Training Center (PTCs)

Other PCHD-funded STD programs within your state

Other potential partners: County health departments within your state, regardless of direct CDC funding

Your state’s Title X grantee organization

You local American Academy of Pediatrics or Society for Adolescent Health & Medicine chapters, state primary care association, or other healthcare stakeholders

CSC Application Overview – Due March 5 Indicate CSC or CST Designate the PCHD-funded state or city (or combination): area of focus Provide CSC or CST member name(s), organization, contact info, supervisor

• Note: the CSC, or Primary Contact of CST, must be from a PCHD-funded STD program or a PTC

Tell us briefly:• Why your project area is a great fit for this project• Why you/your team is interested in applying• What existing relationships you have with your local healthcare sector

Rank you/your team’s collective experience in QI, ASH, project mgmt Agree to the responsibilities of the CSC/CST role Upload: Supervisor Letter(s) of Support w/signature(s)

Important CSC/CST Important Deadlines

March 5 | Submission deadline for CSC applications

March 22 | CSC applicants notified about participation acceptance

Benefits of STD Program/PTC Participation in the CT eLC

• Will align with STD PCHD requirements• Will support local providers in improving adolescent sexual healthcare and

chlamydia screening • Will build QI knowledge and expertise in providing tailored TA to clinical

partners to support the implementation of best practices• Will foster skills applicable to other aspects of professional life: project

management, change management, communications with stakeholders, using data to drive program

• Will bolster relationships with stakeholders, PTC-STD program partnerships

“Knowing is not enough; we must apply.Willing is not enough; we must do.”

—Goethe

Epigraph to the 2012 IOM 2012 CDC/HRSA-commissioned report:

“Primary Care and Public Health:

Exploring Integration to Improve Population Health”

Icons: The Noun Project

Questions?

Thank you!Additional Questions?

CONNECT WITH US @: stdqi@cdph.ca.gov