Public Health Department Accreditation: Answering the “So What?” Question

CDC’s Role in Advancing Accreditation

November 18, 2014, 10:30 am–12:00 pmAmerican Public Health Association

Annual Meeting New Orleans, Louisiana

Session #4104.0

Centers for Disease Control and Prevention

Office for State, Tribal, Local and Territorial Support

CDC’s Role in Accreditation Support PHAB—partner and funder National partner organizations

Technical assistance, educational resources, and trainings Accreditation Support Initiatives

National Public Health Improvement Initiative (NPHII) and Performance Improvement Managers Network

Establishing incentives—for preparing and for accreditation status

Building connections to CDC-supported areas and funding streams

NPHII: The Program at a Glance

Key objectives: Accelerate public health accreditation readiness

Improve organizational efficiency and effectiveness through quality improvement activities

Increase performance management capacity

Establish a national network of Performance Improvement Managers (PIM Network)

Supported through the Prevention and Public Health Fund of the Affordable Care Actwww.cdc.gov/stltpublichealth/nphii

FY2010: $42.5M to 76 awardees

FY2011: $33.6M to 74 awardees

FY2012: $33.5M to 73 awardees

FY2013: $32.5M to 73 awardees

NPHII Awardees

Completion of PHAB Prerequisites (as of May 2014)

81% of NPHII awardees completed one or more prerequisites (n=59/73)

48% of awardees completed all three prerequisites (n=35/73)

Accreditation Prerequisite

% of Grantees That Have Completed

% of Grantees Currently

Developing

Total %

Health Assessment 71.2% (n=52) 16.4% (n=12) 87.6% (n=64)

Organizational Strategic Plan

68.5% (n=50) 26.0% (n=19) 94.5% (n=69)

Health Improvement Plan

53.4% (n=39) 30.1% (n=22) 83.5% (n=61)

Completion of Self-Assessment Against PHAB Standards (as of August 2014) N=60

1.1

1.2

1.3

1.4

2.1

2.2

2.3

2.4

3.1

3.2

4.1

4.2

5.1

5.2

5.3

5.4

6.1

6.2

6.3

7.1

7.2

8.1

8.2

9.1

9.2

10.1

10.2

11.1

11.2

12.1

12.2

12.3

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

65%

70%73%

63%

72%

62% 63% 63%

82%

62%

80%

70% 72%

52%55%

73%

67%

72%

65%

57%53%

60%

37% 35%

45%

73%

68%

55%

82%

70%

62% 60%

Standardized Public Health QI Outcomes

• Time saved• Reduced steps in a process• Revenue generated due to billable services• Costs saved• Costs avoided

Efficiency

• Increased customer/staff satisfaction• Increased reach to a target population• Quality enhancement of services and

programs• Quality enhancement of data systems• Dissemination of information, products

and evidence-based practices• Organizational design improvements• Increased preventive behaviors• Decreased prevalence/incidence

Effectiveness

Initial Findings: Increased Efficiencies(as of May 2014)

62%51%

5% 5% 8%21%

By midpoint of Year 4, 63% (n=39/62) of awardees that completed at least one QI initiative increased efficiencies

Perc

ent o

f aw

arde

es

Initial Findings: Increased Effectiveness(as of May 2014)

Quality

enh.

serv /

prog Quali

ty

enh.

system

s

Increase

d reac

h

Increase

d satisfa

ction

Org. desi

gn im

prove

ments

Dissem

. of in

formati

on,

products

, or e

viden

ce-base

d

practice

s

Increase

d preven

tive beh

aviors

Decrea

sed in

ciden

ce/p

revale

nce

Other

effec

tiveness

36% 35%31%

25%

18%15%

9%5%

7%

By midpoint of Year 4, 89% (n=55/62) of awardees that completed at least one QI initiative increased effectiveness

Perc

ent o

f aw

arde

es

NPHII Impact—Voices from the Field “Our map, our strategic plan, it is everywhere in our department. All of this started with the NPHII funding and the drive toward accreditation, performance improvement, and just transparency in what we do.” (from a state HD)

“I think our funding sparked, along with our leadership support, the entire movement in changing the way we do things at our health department. Putting accreditation and performance improvement and now continuous quality improvement on the map, our agency is actually invested now in three additional full-time positions in these areas. Aside from the PIM and the performance management specialist that are supported by the NPHII grant funding, our agency has invested in three other positions to help support this entire unit.” (territorial HD)

“spark(ing)... a movement in changing the way we do things at our health department.... The whole process and the journey of getting through our strategic plan, our state health assessment, looking at our domain, teams across our entire agency. It has changed the awareness of what we do, how we provide our ten essential services. I just can’t say enough; it really has changed the entire way we do things and the way we think.” (state HD)

- From NPHII focus groups with Performance Improvement Managers, 2013

Accreditation Support Initiatives Small amounts of funding to advance accreditation readiness Short period of time Funding from CDC’s Office for State, Tribal, Local and

Territorial Support through national partners: NACCHO—focusing on local health departments APHA—affiliate organizations NIHB—tribal health departments (upcoming)

CDC/NACCHO Accreditation Support Initiative (ASI)

Started in 2011; provided $3.7 million ($2.3 million in ACA funding) through 78 awards—to advance accreditation readiness

Funding to health departments and to organizations supporting health departments

Of 64 awardees eligible for accreditation, 59% (n=38) are in the process of being accredited, and 16% (n=10) have achieved accreditation status

Approximately one quarter of awardees used funds to pay up to 50% of PHAB fees

ASI primary contribution to accreditation readiness was the initiation of activities and acceleration of the pace of accreditation preparation Quality improvement Community health improvement plan Agency strategic plan Workforce development Performance management system

More information at www.naccho.org/asi

ASI Sites 2011–2014

2013–2014 ASI Sites 2013–2014 and 2012–2013 Sites2012–2013 ASI Sites 2012–2013 and 2011–2012 Sites2011–2012 ASI Sites

CDC/APHA Accreditation Support Initiative Started in 2012; provides funding to APHA affiliates partnering

with health departments to advance national accreditation readiness

Year 1 and 2 grantees: Alabama, Arizona, Georgia, Illinois, Indiana, Iowa, Michigan, Mississippi,

Missouri, Montana, Nevada, Ohio, Oklahoma, Oregon, Texas, Utah Sample activities:

Webinar series and educational sessions Gap analysis against PHAB standards and training Focus on tribal partnerships Toolkit development

Accreditation—Making Strategic and Programmatic Connections

How are programs and services reflected in PHAB standards? How can funded programmatic activities aid in meeting PHAB

standards? How can PHAB standards provide the right foundation for

strong programmatic work?

Programs and

Activities

PHAB Standards and

Measures

PHAB Accreditation Language Within CDC FOAs Standard templates and guidance for Funding Opportunity

Announcements (FOAs) Fact sheet available at

www.cdc.gov/stltpublichealth/accreditation Included in 58 FOAs to date (FY13 and FY14) Organizational capacity statement and Budget Narrative Guidance

“…applicants may describe their current status in applying for public health department accreditation or evidence of accreditation…”

“(Applicants) may, if consistent with statutory authority, use funds for activities, as they relate to the intent of this FOA, to meet national standards and/or seek health department accreditation through the Public Health Accreditation Board.”

Examples of Programmatic and Strategic Connections

PHHS Block Grant Healthy People 2020 Preparedness* Chronic disease programs Maternal and child health Environmental public health* Laboratories Infectious disease Immunizations* Occupational safety and health*

*Crosswalk developed or in progress

Informatics Community health

assessment/planning Healthcare-associated infections* Food safety* Health literacy Guide to Community Preventive

Services* National Prevention Strategy HHS quality aims and

characteristics*