quality improvement for maternal child health home visiting models
DESCRIPTION
The What, How, Why and When for South Carolina. A. Brock presentation given at the 2012 South Carolina Home Visiting SummitTRANSCRIPT
Rural Health Research CenterSouth Carolina
Quality Improvement for MCH Home Visitation Models: The What, How, Why, and When for South Carolina
Amy Brock Martin, Dr.P.H.Deputy Director & Research Associate Professor
Nathan Hale, Ph.D.Research Assistant Professor
SC Rural Health Research CenterDepartment of Health Services Policy & Management
Arnold School of Public HealthUniversity of South Carolina
South CarolinaRural Health Research Center
Presentation Objectives
Describe the Institute for Healthcare Improvement’s (IHI) Breakthrough Series concept on quality improvement as it relates to home visitation services;
Identify the IHI activities proposed for South Carolina’s home visitation programs;
Describe why IHI quality improvement activities are important for successful and sustainable home visitation programs; and
Identify the client and program-level outcomes home visitation programs should expect from the IHI quality improvement activities.
South CarolinaRural Health Research Center
Who we are…
South Carolina Rural Health Research Center
1 of 6 Rural Health Research Centers funded by the Health Resources and Services Administration
Administratively located in the Arnold School of Public Health at the University of South Carolina
Mission: to increase knowledge of the persistent inequities in health status among populations of the rural US, with an emphasis on factors related to socioeconomic status, race and ethnicity, and access to healthcare services.
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Why Do QI? – What a difference a year makes…
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Lucas Gregory Martin8lbs, 6 oz
5/1/12Lucas squealing.3gp
Lucas watching SpongeBob.3gp
South CarolinaRural Health Research Center
South CarolinaRural Health Research Center
South CarolinaRural Health Research Center
Why do CQI?
Because what you do matters in the lives of people …with insurmountable crises …having challenges with coping with stress …who may not have a voice …who have few or no advocates …who have very complex physical, emotion, and
psychosocial needs.
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What is Quality Improvement?
“QI involves both prospective and retrospective reviews. It is aimed at improvement -- measuring where you are, and figuring out ways to make things better. It specifically attempts to avoid attributing blame, and to create systems to prevent errors from happening” Department of Family Medicine, Duke Medical
Center
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Your Critics: NGA
Lack of a Cohesive Strategy to Promote Program Quality and Effectiveness. Most states lack an overarching statewide strategy to ensure and promote
the effectiveness of home visiting programs and to provide accountability for public funds.
…most states do not have a coordinated infrastructure to support home visiting programs in achieving ongoing quality improvements.
http://www.nga.org/files/live/sites/NGA/files/pdf/1103HOMEVISIT.PDF
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Who is IHI? The Institute for Healthcare Improvement (IHI) is an independent, not-for-
profit organization whose work is to help lead the improvement of health care around the world.
The IHI Breakthrough Series uses a learning collaborative model that includes: Selecting a topic Convening an expert meeting Developing a framework for change Providing learning sessions for program participants Action period using Plan, Do, Study, Act cycles to test small changes A series of follow-up learning sessions followed by action periods with formal
PDSA cycles Dissemination of findings/spreading and holding the gains
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Proposed MIECHV Implementation Evaluation Framework
Secondary Data
Sources
Client Survey
Aggregate Benchmark/
Construct Reporting
Composite Client Record Maintained by ORS
Program Data
Program Process Matrix
Continuous Quality
Improvement
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Home Visiting Coalition (1)Roles and Responsibilities•Oversight•Etc
Home Visiting Coalition (1)Roles and Responsibilities•Oversight•Etc
Outcomes/Benchmarks (3) Roles and Responsibilities•Data collection•Reporting (Q)•CQI Feedback loop
Outcomes/Benchmarks (3) Roles and Responsibilities•Data collection•Reporting (Q)•CQI Feedback loop
Funded Service Sites (5)Greenville/Pickens (NFP,HFA)
Greenwood Catchment (HFA/PAT, HS, NFP)Charleston (Trident) (NFP)Spartanburg/Union (NFP)
Aiken Charleston (FC-U)
Funded Service Sites (5)Greenville/Pickens (NFP,HFA)
Greenwood Catchment (HFA/PAT, HS, NFP)Charleston (Trident) (NFP)Spartanburg/Union (NFP)
Aiken Charleston (FC-U)
ECCS State Coordinator
Rosemary WilsonProject Evaluation Team
Nathan HaleAmy Brock Martin
Program CoordinatorEric Bellamy, CTSC
Program CoordinatorEric Bellamy, CTSC
Implementation/Coordination (2) Roles and Responsibilities•Coordinate•Implement•?
Implementation/Coordination (2) Roles and Responsibilities•Coordinate•Implement•?
Program Reporting•Client roster (M)•Program Process Matrix (Q)
Client Data•Survey (E, 6, 12, 24 months)•Secondary data runs (Q)
State CQI Oversight Team (4)Expert faculty for the IHI Breakthrough Series Learning Collaborative
State CQI Oversight Team (4)Expert faculty for the IHI Breakthrough Series Learning Collaborative
KeyQ – QuarterlyM – Monthly E- Enrollment
South Carolina MIEC Home Visitation Program-CQI Process Chart
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IHI Breakthrough Series (6 to 18 months time frame)
Select Topic
(develop mission)
Planning Group
Develop Framework & Changes
Participants (10-100 teams)
Prework
LS 1
P
S
A D
P
S
A D
LS 3LS 2
Supports
Email (listserv) Phone Conferences
Visits Assessments
Monthly Team Reports
Dissemination
Publications, Congress. etc.
A D
P
S
Expert Meeting AP1 AP2 AP3*
LS – Learning Session
AP – Action Period
*AP3 –continue reporting data as needed to document success
Holding the Gains
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Learning Session Objectives Learning Session 1
Get Ideas
Get Methods
Get Started
Learning Session 2
Get More Ideas
Get Better at Methods
Get a “Stride”
Learning Session 3
Celebrate Successes
Get ready to Sustain and Spread
Action Period 1 Action Period 2
Test all
changes on
small scale
Test & implement all changes
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Why Test?
Increase your belief that the change will make improvement
Predict how much improvement you can expect from the change
Learn how to adapt the change in your setting Figure out the costs and side-effects of the
change Minimize resistance upon implementation
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Timeline for Activities
Sep/Dec 2012 Jan 2013 Feb 2013
Expert Faculty/ Planning Phase
Learning Session1 Action Period 1
Mar 2013 Apr 2013 May 2013
Learning Session2 Action Period2 Action Period 2
June 2013 July 2013 Aug 2013
Learning Session3 Action Period 3 Data collection
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Summary
Quality improvement must guide our work to prevent our contributions to ‘Amir Jenning’ cases.
The IHI Breakthrough Series is a respected, evidenced-based process for facilitating a culture that promotes collaborative quality improvement in systems. Learning cycles should feel like a natural and obvious
extension of effective program implementation The process allows us to understand our performance
relative to the benchmarks while giving us opportunities to optimize home visitation outcomes
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Contact information
Amy Brock Martin, [email protected]
Nathan Hale, [email protected]
SC Rural Health Research Center220 Stoneridge Drive, Suite 204Columbia, SC 29201803-251-6317 (telephone)