Implementing an IHI Model Collaborative on Tobacco Use Screening in a state and local health depart...
Download
1 / 58

Doug Taylor and Joe Kyle Office of Performance Management - PowerPoint PPT Presentation


  • 66 Views
  • Uploaded on

Implementing an IHI Model Collaborative on Tobacco Use Screening in a state and local health department setting in South Carolina What we did and what we learned. Doug Taylor and Joe Kyle Office of Performance Management South Carolina Department of Health and Environmental Control Pam Gillam

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Doug Taylor and Joe Kyle Office of Performance Management' - tobias-richard


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Implementing an IHI Model Collaborative on Tobacco Use Screening in a state and local health department setting in South Carolina What we did and what we learned

Doug Taylor and Joe Kyle

Office of Performance Management

South Carolina Department of Health and Environmental Control

Pam Gillam

Center for Healthcare Policy and Research

University of South Carolina


Presentation overview
Presentation Overview Screening in a state and local health department setting in South Carolina

Overview SC DHEC and Health Services

Agency Strategic Plan and Priorities

Development of Tobacco Cessation Policy

IHI Collaborative Model

Implementing statewide tobacco cessation policy


Sc dhec structure
SC DHEC Structure Screening in a state and local health department setting in South Carolina

7- Member Board appointed by Governor w/consent of Senate

Commissioner selected by the Board

Agency is not part of the Governor’s Cabinet

Four Deputy Areas

Centralized system/Vertically Integrated

State HD/Central Office

8 Regions

No local BOHs


Sc dhec s 8 public health regions
SC DHEC’s 8 Public Health Regions Screening in a state and local health department setting in South Carolina


Health services
Health Services Screening in a state and local health department setting in South Carolina

Largest Deputy Area in DHEC

2.662 FTE’s statewide in 8 Public Health Regions with local health departments in all 46 counties and over 90 service delivery sites

Major areas of responsibilities include CDC/HRSA programs

Diverse team of health and environmental professionals to include:

Nurses, administrators, physicians, epidemiologists, nutritionists, pharmacists, administrative support, laboratory specialists, health educators, and social workers


General role of central office and role of regions
General Role of Central Office and Role of Regions Screening in a state and local health department setting in South Carolina

Central Office (State) Level

State level Health Improvement

Obtaining Resources

Development of Policies, Regulations, etc

Program Guidance & Oversight

Subject Matter Expertise – Consultations (public & private sector)

State, Federal and National relationships, partnerships

Region (Local) Level

Community level Health Improvement

Direct Service Delivery

Implementation of Policies

Region and local relationships, partnerships


Agency priorities
Agency Priorities Screening in a state and local health department setting in South Carolina

SC DHEC’s Strategic Plan 2005-2010

5 Broad Goals

24 Strategic Goals

88 Objectives

Each Deputy Area monitors their Objectives through performance measures

Since 2007 all Deputy Areas began presenting performance related data to DHEC’s Executive Management Team


DHEC Strategic Plan Screening in a state and local health department setting in South Carolina

Goal

2:Improve the quality and years of healthy life for all

Strategic Goal

2-A:Promote healthy behaviors

Tobacco Related Objectives

2-A-1:Develop effective state and local partnerships to promote healthy behaviors including good nutrition, physical activity and tobacco use cessation.

2-A-3:Implement interventions to prevent tobacco use, promote cessation and reduce exposure to secondhand smoke.

2-A-4:Collaborate with public and private partners to develop and implement statewide prevention plans targeting diabetes, cardiovascular health, cancer, injury, tobacco, obesity or associated risk factors.


Priority performance measure
Priority Performance Measure Screening in a state and local health department setting in South Carolina

DHEC Health Services will adopt policy to implement the Public Health Service Guideline (2As+R) for tobacco use and dependence with all of its clinical clients.


Tobacco cessation policy development timeline
Tobacco Cessation Screening in a state and local health department setting in South Carolina Policy Development Timeline

HS Management Retreat prioritized Tobacco (and Tobacco Use Screening) as a public health issue (Jan 07)

Original draft policy developed in 2007

The updated Clinical Practice Guidelines were released from the Federal Government in May 2008

Tobacco Prevention and Control staff updated draft policy and submitted to DHEC’s Manual Oversight Committee for review and approval (summer 2008)

Policy deployment then delayed until Tobacco Collaborative results were in, since results would affect policy content and deployment strategies

After Collaborative, policy approved in November 2009 with an official implementation date of July 1, 2010 (1st time this way)

State level team organized to support implementation of policy


Scdhec s use of the ihi s breakthrough collaborative for tobacco cessation

SCDHEC’s Use of Screening in a state and local health department setting in South Carolina the IHI’s Breakthrough Collaborative for Tobacco Cessation

Pamela S. Gillam, MPA

Center for Health Services & Policy Research

Arnold School of Public Health

University of South Carolina


Presentation objectives
Presentation Objectives Screening in a state and local health department setting in South Carolina

  • To recognize the key components/phases of the IHI Breakthrough Series as a quality improvement methodology

  • Understand how SCDHEC adapted the IHI Breakthrough Series model to work in its environment


What is the ihi breakthrough series
What is the IHI Breakthrough Series? Screening in a state and local health department setting in South Carolina

IHI’s Breakthrough Series (BTS) is an improvement method that relies on spread and adaptation of existing knowledge to multiple settings to accomplish a common aim.


Ihi breakthrough series 6 to 18 months time frame
IHI Breakthrough Series Screening in a state and local health department setting in South Carolina (6 to 18 months time frame)

Select Topic (develop mission)

Participants (10-100 teams)

Prework

Dissemination

Publications, Congress. etc.

P

Develop

Framework

& Changes

P

P

A

D

A

D

A

D

Expert Meeting

S

S

S

LS 1

LS 2

LS 3

Holding the Gains

Planning Group

AP1

AP2

AP3*

Supports

Email (listserv) Phone Conferences

Visits Assessments

Monthly Team Reports

*AP3 –continue reporting data as needed to document success

LS – Learning Session

AP – Action Period


Ihi goals for a bts
IHI Goals for a BTS Screening in a state and local health department setting in South Carolina

  • Achieve results

  • Accelerate improvement– get results faster!

  • Define, document, and disseminate good ideas

  • Build clinical and public health leaders of change


The ihi breakthrough series is not
The IHI Breakthrough Series is NOT: Screening in a state and local health department setting in South Carolina

  • Research for new clinical knowledge

  • Single-setting (single team) focus

  • Small changes to existing systems

  • A benchmarking project

  • A consulting engagement


Ihi bts 5 phases
IHI BTS- 5 Phases Screening in a state and local health department setting in South Carolina

  • Phase 1- Topic Section- General

  • Phase 2- Topic Selection- Development and Expert Meeting

  • Phase 3- Prework

  • Phase 4- Learning Sessions and Action Periods

  • Phase 5- Holding the Gains and Spread


Ihi breakthrough series
IHI Breakthrough Series Screening in a state and local health department setting in South Carolina

Phase 1: Topic Selection


Dhec tobacco collaborative november 2008 june 2009
DHEC Tobacco Collaborative Screening in a state and local health department setting in South Carolina November 2008 - June 2009

Select Topic (develop mission)

Participants (7 teams)

Prework

Dissemination

Publications, Congress. etc.

P

Develop

Framework

& Changes

P

P

A

D

A

D

A

D

Expert Meeting

S

S

S

LS 1

LS 2

LS 3

Holding the Gains/ Spread

Planning Group

AP1

AP2

Supports

Email (listserv) Monthly Phone Calls

TA Visits Monthly Team Reports

LS – Learning Session

AP – Action Period


Topic selection for tcc
Topic Selection for TCC Screening in a state and local health department setting in South Carolina

  • There is a gap between science (evidence) and practice; 2A+R identified as EBP;DHEC not doing it.

  • Examples of better performance exists; Other states using it.

  • A good “Business Case” exists for the topic; Seen as priority in 2 Regions participating in MLC3.


Adaptation of phase 1 topic selection
Adaptation of Phase 1: Topic Selection Screening in a state and local health department setting in South Carolina


Ihi breakthrough series1
IHI Breakthrough Series Screening in a state and local health department setting in South Carolina

Phase 2:

Topic Development

And

Expert Meeting


Dhec tobacco collaborative november 2008 june 20091
DHEC Tobacco Collaborative Screening in a state and local health department setting in South Carolina November 2008 - June 2009

Select Topic (develop mission)

Participants (7 teams)

Prework

Dissemination

Publications, Congress. etc.

P

Develop

Framework

& Changes

P

P

A

D

A

D

A

D

Expert Meeting

S

S

S

LS 1

LS 2

LS 3

Holding the Gains/ Spread

Planning Group

AP1

AP2

Supports

Email (listserv) Monthly Phone Calls

TA Visits Monthly Team Reports

LS – Learning Session

AP – Action Period


In this step experts are identified
In this step, Experts are Identified Screening in a state and local health department setting in South Carolina

  • Experts are knowledgeable in the subject matter/QI

  • Some experts are chosen to be Collaborative Faculty

    For TCC, faculty were staff from Division of Tobacco Control and Prevention/Office of Performance Mgmt/USC/Regional Leadership


Experts develop the following
Experts Develop the Following: Screening in a state and local health department setting in South Carolina

  • Collaborative Charter, that includes—

  • Change Package- 12 Changes in TCC Change Package

  • Measurement Strategy- Primary Measures used- # of smokers, # who accept referral, amount of time to implement intervention


Adaptation of phase 2 topic development and expert meeting
Adaptation of Phase 2: Topic Development and Expert Meeting Screening in a state and local health department setting in South Carolina


Ihi breakthrough series2
IHI Breakthrough Series Screening in a state and local health department setting in South Carolina

Phase 3: Prework


Dhec tobacco collaborative november 2008 june 20092
DHEC Tobacco Collaborative Screening in a state and local health department setting in South Carolina November 2008 - June 2009

Select Topic (develop mission)

Participants (7 teams)

Prework

Dissemination

Publications, Congress. etc.

P

Develop

Framework

& Changes

P

P

A

D

A

D

A

D

Expert Meeting

S

S

S

LS 1

LS 2

LS 3

Holding the Gains/ Spread

Planning Group

AP1

AP2

Supports

Email (listserv) Monthly Phone Calls

TA Visits Monthly Team Reports

LS – Learning Session

AP – Action Period


Prework
Prework Screening in a state and local health department setting in South Carolina

For Planning Group

For Collaborative Teams

Develop TCC teams

Discuss aims and focus work

Engage the senior leader

Initiate measurement and other information gathering

Begin development of storyboard

  • Develop materials- TCC change package, Prework materials

  • Present to Region leadership on TCC

  • Assist regions in developing teams

  • Plan LS1


Tcc teams
TCC Teams Screening in a state and local health department setting in South Carolina

Region 4

Region 8

Beaufort Family Planning

Hampton Family Planning

Jasper WIC

Colleton WIC

  • Lake City Family Planning

  • Darlington WIC

  • Sumter WIC


Adaptation of phase 3 prework
Adaptation of Phase 3: Screening in a state and local health department setting in South Carolina Prework


Ihi breakthrough series3
IHI Breakthrough Series Screening in a state and local health department setting in South Carolina

Phase 4: Learning Sessions and Action Periods


Dhec tobacco collaborative november 2008 june 20093
DHEC Tobacco Collaborative Screening in a state and local health department setting in South Carolina November 2008 - June 2009

Select Topic (develop mission)

Participants (7 teams)

Prework

Dissemination

Publications, Congress. etc.

P

Develop

Framework

& Changes

P

P

A

D

A

D

A

D

Expert Meeting

S

S

S

LS 1

LS 2

LS 3

Holding the Gains/ Spread

Planning Group

AP1

AP2

Supports

Email (listserv) Monthly Phone Calls

TA Visits Monthly Team Reports

LS – Learning Session

AP – Action Period


Learning session objectives
Learning Session Objectives Screening in a state and local health department setting in South Carolina

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

Test all

changes on

small scale

Test & implement all changes

Action Period 1

Action Period 2


Learning session objectives1
Learning Session Objectives Screening in a state and local health department setting in South Carolina

  • Learn and “get” the Change Package

  • Learn method for accelerating improvement (PDSA)

  • Get connected to colleagues

  • Make solid plans for taking action quickly


Tcc ls1 agenda
TCC LS1 Agenda Screening in a state and local health department setting in South Carolina

DAY 1

DAY 2

Orientation to The Model for Improvement/PDSA

Measurement and Reporting

Team Meeting time

Next Steps (Action Period 1)

  • Introduction to IHI BTS process

  • Review of Collaborative’s mission and goals

  • Intro of 2As + R

  • Intro of Change Package

  • Training in 2As + R

  • Intro to QI

  • Team Meeting time


Model for Screening in a state and local health department setting in South Carolina Improvement

What are we trying to accomplish?

AIM

How will we know that a change is an improvement?

MEASURE

What change can we make that will result in improvement?

CHANGES

Plan

Act

Study

Do

From: Associates in Process Improvement


Sumter county hd
Sumter County HD Screening in a state and local health department setting in South Carolina

AIM 1:

By the end of the collaborative, 100% of Prenatal/Post-Partum WIC clients and Sumter Co. HD will receive the 2As + R.

AIM 2:

25% of Tobacco Users will accept referral to Quitline.


Sumter county hd1
Sumter County HD Screening in a state and local health department setting in South Carolina

MEASURES:

  • Length of Client Visit– 1:1 time with NES

  • Average length of time to implement 2As + R with clients

  • Client Tobacco Use Rate

  • % of WIC PN, PP, BF clients who receive 2As + R with fidelity

  • % of tobacco users accepting referral to the Quitline


Sumter county hd2
Sumter County HD Screening in a state and local health department setting in South Carolina

CHANGES: (taken from change package)

  • IB. Include tobacco use as a vital sign.

    • IC. Ask patients if they use tobacco and document tobacco-use status on a regular basis.

  • ID./IVB. Designate staff/clinicians to implement the 2 A’s and R.


Sumter county hd3
Sumter County HD Screening in a state and local health department setting in South Carolina

CHANGES: (taken from change package)

  • IIA. Implement a tobacco-user identification system.

  • IIC./IIIB. Track the degree to which clinicians are identifying, documenting and treating patients who use tobacco and provide feedback to staff/clinicians about their performance.

  • IVA. Have tobacco cessation materials and other information in every exam room or room in which clients are seen.


  • Hampton county hd pdsa cycle
    Hampton County HD Screening in a state and local health department setting in South Carolina PDSA Cycle

    PLAN PHASE (of PDSA)

    WHO: Support Staff will be provided the necessary posters and cards for the Quitline

    WHAT: Material placement and distribution of a set number of materials which will be counted at the beginning and the difference tabulated at the end of the PDSA cycle for the number of cards and the tear off on the posters

    WHEN: Starting on December 15, 2008 and continuing through December 19, 2008

    WHERE: In Health Departments clinic waiting room(s) and exam rooms


    Action period objectives
    Action Period Objectives Screening in a state and local health department setting in South Carolina

    • Support teams in their improvement work

    • Build collaboration and shared learning

    • Assess collaboration and progress

      This is the time of maximal learning

      AND WHERE THE REAL ACTION IS!


    Adaptation of phase 4 learning sessions and action periods
    Adaptation of Phase 4: Learning Sessions and Action Periods Screening in a state and local health department setting in South Carolina


    Ihi breakthrough series4
    IHI Breakthrough Series Screening in a state and local health department setting in South Carolina

    5th Phase:

    Holding the Gains

    and

    SPREAD


    Dhec tobacco collaborative november 2008 june 20094
    DHEC Tobacco Collaborative Screening in a state and local health department setting in South Carolina November 2008 - June 2009

    Select Topic (develop mission)

    Participants (7 teams)

    Prework

    Dissemination

    Publications, Congress. etc.

    P

    Develop

    Framework

    & Changes

    P

    P

    A

    D

    A

    D

    A

    D

    Expert Meeting

    S

    S

    S

    LS 1

    LS 2

    LS 3

    Holding the Gains/ Spread

    Planning Group

    AP1

    AP2

    Supports

    Email (listserv) Monthly Phone Calls

    TA Visits Monthly Team Reports

    LS – Learning Session

    AP – Action Period


    Holding the gains and spread
    Holding the Gains and Spread Screening in a state and local health department setting in South Carolina

    Holding the Gains-- Continued tracking of improvements

    Spread-- Adapting change to areas or populations other than your pilot populations

    Part of the BTS Design!


    For tcc thinking about spread important
    For TCC, Screening in a state and local health department setting in South Carolina Thinking about Spread Important

    • 2 As + R was going to become a DHEC policy

    • Promising practices for implementing 2As + R in WIC and Family Planning

    • Talked about Spread in LS1 and LS2


    Beaufort county hd 2a r spread training plan
    Beaufort County HD Screening in a state and local health department setting in South Carolina 2A+R SpreadTraining Plan

    • WFD Coordinator presents @ site meetings

    • Ice Breaker

    • Policy

    • Power Point Presentation

      • Current Tobacco Cessation Programs

      • Smoking Prevalence & Disease Connection

      • Impact of Quitting & Success of Cessation Programs

      • 2A’s+R Protocol

    • Role Plays


    Beaufort county hd spread
    Beaufort County HD Spread Screening in a state and local health department setting in South Carolina


    Ihi bts 5 phases1
    IHI BTS- 5 Phases Screening in a state and local health department setting in South Carolina

    • Phase 1- Topic Section- General

    • Phase 2- Topic Selection- Development and Expert Meeting

    • Phase 3- Prework

    • Phase 4- Learning Sessions and Action Periods

    • Phase 5- Holding the Gains and Spread


    Deploying and Implementing the Tobacco Use Screening Policy Screening in a state and local health department setting in South Carolina post Collaborative, throughout the SC system


    State level planning
    State level planning Screening in a state and local health department setting in South Carolina

    • By the Fall of 2009 data from the Tobacco Collaborative, describing impact in FP/STD and WIC clinics and promising ideas on how best to implement

      • DVD of 3rd learning session of major findings and recommendations

      • Final Report with detailed data, findings and recommendations (late summer 2009)

    • CO workgroup convened, all areas affected by policy (September-Nov 2009)

      • FP/STD, HH, NBHV, WIC, and TB with TA from Tobacco Division and Office of PM

      • Reviewed policy, findings from Collaborative

      • Made program specific recommendations on strategies to prepare for July 2010 full implementation


    State level planning1
    State level planning Screening in a state and local health department setting in South Carolina

    • For WIC and FP/STD (programs in the Collaborative):

      • Reviewed results, made additional recommendations to improve upon results (i.e. WIC drop down menu to document intervention rather than write in under Alerts tab)

    • For HH, TB and NBHV (programs not in the Collaborative):

      • Began to design test of changes to figure out best way to implement within their program areas

    • Challenge:

      • Develop implementation strategies for all affected programs

      • Get staff trained in implementation

      • Develop evaluation plan to monitor policy once implemented on July 1, 2010


    Region and state level planning
    Region and State level planning Screening in a state and local health department setting in South Carolina

    • Regions were required to develop testing, training and deployment plans (see plan template handout)

      • To take advantage of unprecedented planning time allowed prior to full policy implementation (Nov 09-June 10)

      • Plans submitted by mid March 2010

    • CO, Tobacco Division developed and implemented a TOT

      • Targeting Region lead Tobacco staff, covered policy, protocol, and program specific steps and requirements

      • TOT materials sent out to regions for all staff training


    Region and state level planning1
    Region and State level planning Screening in a state and local health department setting in South Carolina

    • Monitoring (see handout)

      • Each program responsible for ensuring policy is followed within their area, through site visits and program reports

      • Performance measure developed to monitor program implementation

      • Quitline data reported on to include:

        • Fax referral volume

        • Referrals not reached by Quitline

        • # of referrals enrolled/registered with Quitline


    Region and state level planning2
    Region and State level planning Screening in a state and local health department setting in South Carolina

    • Evaluation (see handout)

      • 7 and 30 day quit rates of clients receiving Quitline services

      • Prevalence of tobacco use among DHEC clients compared to baseline

      • 7 and 30 day quit rates for non referred SC Quitline clients

      • Client satisfaction


    Use of ihi model in other areas
    Use of IHI model in other areas Screening in a state and local health department setting in South Carolina

    • No, for simple, mundane, small (organizationally) level work

    • Yes, if evidence known and how to implement needs to be figured out, for a large system deployment

      • SC: Implementation of FastTrack for STD customers

        • Pilot (to confirm evidence), IHI Collaborativelike 8 teams (one per Region), statewide deployment

    • Yes, if evidence not known

      • Pilot first (to generate the evidence)


    ad