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Applying qi to communicable diseases: initial stories from the nnphi qi award program

Janelle Elza, Red Cliff Community Health Center Pamela Davis, South Carolina Department of Health and Environmental Control Linda Navarre, Kittitas County Public Health Department. Applying qi to communicable diseases: initial stories from the nnphi qi award program.

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Applying qi to communicable diseases: initial stories from the nnphi qi award program

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  1. Janelle Elza, Red Cliff Community Health Center Pamela Davis, South Carolina Department of Health and Environmental Control Linda Navarre, Kittitas County Public Health Department Applying qi to communicable diseases: initial stories from the nnphi qi award program

  2. Applying QI to Communicable Diseases Red Cliff Community Health Center Bayfield, WI Jenelle Elza, RN

  3. The reservation is approximately one mile wide and 14 miles long, located at the top of the Bayfield Peninsula, on the shores of Lake Superior in northern Wisconsin. The village of Red Cliff, the location of tribal offices and businesses, is three miles north of Bayfield Wisconsin, a popular tourist community adjacent to the Apostle Islands National Lakeshore. The reservation population is 924, primarily Native American.

  4. Red Cliff Community Health Center Alcohol and Other Drug Abuse Services (AODA) and Mental/Behavioral Health Clinic (Family Practice, Women’s Health, Pediatrics, Laboratory, X-ray) Contract Health Care (CHS) and Medical Benefits Community Health (Immunization, Disease Prevention) and Environmental Health & Maintenance Dental Pharmacy Maternal Child Health and WIC

  5. The IPC program strives to stimulate the desire and optimism for improvement and intolerance of the status quo; promote wide-spread adoption of best practices that will lead to improvement; test and adapt ideas and knowledge for the Indian health system; help grow a vibrant health care workforce; and ensure that quality is a way of life for future generations. American Indians and Alaskan Native (AI/AN) people face high rates of illness, disability, and death from chronic and preventable diseases. The IHS, Tribal, and Urban health programs participating in the Improving Patient Care (IPC) program aim to reduce these health disparities among AI/ANs by: Ensuring access to primary care for all AI/AN people; Providing high-quality primary care; Coordinating care across the continuum or integrating primary care, inpatient care, and the community. Making real and measurable improvements in care. DM Comprehensive Cancer Bundle Health Risk Screening Bundle Physical Activity 3rd Next Available Appointment

  6. Public Health Quality Improvement • Wisconsin’s Public Health Quality Initiative • Developed a team, which consists of CH Nurse Supervisor, CH Nurse, QI Nurse, and Environmental Health. • Completed public health self-assessment • Defined communicable disease reporting along with other areas, as weaknesses. • Participated in weekly webinars related to Public Health QI: QI 101, performance measures and management.

  7. Strengthening the Community of Practice for Public Health Improvement. Assessment of the Public Health Department lead us to communicable disease reporting as our weakness. Currently Bayfield County Health Department does our reporting. This is not being done accurately Double reporting. No reporting We do not know what and how many diseases from the reservation are being reported. Red Cliff wants to take back communicable disease reporting so we can focus on surveillance, control, and prevention.

  8. SMART AIM SPECIFIC - Is the statement precise about what the team hopes to achieve?MEASURABLE- Are the objectives measureable? Will you know if the changes resulted in improvement?ACHIEVABLE- Is this doable in the time you have? Are you attempting too much? Could you do more?REALISTIC - Do you have the resources needed (people, time, support?)TIMELY - Do you identify the timeline for the project - when will you accomplish each part?

  9. AIM Statement The Red Cliff Community Health Center will assume responsibility of reporting all communicable diseases to the Wisconsin State Health Department by November 30, 2012 The Public Health staff will have knowledge in all areas of the reporting process as measured by completing a knowledge test with a score of 95% or better by September 30, 2012.

  10. Steps…. Team in place-Roles defined. Training- QI process, Reportable diseases, Investigation, computer systems, etc… Meeting- Designating time! Weekly team meetings.

  11. Plan-Do-Study-Act Select your change- All improvement requires making changes, but Not all changes result in improvement. Test your change- planning it, trying it, observing the results, and acting on what is learned. Implement your change - After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the team can implement the change on a broader scale. Spread your change- After successful implementation of a change or package of changes for a pilot population or an entire unit, the team can spread the changes to other parts of the organization or in other organizations.

  12. Key Lessons Learned Slow Down! Do PDSA cycles Spread the wealth- don’t do it all yourself Get Organized! Be transparent Celebrate success! It’s about the process not the people Communication Share senselessly and steal shamelessly! What gets measured gets managed

  13. The goal for the Red Cliff Community Health Center is to have a functional and reliable count of all communicable diseases in our community. This is necessary for program development to help control spread and work towards prevention of all communicable diseases. We are working towards a healthier community!

  14. National Network of Public Health Institute Open Forum Meeting for Quality Improvement in Public Health Apply QI to Communicable Diseases: Initial Stories from the NNPHI QI Award Program June 19, 2012 Pamela Davis South Carolina Department of Health and Environmental Control STD/HIV Division

  15. Background • December, 2006 - Missed Opportunities Research • HIV testing practices in South Carolina failed to identify a substantial proportion of HIV-infected persons early in the course of their infection. • Among the persons identified in this report as late testers (i.e., persons who received an AIDS diagnosis within 1 year of HIV diagnosis), approximately three fourths had visited a South Carolina health-care facility before having HIV diagnosed. • Most of the late testers made multiple visits, and most of their visits occurred 1 year or more before diagnosis of HIV infection. • These health-care encounters represent missed opportunities for earlier HIV diagnosis

  16. Background • In 2007, CDC implemented a new HIV testing program, CDC-RFA-PS07-768: • Expanded and Integrated Human Immunodeficiency Virus (HIV) Testing for Populations Disproportionately Affected by HIV, Primarily African Americans, aimed at significantly increasing the number of persons tested each year in jurisdictions with a high incidence of HIV among disproportionately affected populations affected by HIV – African Americans, Hispanics, MSM, and IDUs, primarily in healthcare settings • Testing efforts were sustained with CDC FOAs • PS10-10138 (2010-2011) • PS12-1201 (2012-2014)

  17. Goal • To increase the number of persons who receive HIV testing, and the number and proportion of HIV-infected persons who are aware of their infection by: • Providing routine HIV screening in healthcare settings serving these populations. • Expanding targeted HIV testing in non-healthcare settings or venues where high-risk members of these populations can be accessed. • Ensuring that persons testing positive for HIV infection (new positives and previously diagnosed positives not in care) receive HIV test results, prevention counseling and linkage to medical care, Partner Services, and HIV prevention services.

  18. PlanDoStudyAct PLAN

  19. Planning Phase • QI Team formed • Health department (HD) QI Team Assembled • Expanded Testing Staff • Latasha Robinson • Jarvis Carter • Pamela Davis • HD 1st QI team Meeting • Revisited AIM statement • By December 31, 2012, the identified hospital ED will implement routine opt-out rapid HIV testing where 80% of patients that present in the ED and meet testing criteria will receive HIV screening. • Discussed HIV testing process in ED • Current Process • Collection of Data • Identified Problems • Identified Potential Improvements

  20. Planning Phase

  21. Planning Phase • Met with QI Coach to discuss QI project • Identified Site for QI Project • Medical University of South Carolina (MUSC) • Identified key staff at QI Project Site • Site QI Team • Dag Shapshack, MD • Assistant Professor Department of Medicine, Division of Emergency Medicine • Roberta Navarro, RN • HIV Early Intervention Program Coordinator • Michael Green • Research Assistant

  22. Planning Phase • QI Team Meeting (HD & MUSC QI Team) • Meeting outline • Purpose of QI project • AIM Statement • Discussed HIV testing process in ED • Current Process • Collection of Data • Identified Problems • Identified Potential Improvements • Developed an Improvement Theory • Developed an Action Plan

  23. Lessons Learned • Be sure to involve everyone (internally/externally) Identify a “Project Champion” • Keep focused on project goals • Everyone on the same page • Team consensus of problem and plan for improvement • Be sure to include the input of stakeholders

  24. Barriers/Challenges • Getting the buy-in of the QI project from: • QI team • Administrators • Front-line staff • Ensure QI project does not interfere and/or interrupt patient care and daily operation.

  25. What Do We Expect to Achieve? • Develop a model program for routinizing HIV testing during a healthcare visit.

  26. Applying Quality Improvement to Communicable Diseases: QI IN ACTION • Total population: 40,500 • 14.5 FTEs

  27. Team Members • Linda Navarre, Community Health Services Supervisor, Project Lead • Tiffany Beardsley, Public Health Nurse • Julia Karns, Community Outreach Worker

  28. Why focus on hepatitis C testing? • Dramatic decline in hepatitis C testing • One in four tested in the 2010-2011 time period were positive for hepatitis C

  29. Initial Steps • What are we really trying to improve? • What more do we need to know? • How will we obtain this information?

  30. AIM STATEMENT By November 1, 2012, KCPHD will have a 50% increase in the number of ADDS (Alcohol and Drug Dependency Services) referred clients who follow through with hepatitis C testing.

  31. What do we hope to achieve? • A sustainable referral process • “Know your status” awareness • Develop useful tools to share with others • QI stepping stone for staff

  32. Successful QI Method or Tool • Top three QI tools used: • Process mapping • Affinity diagram • Surveying stakeholders

  33. Survey Results n=8

  34. The Reward

  35. Challenges • “Fix it Now” mentality • Difficult barriers to overcome • Balancing workload

  36. QI Lessons Learned • Administrative support • Utilize your staff’s strengths • Find your champion • Acknowledge and praise • Reward your partners

  37. Recommended Resources • Embracing Quality In Public Health, Second Edition • The Public Health Memory Jogger II

  38. Thank you A special thank you to the NNPHI QI Awards team and our quality improvement coach, Jim Butler.

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