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Quality Health Services & SBHCs. Joy Twesigye, MS, MPP, WHNP-BC Associate Director, Programs and Professional Services. November 12, 2012. There is very little standardization in SBHCs – there is variability in terms of scope of services, staffing, location, sponsorship and funding.

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quality health services sbhcs

Quality Health Services & SBHCs

Joy Twesigye, MS, MPP, WHNP-BC

Associate Director, Programs and Professional Services

November 12, 2012


There is very little standardization in SBHCs – there is variability in terms of scope of services, staffing, location, sponsorship and funding

questions we want answers to
Questions we want answers to
  • Individual-level impact: What is the impact of the SBHC on student health and academic achievement?
  • Cost effectiveness: What staffing models and funding patterns are most cost effective and impactful?
  • How do we improve our advocacy so that we can increase federal investment?
  • Academic accountability for school health services
  • Need to improve student health outcomes
  • Evaluating the impact of SBHCs is complicated because of:
  • 1) The wide range of services provided
  • 2) The limited resources devoted to conducting rigorous research

Going forward, the field of SBHC needs to establish a more standarized set of health services indicators, with a stronger emphasis on health outcomes, to better document the value of this model of care.

  • The gold standard would to have standarized best practices for tobacco prevention, obesity prevention, reproductive health
quality care
Quality care

Providing patients with appropriate services in a technically competent manner, with good communication, shared decision making, and cultural sensitivity.

Degree to which health care services increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

quality assessment
Quality assessment

The act of measuring care provided to identify positive examples or detect challenges of providing quality care.

quality improvement
Quality improvement

A continuous process of striving for improved performance, involving problem identification, testing of solutions, and the monitoring of solutions on an ongoing, system-level basis.

quality assessment and improvement
Quality assessment and improvement

The entire cycle of assessment which extends beyond problem identification to include:

verification of the problem

identification of intervention point

initiation of intervention(s)

continual review

to assure that identified issues have been adequately addresses and ensure the system has been adjusted to prevent further issues.

theory of continuous quality improvement cqi
Theory of Continuous Quality Improvement (CQI)


Problem is rarely related to the people but to the process, job design, failure of leadership, or unclear purpose

Need to understand and revise the process

Use a variety of measures

Attempts to improve quality by advancing the mean in incremental steps

cqi is not

Theory of bad apples

Establishing a threshold of acceptability

Blaming individuals

Elimination or control of outliers and reduction of the variation around the mean

qai in the sbhc setting
QAI in the SBHC setting

Efficiency: measure what is truly important to the health of students in your SBHC

Clinical appropriateness: accurately identify good health care for SBHC

Impact: bridges the gap between the development and dissemination of evidence-based practice

Practicality: mitigates against real life contingencies

Professionalism: connects training, practice, research, and policy

why state funds matter
Why State Funds Matter

Nearly one in two school-based health centers rely on state-directed public funds to help sustain their services.

states accountability for sbhc funds
States’ Accountability for SBHC Funds
  • 14 of 18 States set SBHC operating standards as condition of grant funds
    • States monitor adherence to SBHC standards through combination of paper review and/or in-person site visit
  • All 18 States track SBHC performance indicators
  • All 18 States collect a range of program data
  • 7 of 18 States monitor Medicaid billing practices
sbhc performance indicators most frequently tracked by states top 5 of 28 choices
SBHC Performance IndicatorsMost Frequently Tracked by StatesTop 5 of 28 choices

States that fund SBHCs (n=17)

most common sbhc data collected by states
Most Common SBHC Data Collected by States

States that fund SBHCs (n=18)

state medicaid s view of sbhc role
State Medicaid’s View of SBHC Role

Of the 19 states that fund SBHCs, 12 responded