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Presentation Overview

Cycle III Outcome Data Healthy Start Interconception Care Learning Collaborative Juliann DeStefano Johannie Escarne September 12, 2012. Presentation Overview. History of Interconception Care Learning Collaborative (ICC LC) Measurement in Cycle III (change concepts) Review Outcome Data

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Presentation Overview

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  1. Cycle III Outcome DataHealthy Start Interconception Care Learning CollaborativeJuliann DeStefanoJohannie EscarneSeptember 12, 2012

  2. Presentation Overview • History of Interconception Care Learning Collaborative (ICC LC) • Measurement in Cycle III (change concepts) • Review Outcome Data • 2 Community Level Measures • Common Measures Selected for Each Collaborative

  3. Why Healthy Start and Quality Improvement • Improve maternal and infant outcomes • Meet existing and future service need • Strengthen/Integrate evidence-based practice • Improve collaboration, consumer and staff satisfaction

  4. Qualitative Improvement (QI) • Implementing a quality improvement (QI) “learning collaborative” model in all Healthy Start projects • Applying QI model to improve non-clinical, community-based services • Using best practice and developing evidence-based practice (EBP)

  5. Evidence Review for ICC • ICC LC Project literature review (March 2009) • Content of Preconception Care (Jack et al, AJOG 2008) • Assessment of first 35 Healthy Start Grantees’ Interconception Care efforts (Johnson, 2007) • Evaluation of Healthy Start (Abt Associates 2006)

  6. Expert Workgroup (EWG) • Critical piece of learning collaborative process • Provided in-depth review of current literature in each of the core content areas • Provided guidance during first 2 LC meetings • Continued ongoing support as needed

  7. ICC Core Topic Contents • Case Management (CM) • Family Planning / Reproductive Health (FP) • Healthy Weight (HW) • ICC Risk Screening /Assessment (SCR) • Maternal Depression (DEP) • Primary Care Linkages (PC)

  8. Change Concepts Change Concepts • - Strengthen partnerships and linkages among community providers • - Advance use of evidence-based tools, data collection, and performance monitoring • - Improve staff training and protocols to improve quality and consistency

  9. Framework for Change Projects

  10. Linkages and Partnerships • Identification • Has your project identified possible linkages/partnerships in the community that can provide services to ICC participants? Y/N • Establishment • Has your project established, reestablished, or strengthened linkages/partnerships with organizations in the community that can provide services to ICC participants? Y/N • Establishment • How many linkages/partnerships in the community were established, reestablished, or strengthened by your project during Cycle II?

  11. Tools • Tool Modification • Has your project modified an evidence-based tool? Y/N • Tool Modification – Qualitative Data • If your project modified an evidence-based tool what processes were used to modify the tool? Challenges? Lessons Learned? • Tool Selection • Has your project selected an evidence-based tool? Y/N • Tool Implementation • How many women were screened using the evidence-based tool? • Tool Identification • Has your project identified an evidence-based tool? Y/N

  12. Staff Skills Follow-Up Procedures • Has your project established or updated staff protocols to implement the change project? Y/N Staff Training • Have staff members received training to implement the change project (e.g., training on tools, protocols, follow-up procedures, referral process)? Y/N Staff Training • How many staff members received training to implement the change project?

  13. Model for ImprovementPlan Do Study Act (PDSA) • What are we trying to accomplish? • How will we know change is an improvement? • What changes can we make that will result in improvement?

  14. The PDSA Cycle for Continuous Quality Improvement “Start Here” Act Plan • Objective • Questions & • predictions (why) • Plan to carry out the cycle • (who, what, where, when) Adapt? Adopt ? Abandon? Next cycle? Do Study • Complete analysis of the data • Compare data to • predictions • Summarize what • was learned • Carry out the plan • (on a small scale) • Document problems • and unexpected • observations • Begin analysis

  15. ICC LC Building from Teams Each HS team chose a content area & a change concept Change project developed with aim, tools, & measures Measures correspond to HS performance measures and outcomes Fit with Healthy Start grantee capacity and readiness Doable and measurable in a 9-month time period Teams with similar kinds of change projects grouped together into Learning Collaboratives Divided by change concept and content area

  16. August 2010 – April 2011 May 2011 – January 2012 Two 9-month cycles and one 7-month cycle 104

  17. Evolution of Measurement • Purpose of Measurement in the Quality Improvement Process • Measurement & ICC • Cycle I: Focused on the PDSA process • Cycle II: Measures were created & implemented • Cycle III: Continued use & improved reporting of measures • Measuring Change • Aim, Change, Select Collaborative Measures, Baseline Data, Systematic Data Collection, Review Results

  18. Measurement in Cycle III • Measurement Occurred Twice (baseline and final, varies with project but within Cycle III) • ICC Website • Discussed on Collaborative Calls • Problems Noted - grantees reported difficulty in using ICC website - timely submissions from grantees

  19. Community Level Measures Measure I: Topic Awareness In Cycle III 80% Healthy Start staff were made aware of the selected ICC Topic through trainings and meetings. Measure II: Data Collection In Cycle III, 88.5%Healthy Start Grantees reported having a data collection and management system in place to collect information on the selected ICC Topic.

  20. Common Measures: Case Management CM1: Linkages • Comprised of 2 Healthy Start Projects Measures Used • Identification • 2 grantees identified linkages/partnerships • Establishment • 2 grantees established linkages/partnerships • Establishment • 12 new linkages/partnerships established

  21. Common Measures: Case Management CM2: Staff Skills • Comprised of 8 Healthy Start Projects Measures Used • Staff Training • 5 of 5 had provided staff training • Staff Training • 90 Healthy Start staff received training

  22. Common Measures: CM continued CM3: Tools • Comprised of 2 Healthy Start Projects Measures Used • Tool Identification • No teams identified tools in Cycle 3 • Tool Implementation • No women were screened using the selected tools during Cycle 3

  23. Common Measures: Maternal Depression DEP1: Linkages • Comprised of 4 Healthy Start Projects Measures Used • Identification • 4 grantees identified linkages/partnerships • Establishment • 10 new linkages/partnerships established

  24. Common Measures: Maternal Depression DEP2: Tools • Comprised of 6 Healthy Start Projects Measures Used • Tool Selection • 5 grantees selected tools • Tool Implementation • 118 women were screened in during Cycle 3

  25. Common Measures: Maternal Depression DEP3: Staff Skills • Comprised of 7 Healthy Start Projects Measures Used • Follow-Up Procedures • 4 grantees had established or updated protocols • Staff Training • 41 staff trained during Cycle 3

  26. Common Measures: Family Planning FP1: Linkages • Comprised of 5 Healthy Start Projects Measures Used • Identification • 5 grantees identified linkages/partnerships • Establishment • 5 grantees established linkages/partnerships

  27. Common Measures: Family Planning FP2: Tools • Comprised of 8 Healthy Start Project Measures Used • Tool Selection • 7 teams selected tools in Cycle 3 • Tool Implementation • 332 women were screened using the selected tools in Cycle 3

  28. Common Measures: Family Planning FP3: Staff Skills • Comprised of 5 Healthy Start Projects Measures Used • Follow-Up Procedures • 5 teams established protocols in Cycle 3 • Staff Training • 64 Healthy Start staff were trained during Cycle 3

  29. Common Measures: Family Planning FP4: Tools • Comprised of 5 Healthy Start Projects Measures Used • Tool Selection • 5 grantees selected tools • Tool Implementation • 390 women were screened in during Cycle 3

  30. Common Measures: Healthy Weight HW1: Linkages • Comprised of 8 Healthy Start Projects Measures Used • Identification • All 8 teams identified linkages/partnerships • Establishment • All 8 teams established partnerships during Cycle 3

  31. Common Measures: Healthy Weight HW2: Staff Skills • Comprised of 7 Healthy Start Projects Measures Used • Follow-Up Procedures • 5 teams established protocols in Cycle 3 • Staff Training • 83 Healthy Start staff were trained during Cycle 3

  32. Common Measures: Healthy Weight HW3: Tools • Comprised of 8 Healthy Start Projects Measures Used • Tool Selection • 6 grantees selected tools • Tool Implementation • 130 women were screened in during Cycle 3

  33. Common Measures: Healthy Weight HW4: Tools • Comprised of 4 Healthy Start Projects Measures Used • Tool Identification • 4 teams identified tools in Cycle 3 • Tool Selection • 4 grantees selected tools

  34. Common Measures: Healthy Weight HW5: Tools • Comprised of 4 Healthy Start Projects Measures Used • Tool Selection • 4 grantees selected tools • Tool Implementation • 319 women were screened in during Cycle 3

  35. Common Measures: Primary Care PC1: Staff Skills • Comprised of 6 Healthy Start Projects Measures Used • Staff Training • 6 of 6 had provided staff training • Staff Training • 69 Healthy Start staff received training

  36. Common Measures: Screening & Risk Assessment SCR1: Staff Skills • Comprised of 9 Healthy Start Projects Measures Used • Staff Training • 9 of 9 had provided staff training • Staff Training • 86 Healthy Start staff received training

  37. Tools in Cycle 3 • Tool Identification • 4 grantees identified evidence-based tools in Cycle 3 • Tool Selection • 31 grantees selected an evidence-based tool in Cycle 3 • Tool Implementation • In Cycle 3, 1289 women screened using the selected evidence-based tool

  38. Staff Skills in Cycle 3 • Follow-Up Procedures • 14 grantees established or updated staff protocols to implement the change project • Staff Training • 20 grantees provided staff training to implement the change project • Staff Training • In Cycle 3, 433 Healthy Start staff members received training to implement the change project

  39. Linkages & Partnerships in Cycle 3 • Identification • 15 grantees identified possible linkages/partnerships during Cycle 3 • Establishment • 15 grantees established linkages/partnerships during Cycle 3 • Establishment • In Cycle 3, 12 linkages/partnerships were established by Healthy Start grantees

  40. Summary • The ICC process was supported by DHSPS for ongoing activities within each project • Each project identified an area of ongoing work that would benefit from a collaborative process within their community • Results from collaborative work within each community shows promise as Healthy Start sites work toward implementing best practices and development of EBP.

  41. Next Steps • DHSPS will continue to work with projects in the implementation of the learning collaborative process within their communities. • The development of the Toolkit based on the experiences of grantees during the 3 year ICC LC process will be a useful tool for the ongoing LC process.

  42. Next Steps continued • DHSPS will hold a webinar on the Toolkit in late Fall. • The Toolkit will be accessible on the MCHB website. • HS project officers are available to work with each of their grantees in implementation of the LC process and the development of EBP.

  43. Thank you for your hard work in improving the interconception care services across all of our projects! Your quality improvement efforts are truly making a difference in the communities we serve!

  44. Contact Info Division of Healthy Start and Perinatal Services (DHSPS) Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA) (301) 443-8283 Your federal Healthy Start Project Officer

  45. Questions? Please Submit a Question. Also: Please take a moment before leaving the webcast to take our survey so that we can continue to improve. An archive of this presentation will be available in approximately two (2) weeks at: www.learning.mchb.hrsa.gov

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