01 PQRI Quality Risk Mgt Quality Systems and Improved Product Quality 3
and Improved System Quality or What Do I Think About the ...
Transcript of and Improved System Quality or What Do I Think About the ...
Brad Therrell, NNSGRC M. Ramachandran, Georgia Julie Miller, Nebraska
or or What Do I Think About the What Do I Think About the
Performance Performance Evaluation and Evaluation and Assessment Assessment Scheme?Scheme?
Newborn Screening Self Assessment Newborn Screening Self Assessment and Improved System Quality and Improved System Quality
NEWBORN SCREENING PERFORMANCE EVALUATION AND ASSESSMENT - HRSA Cooperative Agreement
Purpose:
To support improvement of newborn screening (NBS) systems, and ultimately patient services, by developing a Program Evaluation and Assessment Scheme (PEAS).
Activities:
1. Develop multi-disciplinary project team(s)
2. Collect and assess PEAS tools/activities currently available
3. Create a comprehensive PEAS for the NBS system
4. Validate the usability of PEAS within the community
5. Update and periodically reevaluate based on user input
PEAS PROJECT OVERSIGHT/ADVICE COMMITTEE
Committee MembersWilliam Becker Association of Public Health Laboratories E. Stephen Edwards American Academy of Pediatrics Charlie Homer National Initiative for Children’s Healthcare Quality Alex Kemper University of Michigan (Evaluation Specialist) Christopher Kus Association of Maternal and Child Health ProgramsKelly R. Leight CARES Foundation, Inc. – Lay Advocate
(CAH Research, Education, and Support) Trish Mullaley Genetic Alliance – Lay Advocate
(PKU and Allied Disorders) Patricia McLaughlin Association of Women’s Health, Obstetric and
Neonatal Nurses (AWHONN) David Ross Public Health Informatics Institute
Project Overall Direction (POD)Brad Therrell NNSGRC Michele Puryear HRSA Marie Mann HRSA Harry Hannon CDC Marion Schwartz Follow-up/Education Working Group (Contractor) Carol Southard Laboratory Working Group (Contractor)
LABORATORY WORKING GROUP
Project Co-Manager:
Carol Southard New Jersey – NBS Laboratory Director
Members:
Lisa Bates Florida – NBS Laboratory Director Roger Eaton Massachusetts – Regional NBS Laboratory Director Cheryl Hermerath Oregon – Regional NBS Laboratory DirectorGary Hoffman Wisconsin – NBS Laboratory DirectorEldridge Hutcheson Texas – Laboratory Operations ManagerMark McCann Minnesota – NBS Laboratory Director John Sherwin California – NBS Laboratory Director
Oversight:
Brad Therrell NNSGRC Marie Mann HRSA Harry Hannon CDC
Ex Officio:Donna Williams NNSGRC – Texas NBS Laboratory QA
Project Co-Manager:Marion Schwartz New Jersey – Follow-up Coordinator
Members:Sharon Anderson New Jersey – Practicing Nurse Louis Bartoshesky Delaware – Physician Consultant Mary Ann Gordon Maine – Consumer Advocate Penny Hatcher Minnesota – Follow-up Supervisor (DBS/NHS) Pam King Oklahoma – Follow-up Supervisor Marcia Lavochkin New Hampshire – Follow-up Coordinator Fred Lorey California – Development/Evaluation Director Julie Miller Nebraska – Program Manager Charles Myers Louisiana – Program Manager Ellie Mulcahy Maine – Program Manager Sheila Neier Washington – Follow-up Supervisor Sonya Ross Maryland – Sickle Cell Disease Association
Observers:Irene Forsman HRSA – Newborn Hearing Screening John Eichwald CDC – Newborn Hearing Screening
OversightBrad Therrell Texas – NNSGRC Marie Mann HRSA – Contract Officer
FOLLOW-UP/EDUCATION WORKING GROUP
NEWBORN SCREENING PERFORMANCE EVALUATION AND ASSESSMENT
SELF-ASSESSMENT PERFORMANCE CHECKLISTWith Example References/Activities for Improvement
I. CROSS-CUTTINGII. PRE-ANALYTICALIII. ANALYTICALIV. POST-ANALYTICALREFERENCES
PERFORMANCE INDICATOR FINDINGS EXAMPLES/REFERENCES
Yes In Prep No
Philippine PEAS Philippine PEAS –– Poster 44 Poster 44 –– C. Padilla C. Padilla Brazil PEAS Brazil PEAS –– In Development In Development –– J. J. BotlerBotler
Georgia Newborn Screening Program
Screening Laboratory
All metabolic cases.Emory UniversityPediatrics Dept.
Division of Med.Genetics
All SCD casesGrady Hospital
Locate the childKeep under observation
Confirmatory TestingManagement
Feedback to Program
Reference TestingMedical College
of Georgia, Augusta
Sickle- cellFoundationCounseling
Hemoglobin Genetic Testing
Family Studies
HospitalsPediatric clinics
Health Dept.
Genetic Adv.Committee
Voice Responsesystem
AdministrationBudget
Director
PROGRAM EVALUATION AND ASSESSEMENT SCHEME (P.E.A.S)
SCHEME AIMS AT PROVIDING:SCHEME AIMS AT PROVIDING:
““Precise Program DefinitionPrecise Program Definition””
““Flexible program evaluationFlexible program evaluation””
A tool to A tool to ““refine and enhancerefine and enhance”” systemsystem
A A ““system assessmentsystem assessment”” tooltool
PROGRAM EVALUATION AND ASSESSEMENT SCHEME (P.E.A.S)
1.1. As a planning tool.As a planning tool.2.2. As an Evaluation tool.As an Evaluation tool.
Criteria:
SpecificMeasurableAchievableRealisticTime-bound
Criteria:
SSpecificMMeasurableAAchievableRRealisticTTime-bound
Components:Components:
GENERALGENERALPREPRE--ANALYTICALANALYTICALANALYTICALANALYTICALPOSTPOST--ANALYTICALANALYTICAL
I General Considerations:
Addresses: EducationInformation SystemsMonitoring timely and Universal ScreeningProgram Administration and Financing.Contingency plan
1)1) As a planning tool As a planning tool –– a very good check lista very good check list2)2) As an Evaluation tool As an Evaluation tool –– some issuessome issuesSS –– YesYes
MM ––YesYesAA –– May beMay beRR –– Not in Some areasNot in Some areasTT –– YesYes
Planning
25
75
YES NO IP
Perc
enta
ge
Evaluation
75
25
YES NO IP
Perc
enta
ge
1. As a Planning Tool : 1. As a Planning Tool : ““Exhaustive ListExhaustive List””2. As an Evaluation Tool: helps identify issues2. As an Evaluation Tool: helps identify issues
CommentsCommentsA A ““Mandatory data setMandatory data set”” –– Uniform formatUniform formatCompatibility with different systemsCompatibility with different systemsFire walls/alternatives?Fire walls/alternatives?Different wings of the program have different time line/Different wings of the program have different time line/--Priorities. Priorities. Vital records are completed very late. Monitoring screening to Vital records are completed very late. Monitoring screening to completion is not always possible. completion is not always possible.
-- Factual approachFactual approach-- Probability approachProbability approach
SS –– YesYesMM –– YesYesAA –– Yes/ May beYes/ May beRR –– Yes/ May beYes/ May beTT -- YesYes
Computerized Information system33
10 9
YES NO IP
78
1
YES NO IP
EducationGeneral considerations
Monitoring of Timely and Universal Screening
1.Planning tool : Useful/addresses all 1.Planning tool : Useful/addresses all possibilitiespossibilities
2.Monitoring tool : Useful2.Monitoring tool : Useful
S S –– Very SpecificVery SpecificM M –– YesYesA A –– Yes/NoYes/NoRR –– YesYesTT ---- YesYes
CommentsCommentsInitial Screening may be monitored to completionInitial Screening may be monitored to completionSubsequent screening Subsequent screening ––VitiatedVitiated by participation from private labsby participation from private labsAssignment of responsibilities/MonitoringAssignment of responsibilities/Monitoring
78
1
YES NO IP
Program Administration/Financial1.Planning tool : Useful/has limitations1.Planning tool : Useful/has limitations2.Monitoring tool: Idealistic2.Monitoring tool: Idealistic
SS –– Not Very SpecificNot Very SpecificMM –– Yes but not fullyYes but not fullyAA –– May beMay beR R –– No/some unrealisticNo/some unrealisticTT -- DonDon’’t Knowt Know
Comments:Needs revision in the light of Expanded screening/
“Fee systems’.Can be revised to make it more realistic and
meaningful.
35
15
2
YES NO IP
II PRE-ANALYTICAL CONSIDERATIONSAddressesAddresses
PersonnelPersonnelPrenatal EducationPrenatal EducationScreening Process/Special collection Screening Process/Special collection Lab safetyLab safety
276 416
1,0651,683
3,091
6,531
Date Of Birth Date Collected Time Collected Time Of Birth Birth Weight IncompleteDemography
Missing Demography
Num
ber o
f Spe
cim
ens
138
256
YES NO IP
SS –– YesYesMM –– YesYesAA –– May be/not alwaysMay be/not alwaysRR –– IdealisticIdealisticTT -- YesYes
Comments:Comments:-- Very Exhaustive Very Exhaustive -- More useful as a monitoring toolMore useful as a monitoring tool-- Program has only recommendatory roleProgram has only recommendatory role-- No actual control over preNo actual control over pre--analytic variancesanalytic variances-- Talks exhaustively about documentation of every Talks exhaustively about documentation of every
prepre--analytic activityanalytic activity
III. ANALYTICAL CONSIDERATIONSAddresses:Addresses:
TestingTestingInstrumentationInstrumentationlab. Supplieslab. SuppliesWorking EnvironmentWorking Environment
87
16
2
YES NO IP
SS –– Very SpecificVery SpecificMM –– Yes Yes AA –– Yes Yes RR –– YesYesTT -- YesYes
As a Planning tool As a Planning tool –– A very Comprehensive check listA very Comprehensive check listAs a Monitoring tool As a Monitoring tool –– Excellent check list Excellent check list
COMMENTSCOMMENTS-- Scores both as a planning and monitoring tool.Scores both as a planning and monitoring tool.-- More of the environmental More of the environmental controlscontrols monitored at the labmonitored at the lab--levellevel
IV POST- ANALYTICAL CONSIDRATIONSAddresses:Addresses:
Screening Test resultsScreening Test resultsShortShort--term followterm follow--upupFollowFollow--up support activitiesup support activities
88
44
26
YES NO IP
SS –– Exhaustively SpecificExhaustively SpecificMM –– NoNoAA –– Not in full Not in full RR –– Not practical in certain areasNot practical in certain areasTT –– YesYes
Comments:Comments:1.1. Needs to be made more realistic and achievableNeeds to be made more realistic and achievable2.2. Good details are lost by an Good details are lost by an ““idealistic approachidealistic approach””..3.3. Medical Management protocolsMedical Management protocols-- Can this be monitored by screening program?Can this be monitored by screening program?4.4. long term followlong term follow--up up ––VagueVague--Intentional flexibility?Intentional flexibility?
Using the PEAS for program development in Nebraska
Julie Miller, Program Manager
May 2007 NBS & Genetics Symposium
Background
Nebraska’s NBS program administered out of Dept. Health & Human ServicesLaboratory Services are contracted (Pediatrix)Follow-up (Short-term) is within the Dept.Some Treatment (long-term) is paid for by Dept. via contracts with sub-specialty clinics & metabolic foods companies
Who should complete the self-assessment tool?
Program Manager in our case, with technical lab evaluation done by the Laboratory Director
In some states will be Lab Director and Follow-up Director and/or Medical Director
Should be whomever knows the system the best
How we used it:
1) Completed the PEAS 2) Asked for program staff review3) Distributed copies to all members of the Nebr. NBS Advisory Committee (NBSAC)4) Reviewed missing or “in progress”elements at quarterly NBSAC meeting
Advisory Committee1) Reviewed and discussed
whether or not they agreed with the initial assessmentareas needing work
2) Considered resources available to address weaknessesimpact of elements not being in placeurgency of getting missing or weaker elements in place
3) Considered strategies for addressing themwork groups to concurrently address thingsprioritizing and using existing program staff to address one at a timecontract with outside help (hiring freeze)find volunteers to help
Advisory Committee1) reviewed and discussed
Whether they agreed with the initial assessmentAreas needing work
2) Considered resources available, impact of elements not being in place, urgency of getting missing or weaker elements in place
3) Considered strategies for addressing them:Work groups to concurrently address thingsPrioritizing and using existing program staff to address one at a timeContract with outside help (hiring freeze)Find volunteers to help
Work to be done…
Education “Plan”Informatics “Plan”Communications PR “Plan”Contingency PlanProcedures to “ensure” EI and LT/FU connectedShort-term Follow-up “Evaluation Plan”Long-term follow-up
Work to be done…
Education Plan Informatics PlanCommunications PR PlanContingency PlanProcedures to ensure EI and LT/FU connectedShort-term Follow-up Evaluation PlanLong-term follow-up
How it has helped:
Director of HHS was informed of Committee discussion, and the progress on development of an “All Hazards Preparedness Plan” for NBS. Supportive of use of other Dept. resources, e.g. pan-flu coordinators, development of table-top exercises etc.
Other benefits
Helped us stand back and take a comprehensive look.A lot getting done, but often not in a planned manner, with evaluation built in.Helps focus efforts.
Acknowledgements:Advisory Committee
Khalid Awad, MDLawrence Bausch, MDJohn Colombo, MDKevin Corley, MDJeanne EggerDavid Gnarra, MDJames Harper, MD Vice ChairKathryn Heldt, RDMary KisickiRichard Lutz, MD, ChairBev MortonHoward Needleman, MDSamuel Pirruccello, MDChristine Reyes, MDWilliam Rizzo, MDKathy Rosssiter, MSN, APRNJill Skrabal, RDCorri StearnesDouglas Stickle, Ph.D.William Swisher, MDB.J. Wilson, MDHobart Wiltse, MD
Nebraska NBS Staff:Krystal Baumert, Follow-up CoordinatorKaren Eveans, Follow-up SpecialistMike Rooney, Adm. Asst./PKU Foods program
Nebraska HHS Administration:JoAnn Schaefer, MD, Chief Medical Officer & Department Director Jackie Miller, DDS, Director Health ServicesPaula Eurek, Administrator, Family Health