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Healthy Start Interconception Care Learning Community (ICC LC)
Using Quality Improvement for Better Preconception Care
Preconception Care Summit
June 14, 2011Lisa LeRoy, PhD Abt Associates
Kay Johnson, MPH, Johnson Group Consulting
Healthy Start Interconception Care Learning Community (ICC LC)Healthy Start Interconception Care Learning Community (ICC LC)
Acknowledgements
This Project is funded by the Division of Health Start and Perinatal Services, HRSA
Project Team: Deborah Walker, EdD Cheryl Austin, RD, MPH Sarah Ball, DrPH Vonna Drayton, PhD Meredith Pustell Kay Johnson, MPH Lisa LeRoy, PhD
Healthy Start Interconception Care Learning Community (ICC LC)
Overview of Presentation
Goals of the Healthy Start Interconception Care Learning Community (ICC-LC)
The Quality Improvement Model
Examples of ICC LC change projects
Challenges
Lessons Learned
Healthy Start Interconception Care Learning Community (ICC LC)
Goals of the Healthy Start ICC-LC
The Healthy Start Interconception Care Learning Community (ICC-LC) was developed by the Maternal Child Health Bureau (MCHB) to: Improve the quality of Healthy Start interconception care
(ICC) components
Use the Model for Improvement
Develop a toolkit to guide MCH programs in their quality improvement activities
Healthy Start Interconception Care Learning Community (ICC LC)
Why interconception care focus?
In Healthy Start, interconception period is 24 months after one pregnancy for high-risk women.
ICC is a required component for all Healthy Start projects.
Evidence-based practices can be implemented or promoted by Healthy Start grantees.
Content of ICC had not been operationalized for women in Healthy Start. Work with infants and toddlers is better defined. This is a chance for grantees to apply new evidence.
Healthy Start Interconception Care Learning Community (ICC LC)
What’s new about ICC LC?
Implementing a quality improvement (QI) “learning collaborative” model in all 104 Healthy Start projects
Applying a QI model to improve non-clinical, community-based services
Translating ICC research to practice
Healthy Start Interconception Care Learning Community (ICC LC)
The “Model for Improvement”
for ICC-LC Change Projects
Healthy Start Interconception Care Learning Community (ICC LC)
The Model for Improvement
What are we trying to accomplish?
How will we know that a change is Improvement?
What changes can we make that will result in Improvement?
Plan
Do
Study
Act
The Improvement Guide, 1996 Jossey-Bass
Healthy Start Interconception Care Learning Community (ICC LC)
ACT: - Adapt?
- Adopt on wider scale? - Abandon?
- Next cycle?
PLAN: - Objective, aim, change- Questions (why)- Plan to carry out the cycle
(who, what, where, when)
DO: - Carry out plan on small
scale, rapid cycle - Document problems and
unexpected results- Begin analysis
STUDY: - Complete analysis of data
- Compare results to predictions
- Summarize lessons learned
PDSA Cycle for Learning and Improvement
Healthy Start Interconception Care Learning Community (ICC LC)
ICC LC Process Each Healthy Start program chose a topic area and
a change concept 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 15 Learning Collaboratives in Learning Community Learning Collaboratives meet bimonthly to discuss the
process and share information
Web-based tools and telephone conference calls facilitate exchange of information
Healthy Start Interconception Care Learning Community (ICC LC)
Modalities for Learning
Face-to-face learning through ICC LC meetings among the 102 teams
Action periods (9 months) between meetings Teams work at home on change project and PDSA
Learning Collaboratives 5-8 teams working on same topic & change concept Meet by telephone (bimonthly)
Technical assistance and support through web-based communication tools
Healthy Start Interconception Care Learning Community (ICC LC)
Healthy Start Interconception Care Learning Community (ICC LC)
Framework for ICC LC ChangeStrengthening
Linkages & Partnerships
Advancing Use of Evidence-Based
Tools & Data Collection
Improving Healthy Start Staff Skills &
Protocols
Case Management
Screening & Assessment
Family Planning
Primary Care
Maternal Depression
Healthy Weight
Healthy Start Interconception Care Learning Community (ICC LC)
Examples of Projects
5 Programs in Texas chose the same Maternal Depression screen (Edinburgh), implemented shared training and data system redesign and are now able to report meaningful results to the state
Indianapolis developed a standardized protocol to measure height & weight, calculate BMI
Educated women as to the meaning of their BMI number and associated health risks
Refered those ≥ 25 to appropriate services
Healthy Start Interconception Care Learning Community (ICC LC)
Examples of Projects
Many HS Projects implemented a Reproductive Life Plan with ICC clients and instituted intensive follow-up on birth control methods
Some teams trained staff on contraceptive methods; conducted sensitivity training around their own family planning values and how to talk with clients about the topic
Oregon and Milwaukee provided family planning baskets to clients (include condoms, Plan B, education materials, lists of acceptable providers)
Healthy Start Interconception Care Learning Community (ICC LC)
Examples of Projects
Chicago programs focused on identifying a medical home for clients
SE Chicago ensured that clients had a PP visit within 60 days of delivery
Many sites implemented an evidence-based screening and assessment protocol to identify women at risk for maternal depression, chronic conditions, etc.
Healthy Start Interconception Care Learning Community (ICC LC)
Summary
Healthy Start Interconception Care Learning Community (ICC LC)
Challenges Encountered
Staff turnover in HS projects
Limited resources (including time) Within the project to follow through with the PDSA plans
Outside of the project (health center partners, providers, etc)
“Buy-in” of staff & clients
Learning curve for technologies used as foundation for learning community
Accountability to Learning Collaborative teams
Healthy Start Interconception Care Learning Community (ICC LC)
Challenges Encountered, continued
Limits on data systems and lack of control that would enable changes (e.g., contractor developed data system)
Having an adequate number of women (clients) to complete the change project on schedule
Competing demands between ICC and PDSA tasks and other Project work
Healthy Start Interconception Care Learning Community (ICC LC)
Lessons Learned
QI using PDSA can help improve Healthy Start interconception services
Staff and participants were satisfied with LC processes; unidentified and unmet needs were discovered and tools to take action were shared and implemented
Evidence-based and promising practices exist for use within a variety of areas of ICC care
QI study/PDSA is different than evaluation and performance monitoring
Healthy Start Interconception Care Learning Community (ICC LC)
Lessons Learned, continued
Focusing intently on making one change at a time within a topic has allowed projects to accomplish more
PDSA processes helped projects be systematic and consistent in applying their change
Projects have shared protocols, instruments, tools, data, and methods with each other, allowing them to be more efficient and effective
Healthy Start Interconception Care Learning Community (ICC LC)
Questions? Comments?
Healthy Start Interconception Care Learning Community (ICC LC)
For More Information:Lisa LeRoy, PhD, ICC LC Project Director
Abt Associates, Inc.