Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better...

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Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14, 2011 Lisa LeRoy, PhD Abt Associates Kay Johnson, MPH, Johnson Group Consulting

Transcript of Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better...

Page 1: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 2: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 3: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 4: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 5: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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.

Page 6: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 7: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

Healthy Start Interconception Care Learning Community (ICC LC)

The “Model for Improvement”

for ICC-LC Change Projects

Page 8: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 9: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 10: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 11: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 12: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

Healthy Start Interconception Care Learning Community (ICC LC)

Page 13: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 14: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 15: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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)

Page 16: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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.

Page 17: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

Healthy Start Interconception Care Learning Community (ICC LC)

Summary

Page 18: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 19: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 20: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 21: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

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

Page 22: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

Healthy Start Interconception Care Learning Community (ICC LC)

Questions? Comments?

Page 23: Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14,

Healthy Start Interconception Care Learning Community (ICC LC)

For More Information:Lisa LeRoy, PhD, ICC LC Project Director

Abt Associates, Inc.

[email protected]