Transcript Slide 1

New Hampshire
Quality Improvement Learning Teams
Reducing Preventable Risk Factors that
Predispose to Chronic Disease
*Focus on reducing childhood obesity*
Existing NH Public Health Infrastructure
• 234 cities and towns
– Health Officer required by statute
• 5 communities with public health departments
• No county health departments
• State level:
–
–
–
–
DHHS (lead agency),
Department of Environmental Services
Department of Education
Department of Safety
• Strong community-level informal public-private
partnerships
• Currently engaged in a regionalization process
Selection process:
Mini-Collaboratives (QuILTs)
• RFP
• Ranked target area:
• Reducing Preventable Risk Factors that
Predispose to Chronic Disease
– Focus on reducing childhood obesity
• Formal proposal review process
• Aligned with state health priorities and
strategic plan
QuILTs
•
Currently: 1st of 2 cohorts, 3 each, 15 months
– Caring Community Network of the Twin Rivers
– Lakes Region Partnership for Public Health
– Mascoma Valley Health Initiative
•
Content experts
– Regina Flynn, Health Promotion Advisor - KidPower! Program, NH DHHS Nutrition & Health Promotion
– Mindy Fitterman, M.Ed., R.D., Nutrition Consultant, NH Fruit and Vegetable
Program DHHS, Division of Public Health Services
•
Timeline
–
–
–
–
–
Kickoff 9/08
Monthly meetings – conference call, LiveMeeting, in person
Mid session: 4/09
Completion 11/09
Mentors to Cohort 2 through 4/2011
•
Lead: Susan Laverack
• Identify an Opportunity: Obesity
•
Belknap County:
• One of top 4 health issues
• Greatest % overweight and obese WIC enrolled children
• 75% of residents consume < 5 servings fruits &
• Assemble a Team:
•
Lakes Region Physical Activity and Nutrition Committee (PAN)
• LRGHealthcare (Dieticians, Education and Outreach), Parks and Recreation
Director, UNH Extension Specialist, Belknap-Merrimack CAP Laconia Child Care
Director
– SAU Superintendent
– Pleasant Street School Staff
– Principal, nurse, teachers, SAU food director, guidance counselor
Examine Current Approach & Identify Potential
Solutions
• Current approach
•
Lack of Resources
School not eligible
for USDA F/V snack
program.
9.4% or residents in Laconia below
poverty level
Curriculum full,
little room to add
topic areas.
Fresh F/V may be
inconvenient for
families to keep in
stock.
Sweets and junk
foods given as
rewards.
Prepackaged
foods are more
convenient.
Parents may be unaware of or
lack access to healthy resources
Students: not cool
to bring a healthy
snack.
Lack of Knowledge
– Few healthy eating/active living
activities
2nd grade students at
Pleasant Street School
do not each enough
fruits and vegetables
at snack time.
Students unaware of
the benefits of fruits
and vegetables.
Teachers may be
unaware of the
resources available to
support teaching.
Incentives/Motivation
– Nurse and Guidance Counselor teach a
4-wk Wellness Curriculum for 5th grade
Environment
F/V expensive, short
shelf life.
School w/ high interest level,
fragmented coordination
Parents may be unaware
of the nutritional
benefits of fruits and
vegetables
• Potential Solutions
•
Interventions based on 5-2-1-0 w/ focus
on the “5” in one 2nd Grade classroom
– Consulted with DHHS and local
nutritional experts
– Determined all possible ways food is
consumed by students before, during
and after school - greatest potential to
impact improvement at snack time
Develop an Improvement Theory
Through multi-component nutritional intervention the % of 2nd grade students
who bring a fruit or vegetable for snack will increase.
*****
AIM: 2nd Grade Students will bring fruit and/or
vegetable for snack at least 60% of the time by 6/09
*****
• Multi-component nutritional information and activities to 2nd grade
students
•
•
•
•
•
Taste Testing
Visit to grocery store
Design bulletin board
Prepare & serve healthy foods to 5th grade “Book Buddies”
Integrate project into school’s Wellness Committee
Check the Results
• ↑ Fruit/Vegetable ID and
Percentage of 2nd Grade Students Consuming
F/V at Snacktime
understanding of nutritional
benefits (pre-post test)
90
80
77
• Cycles of Change
– Dec: Taste Tests
– Feb: Trip to Grocery Store
– April: School-Wide
Principal’s Tie Challenge
– May: Prepare & serve
healthy snacks to 5th
graders
–
↑ awareness and
enthusiasm across the
school
Mean Percentage
70
63
60
52
50
40
30
20
25
10
0
Dec
Feb
Apr
Months of Measurement
June
Establish Future Plans
• Improve processes for working with QuILT
members
• Broaden successes to fifth grade
• Developmentally-appropriate activities (e.g., student
involvement in tracking tools and data collection)
• HEAL funding source to broaden initiatives to
other schools within region
• Explore Snack Policy (informal)
• create school-wide practice “this is how we do it”
Improve Nutrition Literacy
and Food Choices in
Elementary
Students and their Families
Mascoma Valley Health Initiative
in partnership with
Canaan Elementary School
Lead: Susan F. Houghton, MA, PhDc., ED, MVHI
Improvement Theory/ Assemble Team
• Improvement Theory
• Rates of overweight and
obesity, and obesity-related
chronic disease, can be
positively impacted through
nutrition education that:
– Integrates hands on
learning
– Involves the family
– Results in an increase in
healthy food choices
Mascoma Valley Health Initiative
• Building the Team
– Elementary school
Guidance Counselor
– Elementary Principal
– SAU Superintendent
– Pediatrician
– Pediatric NP
– Community Health
Manager, Alice Peck Day
Hospital
– MVHI Project Coordinator
Current Approach/Potential Solutions
•
•
Current Approach
– A faculty-developed
nutrition curriculum
– “Big 3” macro-nutrients
Environmental Challenges
– Food Desert
•
Snack packing literacy: What’s in your
snack?
•
Calcium and bone density: how do
beverages matter?
•
“Find the Fiber” in food labels – how
“special” is Special K?
•
Healthy eating! Popcorn, salsa,
vegetables.
•
Posters based on new food pyramid
•
Family night and poster show
•
Family quiz game
•
4-Ingredient Trail Mix: Cheerios, Dried
Cranberries, Raisins, Chocolate Chips
•
Group work: benefits of nutrients
– Socieconomics
•
Intervention
– Target: 4th grade students
(n=50)
– Teach new food pyramid,
macro- and micro-nutrients,
focus on Calcium
– Nutrition literacy: reading
food labels
Check the Results
• Measurements: Food
Knowledge and Family
Participation
• Family night drew more than
75 people
• 40 copies of 4-Ingredient Trail
Mix recipe distributed
• New School-wide Wellness
Policy developed, Approved
by School Board and
Implemented Fall 09
• QuILT leader member of
Wellness Committee
Next Cycles of Improvement
• Increase focus on food choices:
– Measuring snacks brought from home
– Increase in-school and take-home messaging about snacks
• Follow current 4th graders to Middle School next year
• Incorporate food preparation (classroom kitchen)
• Integrate other activities to teach a “healthy food environment”
curriculum:
– Physical activity – energy balance
Mascoma Valley Health Initiative
C
CNTR
Caring Community Network of the Twin Rivers
841 Central Street, Franklin, NH 03235
Working Together for Healthier Communities
Telephone (603) 934-0177 Fax (603) 934-2805 website www.ccntr.org
Childhood Weight Management and Obesity Prevention
Quality Improvement
Serving a Population of over 34,000
Michael Loomis, MPH
Community Program Specialist
Team Members
•
•
•
•
•
•
Rick Silverberg, LICSW (CCNTR)
Michael Loomis, MPH (CCNTR)
Sally Minkow, BSN, CHES (LRGH)
Rick Wilson, MD (LRGH)
Melissa Rizzo, M.Ed (LRGH)
Wendy Pavnick, PA-C (Health First Family Care
Center, FQHC)
Assessment of Need
2007-2008 Age/Gender Specific Body-MassIndex (BMI) Percentile for Franklin School
District Kindergarten-4th Grade
Percent of Students in Risk
Rating
60%
50%
40%
Students (n=496)
HEAL Goal*
30%
20%
10%
0%
Healthy
Weight
Overweight
Obese
BMI Percentile Risk Rating
• Upon notice to parent from school nurse of overweight
or obese status and health risks related, parents
respond with negative feedback with noted reflection
to absence of discussion during primary care visit
• Run report at 3 local primary care practices of children
ages 2-19 with a well-child visit in 2007 fiscal year with
a documented BMI or BMI percentile
• Focus on Primary Care Setting and how weight
related risk and behavioral assessment is being
delivered to youth
PLAN
• Documentation Rates Baseline:
– BMI documentation rates in 2-19 year olds with a
well-child visit between 7/1/07-6/30/08 among 3
local primary care practices vary (12.6-90%)
• EMR well-child vital sign template with BMI risk rating
calculator identified and uploaded
• PCP “Wellness Champion” to test QI in clinic
CHRONIC CARE MODEL!
PLAN
• To begin process, educate providers on BMI
measures, community profile, available
referral resources
• Update Medical staff on research identifying
weight-related health as an indicator for
chronic disease risk
• Motivational Interview training
• BMI behavioral risk screening tool
• EMR technology that auto-calculates BMI risk
rating at well-child office visit
Improvement Theory
• The team will improve health care provider
access to timely BMI risk rating analysis
through redesign of clinical flow to assess
behavior, provide effective communication
strategies and referrals, and interpret weight
related health into diagnosis and treatment
• Goal of all 3 Primary Care Practices
documenting at least 65% of children’s BMI
seen in the following year
DO
• Review evidence and recommendations for
increasing assessment, prevention, treatment
and clinical guidelines
• Identify EMR BMI risk rating tool and upload for
prompt evaluation at time of visit
• Designate a “Wellness Champion” in clinic
• Create and educate medical staff on clinical
office flow for weight-related health risk factor
assessment
• Document SM goal in pt’s chart as a
measurable health indicator
• Educate providers on referral resources to
community HEAL interventions
• Identify locations suitable for outreach activities
to distribute printed materials to community
members
STUDY
GOAL REACHED!
• After 1 year of new EMR applications and provider
education, all three Primary Care Clinics were
documenting at least 65% of children’s BMI and using
EMR 5210 tab to discuss weight related health by
focusing on preventing the risk factors (72%, 89%,
92%)
• Promote routine calculation of BMI risk rating at each
clinical encounter as a VITAL SIGN to encourage
weight-related health and its impact on the patient’s
overall health and well being as well as its impact on
public health
ACT
• Continue to educate and promote the importance of
daily behaviors related to 5210 Healthy NH
• Continue to foster collaboration between CCNTR and
local PCP about referral for local nutritional and
physical activity resources
• Continue to utilize QI tools in day-to-day activities
• Continue broad community outreach to target
population
Establish Future Plans:
• Continue familiarizing CCNTR staff with QI concepts,
tools and methods with particular evidence on
evidence-based interventions
• Relay obesity statistics, trends and health indicators to
health care partners to further develop QI echoing
community efforts
• QI will be expanded to other Healthy Eating Active
Living (HEAL) sectors in the region (worksites &
workplaces, schools, food & recreation industries,
communities & municipalities
Each partner brings their own influence on the
community to the table. When we put them together it
creates a “Quilt” covering our community with a
universally delivered message