Transcript 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
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 nonclinical, 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
The Improvement Guide, 1996 Jossey-Bass
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
Act
Do
Study
Healthy Start Interconception Care Learning Community (ICC LC)
PDSA Cycle for Learning and Improvement
ACT:
- Adapt?
- Adopt on wider scale?
- Abandon?
- Next cycle?
STUDY:
- Complete analysis of data
- Compare results to
predictions
- Summarize lessons
learned
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
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 Change
Strengthening
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.
[email protected]
Healthy Start Interconception Care Learning Community (ICC LC)