Transcript Findings from the Healthy Start Interconception Care Learning Community American Public Health Association Meeting Presentation Overview  Description of the ICC Learning Community  Approach to Quality Improvement  Findings –

Findings from the
Healthy Start
Interconception
Care Learning
Community
American Public Health
Association Meeting
2012
Presentation Overview
 Description of the ICC Learning
Community
 Approach to Quality Improvement
 Findings
– Learning Collaborative and
Individual Grantee Level
– Overall PDSA Results
– Recommendations and Discussion
Abt Associates | pg ‹#›
Healthy Start ICC LC Project Goals
 Advance the quality and efficacy of Healthy Start
interconception care (ICC) components
 Address identified gaps in the provision of ICC in
Healthy Start
 Develop a toolkit to guide
maternal and child health
programs with their
ICC activities
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What’s New About ICC LC?
 Implement a quality improvement (QI) “learning
collaborative” model in all (104) Healthy Start
projects
 Apply QI model to improve non-clinical, communitybased services
 Translate ICC research to practice
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Key Components
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Engagement of Experts:
Who Participated?
 All Healthy Start
grantees (104 teams)
 Expert Work Group
(20 members)
 Abt Associates;
Johnson Group
 DHSPS
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Framework for ICC LC Change:
What HS teams worked on
Strengthening
Linkages and
Partnerships
Advance use of
objective tools and
data collection
methods
Improve Healthy
Start staff skills
and training
Case Management
ICC Screening
Assessment
Family Planning/
Reproductive Health
Primary Care
Linkages
Maternal
Depression
Healthy Weight
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Resources to Support the Work
 Four webinars to lay out the project (a project overview,
review of ICC evidence base, QI principles and speakers
from other QI initiatives, team selection)
 Annual in person meetings with 5 attendees per HS
Project
 Private website with resources, project materials,
discussion forums, master list of all participants, etc.
 Webinars on topics of interest
 individual team consultation with Contractor Project Team
staff via telephone and email
 ICC LC newsletters
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Learning Collaborative Structure
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Plan-Do-Study-Act Cycles
 Institute for Healthcare Improvement (IHI)
model for Quality Improvement
 PDSA Cycles are a way of testing small
changes to see if quality of services improves
 Learning Collaboratives of 5 to 8 Healthy
Start Projects working on similar changes
held 5 peer-learning teleconferences
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Interconception Care
Learning Community:
Findings
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Family Planning: Strengthen
Partnerships and Linkages
 Seven HS teams worked on
this improvement
 Changes were unique to the
local context
– Develop relationships with
OB/GYNs in a rural county
– Create Resource Guide of
Family Planning Organizations
willing to serve Healthy Start
women and appropriate to
refer to
– Organize a Family Planning
community consortium to
minimize service gaps and
maximize resources
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Family Planning: Strengthen
Partnerships and Linkages
AIM:

 Assure at least 50% of
LCHS participant women
have a family planning
method at discharge from
the hospital at delivery.
Percent Clients Using FP Method by
Interval Jan 2010 – Dec 2011
 Assure at least 80% of
LCHS participants are using
an effective birth control
method at 3 months after
delivery, at 9 months, 12
months, 18 months and 24
months after delivery.
MEASURE:
Reporting
Interval
Clients
with
Reported
FP Status
for Reporting
Interval
% of Total
Clients
with
Reported
FP
Method
3 months
373
78%
6 months
270
79%
9 months
192
81%
12 months
139
85%
18 months
45
83%
24 months
0
0
Abt Associates | pg ‹#›
Maternal Depression: Advance Use of
Evidence-based Tools
 AIM:
 MEASURE:
Five HS Sites in Texas
collaborated to select a
uniform maternal
depression screening
tool and train all staff on
the tool in order to help
DPH.
A common tool was
selected and all Texas
Healthy Start Staff were
trained on the screening
tool.
Abt Associates | pg ‹#›
Healthy Weight: Improve Healthy Start
Staff Skills And Training
AIM:
By January 2012,
100% of MBHS
staff will have an
increased
knowledge base in
Healthy Weight
MEASURE:
Pre and Post Survey on
Knowledge & Behavior
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Pre and Post Test Results
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Results from First PDSA Cycle

102 ICC LC Healthy Start teams in Cycle One made
progress as follows:
 9 instituted new or revised care plans, with case
management protocols for referrals and follow up
 20 revised protocols for assuring access to family planning
 10 implemented a reproductive life planning approach
 5 introduced protocols for evidence-based education &
health promotion about healthy weight and postpartum
weight loss
 7 improved BMI measurement and recording
 12 implemented evidence-based maternal depression
screening, and 6 devised new referral and follow up
protocols
 14 revised interconception care screening/assessment tools
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Overall Accomplishments
 Grantee capacity to use QI
 Staff knowledge of topics such as family planning,
healthy weight, and maternal depression.
 Use of evidence-based or evidence-informed
tools (e.g., ICC screening, BMI, depression,
reproductive life plans).
 The number of program participants counseled
 Completed referrals and follow-up through more
rigorous and specific staff protocols
 Strength of linkages and partnerships, visibility in
community
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Challenges
 Finding time to do the work
given other responsibilities
 Bringing community partners to
the table was time consuming
and difficult
 QI concepts and nomenclature
were new to most participants
 Measuring change for QI was
new, and differed from
evaluation metrics
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Project Team Recommendations
 Related to quality improvement (QI)
– Continue focus on quality improvement
– Provide robust TA using varied methods
– Emphasize measurement and provide TA
– Encourage peer learning and sharing
– Increase dissemination opportunities
– Involve program participants in QI
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Project Team Recommendations
 Related to interconception care
– Standardize interconception care
components
– Encourage grantee self-assessment
– Strengthen ties to community resources
(e.g. FQHC)
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Discussion
 What is the optimal way to implement Quality
Improvement in Community based organizations?
– Start with a few organizations who are poised to be leaders
in this QI, provide training and support peer-to-peer
coaching?
 What level of resources is needed to train CBOs on
QI?
 How should we measure success in implementing QI
techniques?
 Which LCs are successful and why? What can we
replicate from existing examples?
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Abt Associates, Inc.
Johnson Group Consulting, Inc.
Lisa LeRoy, Ph.D., M.B.A.
Kay Johnson, Ed.M., M.P.H.
Sarah Ball, Sc.D., M.P.H.
Vonna Drayton, Dr.P.H.
Division of Healthy Start and
Perinatal Services
Meredith Pustell
Juliann DeStefano, RN, MPH
Alice Lee
Johannie Escarne, MPH
Deborah Klein Walker, Dr.Ed.
Kimberly Deavers, MPH
For more information:
[email protected]
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