Lee County Health Department’s Accreditation Preparation Demonstration Site Project

State: IA Type: Model Practice Year: 2009

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In April 2008, LCHD first organized a NACCHO Self-Assessment QI team to complete the self-assessment process using the Operational Definition of a Functional Local Health Department’s Assessment Tool in preparation to become an accredited public health agency.

Two subsets of Standard III, Inform, Educate, and Empower People about Health Issues, were chosen to address during the project period after careful analysis and deliberation of the assessment team members: 1. Standard III-B, General Data and Information Exchange on Issues Affecting Population Health, and 2. Standard III-C, Provide Health Information to Individuals for Behavior Change.

Looking at these two standards, it was decided to narrow the agency’s focus to one agency program—the Maternal Child Health (MCH) program to be able to complete one PDSA cycle by the end of the project period. After a two-day planning and brainstorming session using various QI tools, it was agreed upon by all QI team members that increased awareness of MCH services was necessary and needed. LCHD did not have an effective system in place to inform, educate, and empower the community about MCH services available to link pregnant women and children to needed health care systems. The team chose to increase partnerships with providers as the primary improvement theory for the PDSA cycle.

The final aim statement (goal) was then developed: By October 31, 2008, LCHD will increase awareness of Title V/MCH care coordination services by meeting with at least one provider’s office in each county of the Title V/MCH service area. By October 31, 2008, of the 10 provider offices targeted, 7 (70 percent) agreed to a follow-up in person presentation to increase their awareness of LCHD’s MCH/Title V services and referral process. Many of the offices made positive comments of their increased understanding of the services available and of the referral processes and would make referrals if applicable. Three of the five counties (60 percent) had at least one presentation scheduled/provided.

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Lee County Health Department, Community Nursing and EH Services
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Lee County Health Department’s Accreditation Preparation Demonstration Site Project
In April 2008, LCHD first organized a NACCHO Self-Assessment QI team to complete the self-assessment process using the Operational Definition of a Functional Local Health Department’s Assessment Tool in preparation to become an accredited public health agency. Two subsets of Standard III, Inform, Educate, and Empower People about Health Issues, were chosen to address during the project period after careful analysis and deliberation of the assessment team members: 1. Standard III-B, General Data and Information Exchange on Issues Affecting Population Health, and 2. Standard III-C, Provide Health Information to Individuals for Behavior Change. Looking at these two standards, it was decided to narrow the agency’s focus to one agency program—the Maternal Child Health (MCH) program to be able to complete one PDSA cycle by the end of the project period. After a two-day planning and brainstorming session using various QI tools, it was agreed upon by all QI team members that increased awareness of MCH services was necessary and needed. LCHD did not have an effective system in place to inform, educate, and empower the community about MCH services available to link pregnant women and children to needed health care systems. The team chose to increase partnerships with providers as the primary improvement theory for the PDSA cycle. The final aim statement (goal) was then developed: By October 31, 2008, LCHD will increase awareness of Title V/MCH care coordination services by meeting with at least one provider’s office in each county of the Title V/MCH service area. By October 31, 2008, of the 10 provider offices targeted, 7 (70 percent) agreed to a follow-up in person presentation to increase their awareness of LCHD’s MCH/Title V services and referral process. Many of the offices made positive comments of their increased understanding of the services available and of the referral processes and would make referrals if applicable. Three of the five counties (60 percent) had at least one presentation scheduled/provided.
The following were the chosen priority standards to focus on after careful analysis made by the assessment team members: Standard III-B: General Data and Information Exchange on Issues Affecting Population Health. LHD uses social marketing to understand the informational needs of specific populations. This standard was an area of weakness for LCHD, as identified through the self-assessment. After discussion, LCHD thought this standard would be one to address through our QI process by developing an educational/marketing booklet for providers then following a marketing plan to target physician offices in the MCH/Title V service area to increase access of Maternal and Child Health (MCH) clients (Medicaid, Uninsured, underinsured pregnant women and children ages 0–21) needing medical and dental health care and other support services in the community. Standard III-C: Provide Health Information to Individuals for Behavior Change. Staff has capacity to create materials and campaigns to improve health behaviors. Because this was also an area of lower scoring in the self-assessment, LCHD addressed this standard through our QI process by having all MCH staff members participate in the development of the educational/marketing booklet for providers, and the presentation to be made to address how LCHD can assist with linking underserved pregnant women and children to health care systems to improve health behaviors. The agency completed a self-assessment using the Operational Definition of a Functional Local Health Department’s Assessment Tool to determine the priority areas to focus on. Once the focus areas were chosen, a two-day QI workshop was held in August 2008 facilitated by a contracted NACCHO consultant to teach agency staff involved in the QI project the Plan-Do-Study-Act process. After working through many brainstorming activities using affinity and fishbone diagrams and other QI tools, all QI team members agreed that LCHD did not have an effective system in place for marketing MCH services in the community for linking underserved pregnant women and children to needed health care systems. Increased awareness of MCH services was necessary and needed. The core QI team agreed that if we increase our partnerships with medical and dental providers to raise awareness of MCH services, then we will receive referrals and be able to link additional families and children to needed care. Lee County Health Department thinks implementing a new QI process within the agency using existing and highly recommended quality improvement tools was inventive because the tools allowed us to identify and address an issue within our Maternal Child Health program and develop a plan for addressing it within a short amount of time. Typically local public health agencies, including our own, have not used these QI tools with developed practices in the past. The Plan-Do-Study-Act process was new to our agency and to all staff involved. We used the affinity diagram, fishbone diagram, and brainstorming processes to determine what approach we would take in marketing our Maternal Child Health program to providers in our area, which was new and different to our agency.
Agency Community RolesAdministrative staff/key staff from all of LCHD’s departments/programs participated in the self-assessment process and the two-day QI workshop. Additionally, the Iowa Department of Public Health (IDPH) lead MCH consultant was invited to participate and joined us for one day of the QI workshop, providing feedback and expertise as we developed our plan and aim statement. IDPH also approved our MCH marketing booklet and requested it be presented at the state fall conference in October 2008 to share with other MCH providers across the state of Iowa. Since then two agencies have requested materials to use within their own projects. Our administrator has also been requested to present our project at the University of Iowa College of Public Health Institute for Public Health Fall Colloquium in November 2008 and during the Iowa Public Health state conference in April 2009 sharing our practices and lessons learned. In addition, referral processes have been developed with medical and dental provider offices for linking pregnant women and children to care. LCHD is governed by the Lee County Board of Health, and is well known for its quality services and established community partnerships. Many of the essential services that LCHD currently provides are a result of identified health needs (including gaps in service provision or barriers to accessing care) gathered from ongoing community health needs assessments and health improvement planning efforts with many community partners. Several community coalitions have been formed as a result with LCHD being the lead agency in addressing specific community needs. Access to health or oral health care of underserved populations has been an identified need in most of LCHD’s Title V/MCH five-county service area. MCH services include linking families to care through medical and dental home case management. By further developing public /private relationships to address the barriers pregnant women and children face in our service area, we believe we are addressing the needs of our MCH population. Costs and ExpendituresLee County Health Department received a $15,000 grant from NACCHO to implement the project; LCHD in-kind dollars also supplemented the project. ImplementationTo begin the project in April 2008, LCHD first organized a self-assessment team for completing the Operational Definition of a Functional Local Health Department’s Assessment Tool. All results of the completed assessment tool were submitted to NACCHO by May 15, 2008, as well as the Metrics Survey evaluation by May 29, 2008. The following were the chosen priority standards to focus on after careful analysis by the assessment team members: Standard III-B: General Data and Information Exchange on Issues Affecting Population Health; Standard III-C: Provide Health Information to Individuals for Behavior Change Once the focus areas were identified, a QI consultant was contracted for consultation for the remainder of the project period. To implement the QI process and PDSA cycle, a two-day workshop (August 18–19, 2008) was scheduled and facilitated by the consultant to teach agency staff the Plan-Do-Study-Act process, set the aims statement for systems improvement, establish measures for improvement, and identify the changes most likely to result in improvement. The QI team elected to narrow the agency’s focus during the PDSA cycle to one program—the Maternal Child Health (MCH) program. After the workshop, LCHD’s core QI team implemented the QI plan with assigned roles and responsibilities for each team member. A work plan matrix document was developed to record all meeting minutes, activities assigned with due dates, and the staff members who were assigned specific responsibilities. By September 12, 2008, the QI team finalized what to include in the educational/marketing booklets for targeted providers during the QI project for educating/increasing awareness of our agency’s Title V/MCH services and referral processes for linking children and families to care. By September 15, 2008, the Community Health Director submitted the educational booklets to the Iowa Department of Public Health for approval for use with targeted providers. By September 19, 2008, the educational booklets were put together for delivery to providers. The week of September 22–26, assigned staff members delivered the booklets to 10 targeted provider offices with intent to follow up within one week with a phone call requesting a presentation. By October 31, 2008, all presentations needed to be completed or scheduled with providers assigned to specific staff. The core QI team also identified the method for tracking all QI data and for monitoring progress or barriers on a weekly basis using a tracking log to document follow-up call dates/outcomes, barriers, and presentation dates/outcomes. The team met and compiled results at the end of October 2008. All 10 targeted offices received the marketing booklet, all 10 received a follow-up phone call, 7 of the 10 received or scheduled a presentation with a MCH staff person for increasing awareness of MCH services and referral processes.
Not everyone on team had a full understanding of all Title V/MCH services. Provide staff training and development on Title V and MCH services the agency provides to additional staff members. Do not offer presentations to medical provider offices during flu shot season; try to schedule with office manager if physician is not available. Create more books for offices with multiple providers in office because one is not appropriate for all to review/use.
The Lee County Board of Health (BOH), LCHD’s governing body, fully supports LCHD’s efforts to address the public health needs and have joined efforts with LCHD to learn the capacities of Lee County’s public health system and how well LCHD is providing the essential public health services. LCHD and the BOH are prepared and eager to identify strengths and weaknesses and prioritize opportunities for improvement against a set of optimal national performance standards. This project has assisted in improving our capacity to meet Standard III. LCHD fully intends to continue marketing MCH services to provider offices to link families to needed health care systems as part of the MCH action plan. LCHD already has the marketing booklets available for easy print and use when marketing to providers. This is cost effective for the agency as staff are able to use the agency’s own printer and copier. MCH staff have also been allocated time in the MCH grant budget to include presentation/meetings with provider offices to continue marketing services and improving referral systems. The agency is committed to continuing this practice through written MCH action steps submitted each year to the Iowa Department of Public Health, which have been approved for FFY2009.
 
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