Vector Control Performance Improvement Project Initiative

State: FL Type: Promising Practice Year: 2016

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Outbreaks may occur due to unreported and/or underreported mosquito borne illnesses, such as chikungunya, dengue, and West Nile virus. Surveillance and treatment of mosquito affected properties could be improved through enhanced collaborations and coordination between Florida Department of Health in Broward County (DOH-Broward) and Broward County Mosquito Control Section (BCMC), as well as increasing awareness and education for hospitals, urgent care centers, primary care centers, and the community.

To improve mosquito notification and surveillance efforts of suspected mosquito borne illness through partnerships between the DOH-Broward and local hospital emergency departments, urgent care centers, primary care centers, and the public and by improved coordination of resources and communication between DOH-Broward and BCMC. 

DOH-Broward assessed the status of its vector control program,(which includes mosquito control), using the CDC’s Environmental Public Health Program Self-Assessment Instrument. The vector performance improvement project was selected by DOH-Broward and approved by the Public Health Foundation (PHF).  The idea originated from CDC’s desire to help vector control programs at local health departments improve their performance using self-assessment and quality improvement (QI) tools. With funding from CDC, PHF assisted 13 local health departments that included DOH-Broward, to increase their vector control programs' efficiency, effectiveness, and capacity. PHF also developed the Vector Control Population Health Driver Diagram which DOH-Broward utilized to identify focus areas for the project. A meeting took place between the BCMC and the DOH-Broward where gaps were identified in communication, treatment and enforcement activities. Communication flowcharts were developed to address the gaps noted. The flowcharts were laminated and distributed to program staff within DOH-Broward and BCMC. An additional communication gap was identified between BCMC, DOH-Broward and the local hospitals, primary care and urgent care centers. This gap involved a lack of notification of potential mosquito borne illness cases presented at these facilities. Having advanced notice of these cases will allow BCMC and DOH-Broward to treat and perform surveillance of the affected area to minimize the potential risks of an outbreak. DOH-Broward developed a mosquito information and reporting poster which was distributed and mounted in every treatment room of the hospital ER‘s, primary and urgent care centers. This poster advises and lists the notification process if a suspected case presents. Mosquito information door hanger was also developed by DOH-Broward. These door hangers will be distributed to the affected local community to engage the community in the process of reducing the risk of outbreak in their neighborhood. All communication between the partnering agencies will be tracked for quality improvement and reviewed using spreadsheets and statewide databases.

To improve mosquito notification and surveillance efforts, mosquito posters were developed and distributed to 140 urgent care centers and 17 hospital emergency departments in Broward County and door hangers were revised and printed and will be distributed to affected local communities to engage the public in the process of reducing the risk of outbreak in their neighborhood.   To improve coordination of resources and communication between DOH-Broward and BCMC, “communication” and “actions” flowcharts were laminated and distributed to all of the involved staff for DOH-Broward and BCMC.

Strengthened partnerships between the Florida Department of Health in Broward County, Broward County Mosquito Control section, local hospital district ER departments, primary and urgent care centers was the main factor that contributed to the success of the practice.  Existing partnerships between BCMQ and DOH-Broward were further enhanced and strengthened by working together to develop the mosquito-borne illness reporting structure.  An agreement to partner on enforcement activities is an additional new factor that contributed to the success of this practice.  Additionally, the use of tools provided by PHF, such as Gantt charts, flow charts, and progress report templates assisted DOH-Broward to complete the planning and implementation of the project without the need to create new tools.

Use of the communication and actions flowcharts will improve the effectiveness and efficiency of surveillance, treatment of mosquito affected properties and enforcement activities by providing clearly defined roles and responsibilities for DOH-Broward and BCMC.  Earlier diagnosis by health care providers and subsequent reporting to DOH-Broward will improve surveillance and mosquito control activities.

 

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Broward County Health Department
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Vector Control Performance Improvement Project Initiative
Broward County is located in the southeastern portion of the State of Florida with Miami-Dade County to the south and Palm Beach County to the north.  Broward County’s 2014 population estimate of 1,869,235. DOH-Broward is the lead agency providing core public health functions and essential services in the county as part of a complex public health system that includes hospitals, clinics, planning agencies, community-based organizations and others.  Describe public health issue: Outbreaks may occur due to unreported and/or underreported mosquito borne illnesses, such as chikungunya, dengue, and West Nile virus. Surveillance and treatment of mosquito affected properties could be improved through enhanced collaborations and coordination between Florida Department of Health in Broward County (DOH-Broward) and Broward County Mosquito Control Section (BCMC), as well as increasing awareness and education for hospitals, urgent care centers, primary care centers, and the community. Goals and objectives:  To improve mosquito notification and surveillance efforts of suspected mosquito borne illness through partnerships between the DOH-Broward and local hospital emergency departments, urgent care centers, primary care centers, and the public and by improved coordination of resources and communication between DOH-Broward and BCMC.  How was practice implemented / activities:  DOH-Broward assessed the status of its vector control program,(which includes mosquito control), using the CDC’s Environmental Public Health Program Self-Assessment Instrument. The vector performance improvement project was selected by DOH-Broward and approved by the Public Health Foundation (PHF).  The idea originated from CDC’s desire to help vector control programs at local health departments improve their performance using self-assessment and quality improvement (QI) tools.  PHF also developed the Vector Control Population Health Driver Diagram which DOH-Broward utilized to identify focus areas for the project. A meeting took place between the BCMC and the DOH-Broward where gaps were identified in communication, treatment and enforcement activities. Communication flowcharts were developed to address the gaps noted. The flowcharts were laminated and distributed to program staff within DOH-Broward and BCMC. An additional communication gap was identified between BCMC, DOH-Broward and the local hospitals, primary care and urgent care centers. This gap involved a lack of notification of potential mosquito borne illness cases presented at these facilities. Having advanced notice of these cases will allow BCMC and DOH-Broward to treat and perform surveillance of the affected area to minimize the potential risks of an outbreak. DOH-Broward developed a mosquito information and reporting poster which was distributed and mounted in every treatment room of the hospital ER‘s, primary and urgent care centers. This poster advises and lists the notification process if a suspected case presents. Mosquito information door hanger was also developed by DOH-Broward. These door hangers will be distributed to the affected local community to engage the community in the process of reducing the risk of outbreak in their neighborhood. All communication between the partnering agencies will be tracked for quality improvement and reviewed using spreadsheets and statewide databases. Results: All objectives were met. To improve mosquito notification and surveillance efforts, mosquito posters were developed and distributed to 140 urgent care centers and 17 hospital emergency departments in Broward County and door hangers were revised and printed and will be distributed to affected local communities to engage the public in the process of reducing the risk of outbreak in their neighborhood.   To improve coordination of resources and communication between DOH-Broward and BCMC, “communication” and “actions” flowcharts were laminated and distributed to all of the involved staff for DOH-Broward and BCMC. What specific factors led to the success of this practice?:  Strengthened partnerships between the Florida Department of Health in Broward County, Broward County Mosquito Control section, local hospital district ER departments, primary and urgent care centers was the main factor that contributed to the success of the practice.  Existing partnerships between BCMC and DOH-Broward were further enhanced and strengthened by working together to develop the mosquito-borne illness reporting structure.  An agreement to partner on enforcement activities is an additional new factor that contributed to the success of this practice.  Additionally, the use of tools provided by PHF, such as Gantt charts, flow charts, and progress report templates assisted DOH-Broward to complete the planning and implementation of the project without the need to create new tools. Public Health impact of practice: Use of the communication and actions flowcharts will improve the effectiveness and efficiency of surveillance, treatment of mosquito affected properties and enforcement activities by providing clearly defined roles and responsibilities for DOH-Broward and BCMC.  Earlier diagnosis by health care providers and subsequent reporting to DOH-Broward will improve surveillance and mosquito control activities. Website: http://broward.floridahealth.gov/  
Public health issue: To improve mosquito notification and surveillance efforts of suspected mosquito borne illness through partnerships between the DOH-Broward and local hospital emergency departments, urgent care centers, primary care centers, and the public and by improved coordination of resources and communication between DOH-Broward and BCMC.  What target population is affected by problem?: Broward County’s 2014 population estimate of 1,869,235, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and eighteenth most populous county in the United States (US Census).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.5% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2014 population by race (Black 28.8%, Asian 3.6%, Hispanic 27.4%, other races .5%, for a total of 60.3% and White 39.7%). What percentage did you reach?:  Mosquito posters were distributed to 140 urgent care centers and 17 emergency room departments.  Broward County residents will be reached as potential mosquito borne illnesses occur. What has been done in the past to address the problem?: Communication between DOH-Broward and BCMC was not clearly defined.  Signs and symptoms of mosquito borne illness had not specifically been provided to health care providers as an educational and awareness tool.  No formal communication methods were in place to coordinate surveillance and treatment of property activities between the DOH-Broward and BCMC. Why is current/proposed practice better?:  Gaps were identified in communication, treatment and enforcement activities. Communication flowcharts were developed to address the gaps noted. The flowcharts were laminated and distributed to all of the involved staff for DOH-Broward and BCMC. An additional communication gap was identified between BCMC, DOH-Broward and the local hospitals, primary care and urgent care centers. This gap involved a lack of notification of potential mosquito borne illness cases presenting at these facilities. Having advanced notice will allow BCMC and DOH-Broward to treat and perform surveillance of the affected area to minimize the potential risks of an outbreak. DOH-Broward developed a mosquito poster that was distributed to 17 hospital emergency departments and 140 primary and urgent care centers. This poster advises and lists the notification process if a suspected case presents. Mosquito borne illness information door hangers were also developed by DOH-Broward. These door hangers will be distributed to the affected local community to engage the community in the process of reducing the risk of outbreak in their neighborhood. All communication between the partnering agencies will be tracked for quality improvement and review using spreadsheets and statewide databases. Is current practice innovative?: DOH-Broward modeled the mosquito borne illness poster after its existing measles poster (based on CDC posters) which was well-received by hospitals and urgent care centers.  The Environmental Public Health Program Self-Assessment Instrument helped to identify areas of improvement.  The Vector Control Population Health Driver Diagram and working with CDC to further test its use as a tool to engage community partners in strengthening vector control programs. Is current practice evidence-based?: The practice is evidence-based.  DOH-Broward participated in the CDC Vector Control Performance Assessment and Improvement Initiative. Whether it was improving the quality and quantity of partnerships, increasing effectiveness of outreach to the community, or streamlining vector control operations, performance improvement was evident. In the future, PHF looks forward to refining the Vector Control Population Health Driver Diagram and working with CDC to further test its use as a tool to engage community partners in strengthening vector control programs.     
Goal(s) and objectives of practice:  The goal was to improve mosquito notification and surveillance efforts of suspected mosquito borne illness through partnerships between the DOH-Broward and local hospital emergency departments, urgent care centers, primary care centers, and the public and by improved coordination of resources and communication between DOH-Broward and BCMC.  What did you do to achieve the goals and objectives?: The steps taken to implement this program include:  DOH-Broward assessed the status of its vector control program,(which includes mosquito control), using the CDC’s Environmental Public Health Program Self-Assessment Instrument. The vector performance improvement project was selected by DOH-Broward and approved by the Public Health Foundation (PHF).  The idea originated from CDC’s desire to help vector control programs at local health departments improve their performance using self-assessment and quality improvement (QI) tools. With funding from CDC, PHF assisted 13 local health departments that included DOH-Broward, to increase their vector control programs' efficiency, effectiveness, and capacity. PHF also developed the Vector Control Population Health Driver Diagram which DOH-Broward utilized to identify focus areas for the project. A meeting took place between the BCMC and the DOH-Broward where gaps were identified in communication, treatment and enforcement activities. Communication flowcharts were developed to address the gaps noted. The flowcharts were laminated and distributed to program staff within DOH-Broward and BCMC. An additional communication gap was identified between BCMC, DOH-Broward and the local hospitals, primary care and urgent care centers. This gap involved a lack of notification of potential mosquito borne illness cases presented at these facilities. Having advanced notice of these cases will allow BCMC and DOH-Broward to treat and perform surveillance of the affected area to minimize the potential risks of an outbreak. DOH-Broward developed a mosquito information and reporting poster which was distributed and mounted in every treatment room of the hospital ER‘s, primary and urgent care centers. This poster advises and lists the notification process if a suspected case presents. Mosquito information door hanger was also developed by DOH-Broward. These door hangers will be distributed to the affected local community to engage the community in the process of reducing the risk of outbreak in their neighborhood. All communication between the partnering agencies will be tracked for quality improvement and reviewed using spreadsheets and statewide databases. Any criteria for who was selected to receive the practice (if applicable)?: Broward County hospitals, urgent care centers and primary care providers were selected as they are the first contact for patients that may have mosquito borne illness.  Door hangers will be utilized for public awareness. What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s): DOH-Broward led the process to strengthen partnerships between DOH-Broward, BCMC, local hospital emergency departments, primary care providers and urgent care centers, by developing clearly defined roles and responsibilities and developing and implementing the “communication” and “actions” flowcharts. By involving stakeholders in the planning and implementation process, communication and collaboration improved reporting efforts of mosquito borne illness. Any start up or in-kind costs and funding services associated with this practice?: Start up costs include the printing costs associated with the door hangers used for public awareness public (approximately $1,100 for 5,000 door hangers).  The posters were printed internally on the DOH-Broward copier and hand-delivered by DOH-Broward staff to the 17 hospitals.  Color copy costs are approximately $.50. per page. Posters were mailed to 140 urgent care centers and primary care providers.   Postage costs are estimated at $141.00.  Estimated total costs for practice  $1,309.50.    
What did you find out?: To improve mosquito notification and surveillance efforts, mosquito posters were developed and distributed to 140 urgent care centers and 17 hospital emergency departments in Broward County and door hangers were revised and printed and will be distributed to affected local communities to engage the public in the process of reducing the risk of outbreak in their neighborhood.   To improve coordination of resources and communication between DOH-Broward and BCMC, “communication” and “actions” flowcharts were laminated and distributed to all of the involved staff for DOH-Broward and BCMC.   Inquiries from external providers have increased as a result of this project with 3 callers specifically mentioning the poster.  In 2012, the number of reported cases of Dengue Fever in Broward County residents was 17.  In 2013, 14 cases were reported, and in 2014, 8 cases were reported, all of which were contracted outside of the United States, but diagnosed in Broward County.  From January 1, 2015 – October 23, 2015, 6 cases of Dengue Fever have been reported.  Five cases were contracted outside of the United States and one case is a locally acquired case in a Broward County resident.   In 2012, the number of reported cases of West Nile Virus in Broward County residents was 2, both contracted outside of Broward County (New York and Texas).  In 2013 and 2014, there were no reported cases.  Chikungunya Fever was reported in 82 Broward County residents in 2014, and 22 cases from January 1, 2015 – October 23, 2015, however, all were contracted outside of the United States.  Earlier initiation of mosquito control efforts due to increase communication between DOH-Broward and BCMC may assist in continuing to reduce the number of new cases of mosquito borne illnesses reported.  This practice has proven to be a success due to the decreased number of cases.  While the number of cases of mosquito borne illness has decreased, education and awareness of mosquito borne illness symptoms will continue. Did you evaluate your practice?  Yes List any primary data sources, who collected the data, and how?: ESSENCE FLCHARTS Environmental Health Database List performance measures used. Include process and outcome measures as appropriate. Number of emergency departments targeted; number of urgent centers targeted; number of primary care providers targeted; number of suspected cases of mosquito borne illnesses reported to DOH-Broward by targeted providers; number of door hangers printed and distributed;  number of joint enforcement efforts between DOH-Broward and BCMC.  All reports of suspected mosquito borne illnesses are referred to the DOH-Broward Communicable Disease Director.  DOH-Broward has 24/7/365 reporting capability.  Describe how results were analyzed: Improved communication established by the communication and action flow charts has improved coordination of enforcement activities between DOH-Broward and BCMC.  The number of cases and outcomes are tracked via the Environmental Health Database.  DOH-Broward also tracks the number of suspected mosquito borne illnesses reported to epidemiology. Inquiries from external providers have increased as a result of this project with 2 callers specifically mentioning the poster. DOH-Broward also tracks all communication from BCMC including joint enforcement activities, treatment plans and surveillance activities. Were any modifications made to the practice as a result of the data findings?:  The vector project control project was successful and no project modifications were necessary.    
Lessons learned in relation to practice: This project helped DOH-Broward identify and address gaps in our processes, both internally and in collaboration with other agencies. New communication charts, posters and door hangers were developed to help improve and protect the health and safety of all residents and visitors to Broward County. If any grant opportunities exist the money could be used to purchase mosquito traps for surveillance and kits for testing specific mosquito related illness. Additional funding could also extend the external collaboration this project has put in place.  
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