Using Quality Improvement for Better Preconception Care

1. Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14, 2011 Lisa LeRoy, PhD Abt Associates Kay Johnson, MPH, Johnson Group Consulting

2. 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

3. 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

4. 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

5. 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.

6. 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 non-clinical, community-based services Translating ICC research to practice

7. The “Model for Improvement” for ICC-LC Change Projects

8. Plan Act Do Study 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?

9. PDSA Cycle for Learning and Improvement PLAN: - Objective, aim, change - Questions (why) - Plan to carry out the cycle (who, what, where, when) ACT: - Adapt? - Adopt on wider scale? - Abandon? - Next cycle? DO: - Carry out plan on small scale, rapid cycle - Document problems and unexpected results - Begin analysis • STUDY: • - Complete analysis of data • - Compare results to predictions • - Summarize lessons learned

10. 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

11. 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

13. Framework for ICC LC Change

14. 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 Referedthose ≥ 25 to appropriate services

15. 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)

16. 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.

17. Summary

18. 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

19. 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

20. Lessons Learned QI usingPDSA 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

21. 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

22. Questions? Comments?

23. For More Information: Lisa LeRoy, PhD, ICC LC Project Director Abt Associates, Inc. Lisa_Leroy@abtassoc.com