Lead States in Public Health Quality Improvement: New Hampshire

1. Lead States in Public Health Quality Improvement: New Hampshire Lea R. Ayers LaFave, PhD, RN Community Health Institute/JSI Bow, New Hampshire August 2008

2. Participants in Attendance Joan Ascheim, MSN Bureau Chief NH Division of Public Health Services Bureau of Policy and Performance Management Concord, NH Amy Cullum, MPH, MA Community Health Institute/JSI Bow, NH Lindsey Vacek, MPH Mascoma Valley Health Initiative Canaan, NH

3. Preparing for Accreditation • Regionalization and building the public health infrastructure • Overall Goal: A performance-based public health delivery system, which provides all 10 essential public health services throughout New Hampshire • Repeat National Public Health Performance Standards State Level Assessment

4. Existing NH Public Health Infrastructure • 234 cities and towns • Health Officer required by statute • 5 communities with public health departments • No county health departments • Strong community-level informal public-private partnerships • State level: • DHHS (lead agency), • Department of Environmental Services • Department of Education • Department of Safety

5. Our Vision • The evolution of a 2-tiered public health system based on standards for agency infrastructure and performance • Capacity, expertise, leadership to assure a fundamental public health presence • Performs some level of each essential service • Collaborates with • regional partners • State DPHS • Will require statutory changes.

6. Regionalization Process • April 2008 consolidated 19 All Health Hazards Regions to 15 Public Health Network (PHN) regions • 3 assessments: • Financial • Capacity - modified NACCHO Assessment Tool • Governance • Next Steps • PHNs in selected regions develop detailed plan to implement proposed new model [June 2008-June 2009]

7. Modified NACCHO Self-Assessment Tool [DRAFT]

8. Quality Improvement Learning Collaboratives (QuILTs) • QuILTS • 2 cohorts, 3 each, 15 months • Interest areas • Capacity: • Culturally appropriate care, health improvement planning, competent workforce • Health Status: • Chronic disease, tobacco-related disease, alcohol-related disease and injury • Linkage– health status to capacity indicators • Aligned with state health priorities and strategic plan • Kickoff

9. Kickoff EventSeptember 26th, 2008 • Keynote Speaker Bonnie Zell, MD. MS Senior Advisor for Partnership Development Division of Healthcare Quality Promotion, Office of the Director, CDC IHI George W. Merck Fellow, 2006-2007 • Work Session • Sharing of work to date • Content Expert Speakers • Tracking Tool Training

10. Most interesting… • Including other groups in our QI initiative • DHHS Public Health Improvement Team (PHIT) • Links with other work • PHIT Tracking Tool • To simplify process of tracking improvement initiatives • Create performance measures • Record data • Create performance reports • Download data into MS Excel format • Partnering with University of New Hampshire through the CDC Assessment Initiative • Develop web-based performance measure module in HealthWRQS application

11. PHIT Tracking Tool

12. Most exciting… • Work with Quality Improvement Learning Collaboratives Ayers, LR, Beyea, SC, Godfrey, MM, Harper, DC, Nelson, EC, and Batalden, PB (2005). Quality Improvement Learning Collaboratives. Quality Management in Health Care, 14(4), 234-247. • Developing relationships with international QI experts at The Dartmouth Institute for Health Policy and Clinical Practice www.dartmouth.edu/~cecs/

13. Hopes and Long Term Goals… • Demonstrate the value of public health through evidence • Build capacity • Create a culture of QI simultaneously through regionalization Resulting in…. …an accreditable public health system built from the ground up…