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Quality Health Services & SBHCs

Quality Health Services & SBHCs. Joy Twesigye, MS, MPP, WHNP-BC Associate Director, Programs and Professional Services. November 12, 2012. There is very little standardization in SBHCs – there is variability in terms of scope of services, staffing, location, sponsorship and funding.

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Quality Health Services & SBHCs

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  1. Quality Health Services & SBHCs Joy Twesigye, MS, MPP, WHNP-BC Associate Director, Programs and Professional Services November 12, 2012

  2. There is very little standardization in SBHCs – there is variability in terms of scope of services, staffing, location, sponsorship and funding

  3. Questions we want answers to • Individual-level impact: What is the impact of the SBHC on student health and academic achievement? • Cost effectiveness: What staffing models and funding patterns are most cost effective and impactful? • How do we improve our advocacy so that we can increase federal investment? • Academic accountability for school health services • Need to improve student health outcomes

  4. Challenges • Evaluating the impact of SBHCs is complicated because of: • 1) The wide range of services provided • 2) The limited resources devoted to conducting rigorous research

  5. Going forward, the field of SBHC needs to establish a more standarized set of health services indicators, with a stronger emphasis on health outcomes, to better document the value of this model of care. • The gold standard would to have standarized best practices for tobacco prevention, obesity prevention, reproductive health

  6. Quality care Providing patients with appropriate services in a technically competent manner, with good communication, shared decision making, and cultural sensitivity. Degree to which health care services increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

  7. Quality assessment The act of measuring care provided to identify positive examples or detect challenges of providing quality care.

  8. Quality improvement A continuous process of striving for improved performance, involving problem identification, testing of solutions, and the monitoring of solutions on an ongoing, system-level basis.

  9. Quality assessment and improvement The entire cycle of assessment which extends beyond problem identification to include: verification of the problem identification of intervention point initiation of intervention(s) continual review to assure that identified issues have been adequately addresses and ensure the system has been adjusted to prevent further issues.

  10. Theory of Continuous Quality Improvement (CQI) System-focused Problem is rarely related to the people but to the process, job design, failure of leadership, or unclear purpose Need to understand and revise the process Use a variety of measures Attempts to improve quality by advancing the mean in incremental steps

  11. CQI is NOT… Theory of bad apples Establishing a threshold of acceptability Blaming individuals Elimination or control of outliers and reduction of the variation around the mean

  12. QAI in the SBHC setting Efficiency: measure what is truly important to the health of students in your SBHC Clinical appropriateness: accurately identify good health care for SBHC Impact: bridges the gap between the development and dissemination of evidence-based practice Practicality: mitigates against real life contingencies Professionalism: connects training, practice, research, and policy

  13. Why State Funds Matter Nearly one in two school-based health centers rely on state-directed public funds to help sustain their services.

  14. States’ Accountability for SBHC Funds • 14 of 18 States set SBHC operating standards as condition of grant funds • States monitor adherence to SBHC standards through combination of paper review and/or in-person site visit • All 18 States track SBHC performance indicators • All 18 States collect a range of program data • 7 of 18 States monitor Medicaid billing practices

  15. SBHC Performance IndicatorsMost Frequently Tracked by StatesTop 5 of 28 choices States that fund SBHCs (n=17)

  16. Most Common SBHC Data Collected by States States that fund SBHCs (n=18)

  17. How States Value SBHC Contributionsto Public Health Mission States that fund SBHCs (n=18)

  18. Top Challenges to SBHCs: State Agency Perspective States that fund SBHCs (n=18)

  19. State Medicaid’s View of SBHC Role Of the 19 states that fund SBHCs, 12 responded

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