Paul K. Halverson, Dr.P.H., M.H.S.A., FACHE
Director and State Health Officer
Arkansas Department of Health
Angela Dearinger, M.D., M.P.H., FAAP
Kentucky Public Health Practice-Based Research Network &
University of Kentucky College of Public Health and College of Medicine
Halverson: Hello and welcome to RE-ACT, the podcast supporting evidence-based practice for public health agencies. I am your host, Dr. Paul Halverson. As public health organizations strive to create better processes, structures and service delivery, many of us are turning to a management technique called Quality Improvement, or QI. There are a lot of definitions out there for what Quality Improvement is, but at least to me, the main issue is, it is a continuous process. No matter how good you are, it could always be better, and of course, we all want to try to find better and greater improvements in what we do. It matters a lot to our community that we get the most out of the public health dollar. So, these questions related to how to incorporate public health quality improvement into our day-to-day practice are being explored by several Public Health Practice-Based Research Networks around the country. With me today is a researcher from the Kentucky Public Health PBRN, Dr. Angela Dearinger.
Hello Dr. Angela Dearinger and welcome.
Dearinger: Hello Paul, it’s a pleasure to be here.
Halverson: Well great. I understand your PBRN was recently involved in the study of QI Implementation, using the topic of diabetes self-management education. What were you looking for in that project?
Dearinger: Well Paul, we were attempting to accomplish three related goals in our QI work. First, we wanted to identify factors that might influence organizations to adopt evidence-based
quality improvement strategies. Second, we wanted to find the key factors that seem to affect the uptake and short-term effectiveness of QI methods in local health departments. And finally, we wanted to create a model that local health departments could use to promote evidence-based strategies for system-level quality improvement.
Halverson: So at base, you really were looking at what seems to work for QI in hopes of sharing that knowledge with other health departments, who might be working or considering implementation of their own QI initiatives, is that right? It really doesn’t have to necessarily be constrained to diabetes self-management education, right?
Dearinger: That’s exactly right, Paul. By improving our understanding of what works for some health departments, our findings can help other agencies make decisions about their own implementation processes, regardless of whatever they are looking at.
Halverson: So how many health departments were involved in your study, and what did they do?
Dearinger: We worked with six local health departments in Kentucky, and collectively they serve about a quarter of our state. Each of these departments selected a specific quality improvement project that was centered around diabetes self-management education. We then provided QI training, and we also facilitated them in designing and implementing their own QI project, and then we conducted pre- and post-surveys of participants to determine where changes had occurred.
Halverson: Wow! What did you find?
Dearinger: Paul, we found that the training greatly increased knowledge of specific QI tools, such as flow mapping and PDSA or the plan-do-study-act technique. We also saw changes though in the outreach and delivery of diabetes education. For example, half of the participating departments changed the timing and location of their diabetes education classes as a result of their QI projects. In addition, we also found an increase in the number of community practitioners and local physicians and nurse practitioners who referred patients to the health departments for diabetes education.
Halverson: That’s very interesting. You got an increase in the effectiveness of the intervention, and I think this is the important part for those of us that practice every day, is that it’s not good enough to simply take an evidence-based strategy and just say go off and do it. You're combining the evidence-based strategy, in this case diabetes self-management, with a quality improvement technique in the hopes of getting a better result. So that’s really terrific, and I think that this study has a lot of other things that you have found. In particular, what did you find were the most positive effects of the QI intervention?
Dearinger: Well Paul, first and foremost, the participating health departments reported that just developing a QI team was the single most effective aspect of this project. They also noted that the project facilitation that we offered was very helpful.
Halverson: Were there any elements of the QI training that seemed less effective?
Dearinger: Yes, participants were less enthusiastic about the utility of the QI handbook we provided.
Halverson: Well there's always that paperwork, right?
Dearinger: That’s true, that’s right.
Halverson: Ultimately, what lessons can our listeners take away from your study?
Dearinger: You know Paul, engaging in structured QI training can really benefit local health departments not only in terms of implementing specific projects or subjects like diabetes, but also in terms of creating and sustaining a culture of continuous quality improvement. In fact, five of the six participating health departments in our study are currently planning or conducting additional QI projects.
Halverson: Well that’s terrific, particularly in light of the importance of QI activities for accreditation. This is an excellent example of why QI matters. If our listeners have questions or would like more information about your study, who should they contact?
Dearinger: They can contact me, Angela Dearinger, at firstname.lastname@example.org.
Halverson: Thank you, Angela, and thank you all who are listening to RE-ACT, where we bring you the most recent evidence from public health PBRNs and from the wider fields of public health systems and services research. I’d like to thank you again today, Dr. Angela Dearinger, director of the Kentucky Public Health PBRN, for joining us. Until next time, im Dr. Paul Halverson, and this has been RE-ACT.