SESSION 1B: System Structure & Performance-Quality Improvement
Room: Thoroughbred 2
Tuesday, April 8, 2014, 2-3:15 pm
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KC14 Session 1B on System Structure & Performance: Quality Improvment by NCC for PHSSR
MODERATOR
Carolyn Leep, M.S., M.P.H.
PRESENTERS
Kim Gearin, Ph.D., M.S.
Bringing Together Practice-Based Research and Performance Management:Maximizing Data for Multiple Purposes
Co-Investigator: Beth Gyllstrom, Ph.D., M.P.H
Background: Since 2011, Minnesota’s state/local Performance Improvement Steering Committee has led efforts to improve Minnesota’s governmental public health system through the ongoing use of performance standards, measures and outcome reports that guide system-level quality improvement efforts and decision-making.
Research Objective: The objective of this study was to test the feasibility of engaging a public health practice-based research network (PBRN) to (1) develop and test performance measures for Minnesota’s Local Public Health Act, (2) integrate those measures into a performance management system for all 52 Minnesota community health boards (CHBs), and (3) use those findings to conduct practice-based research.
Data Sets and Sources: The Planning and Performance Measurement Reporting System furnished all data used in this study. All CHBs in Minnesota use this electronic system annually to report on expenditures, staffing and performance. The system includes measures of local public health services and capacity (recently revised to align with the national standards and to reflect QI maturity and health equity measures developed through practice-based research). Data was collected in February-March 2013 on 2012 activities.
Study Design: Descriptive Analysis Frequencies and distributions were generated for each of the performance measures. These data are considered baseline measures for the newly revised system.
Principal Findings: System-level data highlighted variation in capacity and identified areas of notably strong performance, as well as areas for improvement (e.g., measures related to quality improvement, performance management and strategic planning). Findings were used to prioritize areas for improvement, establish system-level objectives, and inform practice-based research.
Conclusions: Minnesota’s experience underscores the potential to bridge research and practice in system-level performance management. Tailored and system level baseline reports have spurred local and system level actions, produced data for a multi-state practice-based research project, and demonstrate that measures developed by this PBRN have been translated into routine practice.
Implications: Practice-based research networks can provide valuable insights into the development of ongoing, systematic data collection efforts aimed at characterizing the capacity of local public health systems. The information gathered through these efforts can then be maximized for research purposes, while minimizing the data collection demands on local agencies.
Carole Myers, Ph.D., M.S.N., B.S., RN
Exploring Reasons for Missed Appointments in a Local Health Department: A Practice-Based Research Example and Discussion of Lessons Learned
Co-Investigator: Kathy Brown, Ph.D., M.P.H, RN (presenting)
Background: Hallmarks of practice-based research include questions that originate from practice, rapid cycle translation of findings into actionable recommendations, and meaningful collaborations between practitioners and academicians. The purpose of this presentation is to review findings from a study conducted at the Knox County Health Department (KCHD) by a team of KCHD professionals and faculty and students from the University of Tennessee (UT). The study was the first research collaboration conducted under the auspices of the KCHD/UT Academic Health Department (AHD) and served to advance specific goals of the AHD including bridging the practice/research gap, enhancing public health education, training, and research to improve community health.
Research Objective: The study aim was to gain insight into reasons for the high percentage of missed appointments in the KCHD Women’s Clinic from the client perspective. Missed appointments are problematic for several reasons, including staffing, operational efficiencies, great demand for appointments, and consequences to women who miss appointments and do not re-schedule.
Study Design & Analysis: The mixed methods study entailed two phases: 1) Two years of detailed records kept daily were analyzed to describe the rate and type of missed appointments and 2) Twenty-eight semi-structured interviews were conducted. Interviews were analyzed and coded using conventional content analysis.
Findings: Variations in the number of missed appointments were due primarily to clinic-related factors such as staffing and hours and days of operation. Major themes identified from interviews include: challenges scheduling appointments, challenges in keeping scheduled appointments, and clinic barriers. Interviewees also identified what motivated them to not miss appointments and offered suggestions for decreasing missed appointments.
Conclusions: A major lesson learned from the study is that available data is not necessarily designed for research purposes. However major trends related to the adoption of electronic health records and public health accreditation are driving improved data elements, collection, and reporting which support process improvement and may contribute to improved population health.
Implications: Other lessons relate to the important work of relationship-building and creating a foundation for ongoing work. Both require major organizational and personal commitments. Insight from a practice and an academic PI will be shared.
Katherine Stamatakis, Ph.D., M.P.H.
Quantifying Local Public Health Infrastructure for Obesity Prevention through a Practice Inventory of US Local Health Departments
Co-Investigators: Allese Mayer, M.P.H. (presenting), & Anna Hardy, B.S., RN
Background: The large geographic variation in obesity prevalence across localities underlies the importance of a locally-oriented response that includes changes to policy, systems and environment. Little is known about the breadth of practice in obesity prevention among local health departments (LHDs) across the United States.
Research Objective: The purpose of the study was to provide a snapshot of a broad cross-section of obesity prevention-related practices in US LHDs, using reliability-tested measures.
Data Sets and Sources: Recruitment was conducted among a random sample of US LHDs in February-April of 2014. Based on an expected response rate of 60%, 833 of the 2,565 enumerated LHDs were contacted. The sample was stratified based on size of population served (
Study Design: The study was a cross-sectional survey of a random selection of US LHDs. Analysis Analyses of the data include descriptive statistics and test-retest reliability, along with comparisons of complementary data from a census sample of LHDs.
Principal Findings: The final sample was n=394 LHDs, with a response rate of 52% after excluding those we were unable to confirm contact (n=75). The most prevalent practices related to healthy eating were encouraging usage of farmers markets among WIC participants (52%) and applying school-based nutrition interventions (56%). The most prevalent practices related to physical activity were promoting policies for daily school PA (42%), and increasing open spaces in communities (40%). Additional results include test-retest reliability and infrastructural characteristics related to patterns of obesity prevention practice.
Conclusions: The distribution of patterns of practice in obesity prevention among US LHDs provides insights into the extent to which LHDs are meeting targets for evidence-informed practice.
Implications for Public Health Practice and Policy: There is a need to improve obesity prevention through better utilization of the existing local public health infrastructure. These data provide a foundation for linking LHD activities with performance metrics, changes in policy and built environments, and community health indicators.