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WASHINGTON STATE QUALITY IMPROVEMENT CHRONIC DISEASE

WASHINGTON STATE QUALITY IMPROVEMENT CHRONIC DISEASE. Jane Lee Department of Health. Torney Smith Spokane Regional Health District. WASHINGTON STATE. Whatcom. Pend. 193,100. Ferry. Stevens. Oreille. San Juan. 7,800. 44,000. 12,900. Okanogan. 16,300. Skagit. 40,500. Northeast

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WASHINGTON STATE QUALITY IMPROVEMENT CHRONIC DISEASE

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  1. WASHINGTON STATEQUALITY IMPROVEMENTCHRONIC DISEASE Jane Lee Department of Health Torney Smith Spokane Regional Health District

  2. WASHINGTON STATE

  3. Whatcom Pend 193,100 Ferry Stevens Oreille San Juan 7,800 44,000 12,900 Okanogan 16,300 Skagit 40,500 Northeast Tri County 118,900 Island Clallam Snohomish 69,500 704,300 72,600 37,600 Jefferson Chelan -Douglas 29,000 Lincoln Spokane Kitsap Seattle - King 10,450 465,000 Mason 1,909,300 Grays Harbor Grant Kittitas 71,200 86,100 Adams Whitman Tacoma - Pierce 39,900 Thurston 18,000 43,300 813,600 Pacific Lewis Garfield 21,800 Yakima 75,200 Benton - Franklin 2,250 238,400 72,700 Columbia Wahkiakum Cowlitz 4,100 Asotin 4,100 Walla Walla 99,600 169,300 21,500 59,200 Skamania 10,800 Klickitat Clark 20,200 431,200 POPULATIONS SERVED Washington State Total Population April 2009 6,668,200 80,300 247,600 56,800 249,800

  4. WASHINGTON OVERVIEW • 35 independent health departments/districts • Local boards of health • About 50% of local agencies’ funding is local (taxes, fees) • Remainder is state and federal, various sources • Huge variation among agencies: $11 to $107 per capita • State authority limited • Economic conditions for state and local are currently declining

  5. HISTORY OFPERFORMANCE IMPROVEMENT • 1993 Public Health Improvement Partnership Law • 1999 development and testing of standards • 2002 baseline standards assessment • 2005 first review (35 local health agencies, Department of Health, State Board of Health) • 2008 second state and local review • 2011 preparation for third review

  6. BUILDING BLOCKS FORIMPROVING PERFORMANCE HEALTH INDICATORS - How healthy are we? - How does our health compare to others? - What specific problems could we address Population level data STANDARDS AND MEASURES - What should a health department be able to do? - Do we provide basic expected functions? - How do we compare to others? - Where do we need to improve? System/organization level data QUALITY IMPROVEMENT EFFORTS – PROGRAM/SERVICE BASED - How can we improve the work we do, that will result in better health or protection? ACTIVITIES AND SERVICES - What does local public health do and how is it done? Example: Number of food safety inspections, WIC clients served, health assessments conducted Service-level data

  7. MLC 3 • Increase statewide understanding of quality improvement approaches and skills • Develop alignment with national accreditation efforts • Inform PHAB through input from Washington • Develop evaluation process

  8. HOW TARGETS WERE SELECTED • MLC 3 target area list • Overlap with legislative mandate • Investigation of notifiable conditions • Improvement of immunization rates • Reduce obesity and risk for chronic disease • Health problems in the state are identified through indicators • Additional funding received for prenatal care

  9. SELECTED TARGETS • Reduce the incidence of vaccine preventable disease • Reduce infant mortality rates • Reduce preventable risk factors that predispose to chronic disease

  10. PROJECT RFP REQUIREMENTS • Senior leadership involvement and support • Community partnerships • Team effort • Participation in web conferences with peer project teams, state technical leads and consultants • Quarterly reports and presentations at two quality improvement learning congresses

  11. PROJECT SELECTION PROCESS • RFP – Reduce preventable risk factors that predispose to chronic disease • Project selection criteria • Review and understand BRFSS data in that area • Community involvement and partnerships • Previous ability to mobilize community • Knowledge of health impact assessment literature • Funding • Each project receives $12,000 a year for 2.5 years • Application scored by 3 reviewers

  12. KICK-OFF TRAINING • Principles covered at kick-off training in January 2009: • Know your stakeholders and what they need • Focus on processes • Use data for making decisions • Understand variation in processes • Use teamwork to improve work • Make quality improvement continuous • Demonstrate leadership commitment

  13. TARGET AREA 1: AIM Statements • GRAYS HARBOR Increase providers’ understanding of how their practices contribute to overall county vaccination rates • KITTITAS Increase the uptake of adolescent vaccines 10% by Dec 2010 by understanding parent and provider reasons for under vaccination, and addressing through provider education • GRANT Increase the percentage of 6th grade complete vaccination for Chief Moses Middle School from 78% to 85% and Frontier Middle School from 38% to 65% by December 31, 2010

  14. TARGET AREA 2: AIM Statements • TACOMA-PIERCE Increase the number of MSS eligible pregnant women referred to the local health department who receive a visit in the first trimester of pregnancy by 20% • WALLA WALLA Decrease teen pregnancy of sexually active females <20 years of age by 35% from the current rate of 10.99% per 100 births • CLARK Improve first trimester prenatal care for TANF (Temporary Assistance for Needy Families) women by 50%

  15. TARGET AREA 3: AIM Statements • ISLAND Increase percent of adolescents grades 9-12 who engage in 20 minutes of vigorous physical activity 3 or more days each week • SKAGIT Increase percent of adults 18 years of age and older who engage in 30 minutes of moderate physical activity 5 or more days each week, conduct a health impact assessment (HIA) • SPOKANE Increase percent of adults 18 year of age and older who engage in 30 minutes of moderate physical activity 5 or more days each week

  16. OVERALL PROGRESS TO DATE • AIM statements • Web conference sessions every six weeks with consultants • Work plans • State participation on each team • Learning Congress - August 2009

  17. Percent CHRONIC DISEASE INDICATOR DATA Indicator:Percent of 10th graders who report physical activity 60 minutes a day, 5 or more days a week Better than state* Similar to state State Worse than state* * Statistically significant difference (p< .05) 2006

  18. CHRONIC DISEASE INDICATOR DATA Indicator:Percent of adults age 18 or older who report moderate physical activity (30 minutes a day 5 times a week) or vigorous activity (20 minutes a day 3 times a week) in work or leisure Better than state* Similar to state State Worse than state* * Statistically significant difference (p< .05) 2003-05

  19. ISLAND COUNTY HEALTH DEPARTMENT • Population 80,000 • Rural • 40 FTEs • QI goal: Increase youth physical activity

  20. UNDERSTANDING THE QI PROJECT • TARGET Increase the percentage of adolescents in grades 9-12 who engage in 20 minutes of vigorous physical activity 3 or more days each week • WHY? • Since 2002, adolescent physical activity levels are decreasing in Washington • In 2006, Island County youth are less active than youth statewide (data from Washington State Healthy Youth Survey)

  21. UNDERSTANDING THE QI PROJECT Percentage of 10th graders who engaged in 20 min of vigorous physical activity 3+ days a week Percentage of 12th graders who engaged in 20 min of vigorous physical activity 3+ days a week

  22. QI PROJECT SUMMARY • Analyze the causes, fishbone diagram • Focus on what “we” can do to improve teen physical activity • PDSA • Cycle 1, Collect data (high school surveys) • Cycle 2, Conduct targeted teen surveys/focus groups • Cycle 3, Inventory physical activity opportunities and gaps

  23. QI PROJECT SUMMARY • Analyze best options • Lessons learned • Focus more on community than school for solutions • Involve youth • Next steps • More PDSA cycles • Present findings to community • Seek additional facilities/opportunities • Need more best practices and reliable data source

  24. SKAGIT COUNTY HEALTH DEPARTMENT • Population 117,500 • Predominantly rural • 47 FTEs • $4.3 million budget • Recent staff reductions • 23% in health • QI goal: Increase physical activity among Skagit Valley Hospital employees

  25. UNDERSTANDING THE QI PROJECT • TARGET Increase the percentage of Skagit Valley Hospital employees who engage in 30 minutes of moderate physical activity 5 or more days each week • WHY? • In 2007, Skagit County physical activity declined to 53.7%, from 55.5% in 2001 (data from Behavioral Risk Factor Survey)

  26. QI PROJECT SUMMARY • Employee survey • 30% of 1,273 Skagit Valley Hospital’s employees completed the survey • 21% indicated that they always meet physical activity recommendations • 29% said they do frequently • 100% indicated that physical activity is important • 72% expressed interested in increasing their physical activity level

  27. QI PROJECT SUMMARY • 4% walk or bike to work • 25% of these always meet the recommendations • 50% frequently meet the recommendations • 75% live to far away to walk or bike to work • 21% have considered it • State of change • 72% of contemplators are interested in increasing physical activity (10% thinking about it; 5% interested, 2% intend to soon) • 81 active contemplators (18 would be influenced by commute education classes, 23 would be influenced by bicycle education classes)

  28. QI PROJECT SUMMARY • What worked • Being flexible (budget cuts, decentralized team) • Bike education team recruitment and training • Skagit Bikes pilot classes • Employee survey - data points to a new direction • Outreach to partners (assistance with data analysis) • What did not work • Skagit County team • Employee survey design

  29. SPOKANE COUNTY REGIONAL HEALTH 219 employees $23.7 million budget QI goal: Increase physical activity among Spokane Regional Health District employees

  30. UNDERSTANDING THE QI PROJECT • TARGET Increase the percentage of employees who regularly meet the CDC guidelines for minimum physical activity (150 minutes a week) from 50% to 60% by December 2009 • WHY? • Four years of health risk assessment showed • 50% of staff meet the CDC recommendations • 36% are overweight • 27 are obese

  31. QI PROJECT SUMMARY TIME MOTIVATION Too tired Not knowing how to start Takes away from family Not enough of SRHD employees meet the CDC recommended minimum for physical activity The weather Takes too much time Impacts work time Self-discipline Don’t have anyone to go with Work conflicts with exercise class times No place to exercise No rewards Now is not a good time Equipment Low staff morale Few supervisors engaged in physical activity Can’t afford the gym Classes SRHD not supportive SHRD does not support Not seen as priority History of proposals declined by Exec. Team Takes away from family Why support? People won’t change MONEY CULTURE Team used fishbone diagram and solutions brainstorming with literature review for best practices

  32. QI PROJECT SUMMARY • 103 of 219 employees participated in 19 teams • Participants increased physical activity on average 305 min/wk • Increased the number of participants who met the CDC’s recommended amount of physical activity from 66% to 92% • 3 injuries, no other dropouts • Lots of positive energy around this effort • Next Steps • Complete Biggest Improver Challenge • Asses gains, overall success, needed improvements (survey) • Determine lasting impact • Plan next programs based on success • Assess how to engage the other 53%

  33. QI PROJECT SUMMARY • What worked • Teams of 4-7 people kept everyone motivated • Prizes • Stories about connecting with kids, weight loss, having more energy, etc. • Significant impact, reached many people • What did not work • Suspicion of cheating • Reporting in lunchroom • Top 10 e-mailed list not adequate for offsite

  34. WHAT WORKS IN WASHINGTON Partnerships Data driven efforts Starting small Adaptability Periodic team meetings Directors support (vital) Steal ideas (give credit) Analyze the cause (tools)

  35. THANK YOU RWJ and NNPHI for the support to make a difference

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