Slide 1 HRSA Health Disparities Collaboratives 2006: Perinatal and Patient Safety Pilot Ada Determan, MPH Division of Clinical Quality Bureau of Primary Health Care Health Resources and Services Administration US Department of Health and Human Services Slide 2 Aim of the Pilot To enhance partnerships that would Reduce disparities Ensure safety in pregnancy outcomes These changes will occur by targeting reductions in the primary areas of infant mortality disparities for the African-American population Low birth weight Preterm birth Sudden Infant Death Syndrome Slide 3 Participants Teams 5 health center teams from Illinois, Michigan, South Carolina, Mississippi, and their partner community hospitals Faculty Clinicians, public health professionals, and health center representatives Organizations HRSA: 4 bureaus; BPHC, MCHB, HAB, BHPR Institute for Healthcare Improvement, IHI, slash National Initiative for Children’s Healthcare Quality, NICHQ Federal partners: CDC, OMH Slide 4 Process 1: Vanguard Group 2: Expert panel meeting 3: Planning group meeting 4: Team pre-work meeting 5: Learning sessions 1, 2, 3 6: Site visits 7: Harvest meeting 8: Creation of quote, change package, unquote Slide 5 Core Measures Outcome Measures 1: Preterm birth: HP 2010 2: Low birth weight: HP2010, UDS Process Measures 3: Early prenatal care visits; UDS 4: Risk assessment index 5: Risk screening index 6: Self-management goals 7: Followup index; HEDIS, UDS 8: Availability of medical records Slide 6 Perinatal Change Concepts Change Concept A general or high-level idea for changing a process, usually developed by an expert panel based on literature and practical application of evidence EG, Foster communication with partners Change Idea An actionable, specific idea for changing a process that can be tested in the local environment to see if improvements are gained EG, Meet with State MCH officials Slide 7 Perinatal Change Concepts: Prioritized by highest leverage within each component of the Care Model Initial Input from Harvesting Meeting, February 11th, 2006, and currently undergoing refinement Current as of February 20th, 2006 ORG Foster communication and organization among FQHC, hospital, and other agencies to ensure continuity, quality of care, social supports, and patient safety Ensure that perinatal safety and care is a key part of the strategic plan and regular review of progress takes place Use an effective improvement strategy and supply appropriate resources to optimize high-quality care and patient safety outcomes Assure the provision of culturally and linguistically appropriate services for all by integrating the CLAS standards throughout the health system COM Form partnerships and relationships with community organizations and specialists to support and develop interventions that fill gaps in needed services Increase awareness of and participation in community programs and build relationships to form alliances and programming Advocate for policies to improve patient care SMS Use effective self-management support strategies that include assessment, goal setting, action planning, problem solving, and follow-up Organize internal and community resources to provide ongoing self-management support to patients Develop opportunities for prenatal classes on site Develop and utilize patient educational materials in a culturally competent manner DSD Create a uniform mechanism to ensure timely record exchange between organizations Give care that patients understand and that fits with their cultural background Develop a process and tool to allow the patient to carry pertinent medical history information Utilize a tracking system Provide clinical case management services for complex patients Develop and implement standardized ante-partum visits utilizing comprehensive forms and guidelines Proactively plan and critique emergency drills DS Provide ongoing in-service training for providers and staff, using educational strategies proven to change practice behavior and integrating specialist expertise, knowledge, and standards of care Embed evidence-based guidelines into daily clinical practice with the development of protocols, standing orders, and flow sheets Establish referral criteria, guidelines, and protocols that facilitate links with supportive specialists, community programs, and support agencies CIS Develop a registry system and process to track clinically useful information and data Organize and share information between the hospital and health center Provide timely reminders and prompts Facilitate individual patient care planning Slide 8 Top 7 Change Concepts 1: Foster communication and coordination 2: Organize and share information between the hospital and health center 3: Form partnerships with community organizations and specialists 4: Develop a registry system and process 5: Provide ongoing in-service training for providers and staff 6: Embed evidence-based guidelines into daily clinical practice 7: Use effective self-management support strategies Slide 9 Accomplishments Outreach to community and health care partners to coordinate care, resulting in: Patient linkages to community services and resources Improved efficiency of the health care system Reduced duplication of needed resources Patient safety: communication and transfer of information slash records Development of comprehensive psychosocial tool Increased adherence to ACOG guidelines Improved health center credibility and reputation Strong connection with JCAHO patient safety standards Slide 10 Challenges and Insights Complexities of the perinatal topic Multiple health issues Two patients in one Absence of guidelines: just best knowledge in some area Essential partnership development. Must go outside the walls of the health center and form a complete team to coordinate care from prenatal to intra-partum care Slide 11 Implications for Dissemination Small sample size: 5 health centers First pilot to have hospital partners as team members, going beyond the walls of the health center Complex topic for registry software Teams recommended next steps should include 15 to 20 new health centers with mentoring from original 5 health centers Slide 12 The Future Plans are to integrate the lessons learned from the Perinatal and Patient Safety Pilot, as well as the other Pilots and Demonstrations done in 2005, into an overarching quality improvement initiative, based on documenting the work of delivering Primary Health Care in all of its dimension. The implications for infrastructure support currently are being worked out. Slide 13 For More Information Ada Determan, MPH Public Health Advisor Clinical Quality Improvement Division of Clinical Quality 3 0 1, 5 9 4, 0 8 1 8 ada.determan@hrsa.hhs.gov