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Early Access Prenatal Project: Eliminating Barriers by Improving Processes
Summary
Impact Statement:
A systematic 9- step approach to manage access to prenatal care was the key to improving access to medical exams within the first 2 weeks of a positive pregnancy test. This systematic approach removed previous barriers that caused a delay in the process from pregnancy testing to initial medical visit.
Summary:
Prenatal population-based health status indicators for Osceola County, Florida are worse than state and national benchmark comparisons. Outcomes such as low rate of first trimester prenatal care and high rates of low birth weight, prematurity, and infant mortality were particularly evident in our majority population groups (46% Hispanic and 11% black) that have a tendency to suffer greater health disparities.
Osceola County Health Department’s (OCHD's) quality improvement (QI) project goal was to improve access to prenatal care by eliminating barriers that cause a delay in the process from pregnancy testing to initial medical visit. The aim statement was to improve access to prenatal care, by November 2012, by increasing the percentage of pregnant women receiving their initial prenatal medical exam within 2 weeks of a positive pregnancy test, from a baseline of 4% to 75%. This baseline would be our in-process/leading indicator that could ultimately improve the lagging/outcome indicator of first trimester prenatal care. A total of 615 prenatal patients went through the process at OCHD during the QI initiative from March through November 2012.
The QI team used a 9-Step Process Management Model with Plan-Do-Check-Act (PDCA) as a systematic approach to manage its prenatal access process. Monthly in-process data showed an improvement from the baseline of 4% in December 2011 to 39% in November 2012. There were monthly fluctuations in the data that responded to the improvement interventions the team put into place. Although the team did not reach its aim statement goal of 75%, it made an overall improvement of 35% over the project period. Sustainability of momentum will be achieved through linkage to OCHD’s strategic plan and inclusion in our Scorecard of Clinical Performance Indicators that are measured quarterly and reported to senior management.
This QI project is related to Public Health Accreditation Board (PHAB) standards Domain 7, to promote strategies to improve access to health care services, and Domain 9, to evaluate and continuously improve processes, programs, and interventions.
Organization that conducted the QI initiative:
Osceola County Health Department
Citation:
Crawford, S. Public Health Quality Improvement Exchange. Early Access Prenatal Project: Eliminating Barriers by Improving Processes. Mon, 02/27/2017 - 12:06. Available at http://www.phqix.org/content/early-access-prenatal-project-eliminating-barriers-improving-processes. Accessed October 10, 2024.
Background and Aim
Aim statement:
The intended outcome of OCHD's QI initiative is described by the "if-then" improvement theory prediction: "if... we reduce barriers to accessing care, then... we will have a positive effect on women obtaining earlier prenatal care. This in turn will have a positive impact on reducing poor birth outcomes."
The specific population was the pregnant women who accessed prenatal care at OCHD health centers. OCHD patients included 62% Hispanic (of all races), 11% black/African American, and 20% white. When Hispanics and black/African Americans are combined, 73% were in population subsets considered to be at greater risk for health disparities. Additionally, 97% of these patients lived at or below 200% of the federal poverty level, which is another risk factor for health disparity.
OCHD's aim statement was: By November 2012, OCHD will improve access to prenatal care services by increasing the percentage of pregnant women receiving their initial prenatal medical exam within 2 weeks of a positive pregnancy test, from a baseline of 4% to 75%.
Need For The QI Initiative:
Through continuous work in monitoring health status indicators, OCHD staff recognized the need for improvement in several of the maternal, infant, and child health outcome indicators (these indicators are described in detail a previous section). OCHD’s mission is to “protect and improve the health of all residents in Osceola County.” Additionally, three strategic objectives in OCHD’s 2011–2013 strategic plan link directly to this QI initiative: (1) monitoring/improving health status indicators, (2) improving access to health care services, and (3) integrating a culture of performance excellence/QI throughout the organization. OCHD’s senior administrator/county health officer commissioned a QI project team that included the senior administrator, QI manager, assistant nursing director, eligibility manager, eligibility supervisor, and public information officer.
With the county’s health outcome indicators and the internal OCHD strategic plan in mind, the QI team began this QI initiative by developing objectives to address the need for improving the rate of first trimester prenatal care. The QI team determined, through use of evidence-based knowledge, that it could improve first trimester prenatal admission rates by improving the ease of access to OCHD prenatal health care services. The team also determined that by using a systematic process management methodology, it could ensure a more efficient prenatal care entry process, which in turn would help provide earlier prenatal care and help improve birth outcomes, particularly for health disparate populations.
As the QI team progressed in its internally developed 9-Step Process Management Model with PDCA, it determined that to improve the rate of pregnant women accessing care during the first trimester of pregnancy, it would have to improve the access process from the point of pregnancy testing to initiation of prenatal medical care. During this Plan phase of the PDCA cycle, the team used QI tools and processes to improve access to prenatal care services. The team did this by eliminating barriers and delays caused by our eligibility determination and appointment scheduling processes. Eliminating these barriers would help to improve the rate of pregnant women who have their initial prenatal medical visits within 2 weeks of a positive pregnancy test. The "if-then" improvement theory prediction was that "if... we reduce barriers to accessing care, then... we will have a positive effect on women obtaining earlier prenatal care. This in turn will have a positive impact on reducing poor birth outcomes."
Area for Improvement:
Osceola County has several maternal, infant, and child health population-based health outcome indicators that show a critical need for improvement, particularly for the majority health disparate population subsets (46% Hispanic and 13% black/African American). Improving the well-being of mothers, infants, and children is an important public health goal. OCHD's QI team understood it could help address this goal by reducing the risk of maternal and infant mortality and pregnancy-related complications by increasing access, particularly early access, to quality health care.
Data from the Florida Department of Health’s Florida Community Health Assessment Resource Toolkit (CHARTS) database show the following population-based indicators for Osceola County. About the data:
• Unless otherwise noted, all trends use 3-year rolling averages to smooth out short-term fluctuations and highlight longer-term trends.
• Where indicated, Regional Peer Average is a rate of comparison that includes Florida counties in Osceola’s metropolitan statistical area—Orange, Brevard, and Seminole counties. Peer County Average, as determined by the U.S. Department of Health and Human Services Community Health Status indicators (www.communityhealth.hhs.gov/homepage.aspx), includes Florida’s Okaloosa and Santa Rosa counties, which are considered Osceola’s peers).
1. "Late Entry into Prenatal Care" (after first trimester)
• 20% for Hispanics and 26% for black/African Americans
• Both rates are equal to or worse than the national benchmark of 16% and the severe benchmark of 20%. (National benchmark and severe benchmark are defined by Health Resources and Services Administration’s Core Health Indicators, Data Resources for Demonstrating Need for Primary Care Services.)
2. "Low Birth Weight" (percent less than 2,500 grams)
• 2006–2008 = 8.6%; 2007–2009 = 8.2%; 2008–2010 = 8.3%
• While Osceola’s rate improved slightly over the three measurement periods, the rate has remained worse than the Healthy People 2020 goal of 7.8%.
3. "Premature Births" (less than 37 weeks gestation)
• 2006–2008 = 13.9%; 2007–2009 = 13.8%; 2008–2010 = 13.6%
• Osceola’s rate has remained fairly level over the three measurement periods.
• While Osceola’s rate is similar to the Regional Peers and Florida state overall average, it has been worse than the Peer Counties.
• Osceola’s rate is worse than the Healthy People 2020 target to reduce preterm births to 11.4%.
4. "Fetal Death Rate" (rate per 1,000 deliveries ["fetal" is defined as greater than 20 weeks gestation until the absence of life at delivery])
• 2007–2009 = 6.8; 2008–2010 = 6.2; 2009–2011 = 6.5
• Osceola’s rate has remained fairly level over the three measurement periods.
• While Osceola’s rate has remained slightly better than the Regional Peers and Florida state overall average, it has been slightly worse than the Peer Counties.
• Osceola’s rate is worse than the Healthy People 2020 target to reduce fetal deaths to 5.6 per 1,000 live births.
• In terms of health disparity, Osceola’s fetal death rate trend has been worse for black/African Americans (11.6; 7.8; and 8.4 respectively for 3-year rates) and for Hispanics (7; 7; and 6.3 respectively for 3-year rates) than it has been for the white population (6.3; 5.9; and 5.9 respectively for 3-year rates).
5. "Neonatal Death Rate" (rate per 1,000 live births ["neonatal" is defined as from the time of birth through the first 28 completed days of life])
• 2007–2009 = 5.9; 2008–2010 = 4.7; 2009–2011 = 3.8
• While Osceola’s trend has improved, it has remained slightly worse than the Regional Peers, Florida state overall, and Peer Counties.
• Osceola’s rate is worse than the Healthy People 2020 target to reduce neonatal death rate to 4.1 deaths per 1,000 live births.
• In terms of health disparity, Osceola’s black/African American trend has been significantly worse (10.9; 11; and 8.5 respectively for 3-year rates). The Hispanic trend has been similar to the overall rate (6.1; 5.5; and 4.6 respectively for 3-year rates). The white trend has been lower (5; 4.7; and 3.8 respectively for 3-year rates).
6. "Infant Death Rate" (rate per 1,000 live births ["infant" is defined as from the time of birth through the first year of life])
• 2007–2009 = 8; 2008–2010 = 7.7; 2009–2011 = 6.3
• Osceola’s rate has improved over the three measurement periods; it has remained better than the Regional Peers and Florida state overall average, and has been slightly worse than the Peer Counties.
• In terms of health disparity, Osceola infant death rate is significantly worse for the black/African American population (16.7; 16.1; and 15.3 respectively for 3-year rates). This rate is more than double the rate for the white and Hispanic population subsets.
• Osceola’s overall rate is worse than the Healthy People 2020 target to reduce infant death rate to 6.0 per 1,000 live births.
Additional Data:
• Florida CHARTS 2008–2010 data show there were 751 births annually to families living below 100% federal poverty level, ranking Osceola 16th or worse than 51 of Florida’s 67 counties.
• The 2009–2010 Osceola Community Health Assessment Survey showed 51% of residents reported they had "experienced difficulty or delay in receiving needed health care in the past year," compared with 43% in central Florida and 42% nationally.
1. Osceola is federally designated as a medically underserved area/population and a primary medical professional shortage area (U.S. Department of Health and Human Services).
2. Strategic issues identified through Osceola’s Mobilizing Action through Planning and Partnerships (MAPP) process are the need for access to health services and health care for the uninsured.
• The University of Wisconsin’s 2011 County Health Rankings show Osceola is in the bottom third, 43rd out of 67 Florida counties, for morbidity factors such as the percentage of low birth weight. Osceola ranks even worse, 50th out of 67 Florida counties, for clinical care measures such as lack of access to health care. (Note: At the time OCHD began this QI Award project, the 2011 County Health Rankings were the latest data available.)
• Based on OCHD’s formal 2008–2013 Strategic Plan, the Fetal/Infant Mortality and Morbidity Review (FIMR) committee was established in 2009 to research Osceola’s poor birth outcome indicators. Results show the following:
1. Of the incidents of poor birth outcomes, 13% of the mothers had no prenatal care.
2. In 2009–2010, the highest fetal and infant deaths were in two Osceola ZIP codes, 34741 and 34744. According to the Osceola Economic Profile 2010, there was a 66% minority, health disparate population in these ZIP codes (55% Hispanic and 11% black/African American).
• OCHD is also a public entity federally qualified health center (FQHC) through the Health Resources and Services Administration/Bureau of Primary Health Care. In 2011, for patients who received health care services at OCHD/FQHC, the first trimester admission to prenatal care was 56%, which was worse when compared to other Florida FQHC grantees at 57%, national grantees at 70%, and the Healthy People 2020 goal of 78% (Uniform Data System Summary Report, 2011).
Root Cause:
The initial root cause was determined to be artificially imposed barriers to make the system work for the agency and not necessarily for the patient. This cause was then further reduced to the root cause—too many separate, specialized visits in the prenatal admission process.
Planning and Execution Details
QI Implementation:
The QI team used an internally developed 9-Step Process Management Model with PDCA as a systematic approach to develop, implement, and manage the timeliness and efficiency of the prenatal health care access process. The QI team determined it could more effectively improve the rate of admission to prenatal care during the first trimester of pregnancy, a lagging/outcome indicator, by addressing in-process/leading indicators that ultimately affect the outcome. The QI team determined its in-process indicator would be the rate of pregnant women who have their initial prenatal visits within 2 weeks of their positive pregnancy tests. The project goal was to improve this rate from a baseline of 4% to 75% at the end of this project period. A total of 615 prenatal patients went through the process at OCHD from pregnancy testing, to eligibility, and to the initial prenatal provider visit during the QI initiative from March through November 2012. OCHD staff members included six who were actively involved on the QI team; six staff who processed prenatal eligibility determinations; four obstetric providers; and approximately 10 clinical staff (nursing, medical assistants, and clerical) were involved part of the time in providing direct prenatal clinical services.
QI tools used include the following:
1. Input/output diagram – The QI team used this tool to define the process of prenatal care access. This tool included inputs (pregnant women needing prenatal care), in-process activities (pregnancy test, eligibility appointment, eligibility determination, and prenatal provider appointment), outputs (pregnant woman gets prenatal care), and outcome (improved opportunity for a healthy pregnancy and healthy baby).
2. Process flow charting – Once the QI team had the prenatal access process defined with the input/output diagram, it used that information to develop a process flow chart. The process flow chart, which is a visual depiction, clearly showed the number of steps the patient had to go through from the time of the positive pregnancy test until her first prenatal provider examination. The process flow chart also showed what steps the staff had to perform at each of the patient visits. The QI team was able to clearly see a prolonged access to care for the patient and inefficient use of staff time and scheduling.
3. Brainstorming and fishbone diagram – The QI team used the process flow charting information to brainstorm various issues involved in the prenatal access process. The issues were captured in a fishbone diagram (cause and effect diagram), which served as a visualization tool for categorizing the potential causes of process problems so that the team could further refine it to identify the root cause.
4. 5-Whys and root cause analysis – As the QI team was trying to dig deeper for the real root cause from the various categories on the fishbone diagram, it used the 5-Whys tool to keep asking “why” until it felt it had reached the real root cause. The QI team also brainstormed ideas regarding which of the identified issues that it felt it could control or influence and then selected by consensus the most plausible root cause. Using the 9-Step Process Management Model with PDCA, the team continued through the steps that would test, by data analysis, whether the initial root cause held up as the real root cause. The QI team concluded that the root cause was "artificially imposed barriers to make system work for the agency and not necessarily for the patient; that is, there were too many separate, specialized visits." The team needed to improve access by eliminating and/or combining certain of the visits/steps from pregnancy testing to initial provider visit.
5. Revised process flow – After completing the steps above, the QI team developed a revised or improved process flowchart that it would implement. The improved process flow eliminated one of the four steps in the process; that is, the "separate, specialized" prenatal work-up nurse visit. The QI team combined the activities from this step into the steps before and after; that is, the eligibility step and the provider visit step.
In the five steps above, the QI team had followed the "Plan" and "Do" phases of the 9-Step Process Management Model with PDCA. The team was now at the "Check" phase in which the QI team monitored on a monthly basis the rate of first prenatal exams within 2 weeks of pregnancy testing. The team collected, analyzed, and displayed the data using a line graph. The team presented the line graph each month to senior management, eligibility staff, and prenatal clinic staff, and discussed with them what the data were indicating.
At that point, the QI team started the "Act" phase of the PDCA cycle by identifying opportunities for improvement through revised process flow and testing and taking action to fix obvious problems or identifying root causes of difficult problems. Based on the data, the team then brainstormed with staff the potential causes of why the data were not progressing as planned. The team used input from the staff to determine root causes and what they thought, based on their experience, the team could put into place as an intervention for improvement. Interventions generally were specific and focused on the staff’s experience of what had happened that month to cause a delay in progress. Their suggestions for an improvement intervention were based on what had occurred. The planned interventions for improvement were then set into place and the QI team went into another "Check" cycle to monitor performance for the next month.
Examples of our improvement interventions include the following:
1. The team eliminated the nurse work-up visit, which was being held on a separate day from the medical exam. Removing this visit resulted in a 13% improvement in prenatal patients getting their initial provider visits within 2 weeks of pregnancy testing.
2. Data monitoring showed an increase of 1 month in the average number of days from the eligibility appointment to the first prenatal provider visit. The QI team used the 5-Whys QI tool to help weed through the low-hanging fruit (or symptoms) to identify the root cause. In going through the 5-Whys technique—symptoms, visible problem, first-level cause, higher level cause, and then the highest level/root cause—the QI team determined that staff had begun using prenatal visit slots in the appointment schedule to fill with well-women gynecology exams that were in higher demand that month. This technique substantially decreased the appointment slots available for the prenatal exams. The QI team then went into the "Act" phase to take action to fix the obvious problem. The action taken was to retrain staff in the importance of appropriate scheduling; that is, not using initial prenatal visit slots for well-women gynecology exams. This intervention resulted in a 23% improvement with the next monthly data analysis.
3. The data during September 2012 showed a decline of 19% from the previous month in the initial prenatal visit within 2 weeks of a pregnancy test. The QI team went into the "Act" phase and used the 5-Whys tool. The team identified the root cause to be that the prenatal providers were covering for the absence of another provider who was on extended leave, causing a delay in available appointments for the first prenatal exam. This situation continued during October, then improved 17% in November when the provider returned. The QI team became aware that this prenatal provider would be on leave intermittently during the coming months.
Note: A significant accomplishment that resulted from the QI initiative was that based on prenatal access data that showed inconsistent provider staffing was impacting timely prenatal access, the QI team was able to demonstrate to senior management the need for an additional obstetric provider. As a direct result, senior management initiated a recruitment process to hire another obstetric provider to help ensure timely access to early prenatal care.
QI Methods:
QI Tools:
Other QI tools:
Process management model with PDCA
QI Tool Documentation:
Initiative Dates:
3/1/12
Methods of evaluation:
The QI team used an internally developed 9-Step Process Management Model with PDCA as a systematic approach to develop, implement, and manage the timeliness and efficiency of the prenatal health care access process. Step 7 in the "Check" phase of the PDCA cycle is to monitor performance. This phase established the basis for evaluating the impact of the QI initiative.
The QI team determined it could more effectively improve the rate of admission to prenatal care during the first trimester of pregnancy, the lagging/outcome indicator, by addressing in-process/leading indicators that ultimately affect the outcome. The team determined its in-process indicator would be "the rate of pregnant women who have their initial prenatal visits within 2 weeks of their positive pregnancy tests." If the team could improve this in-process indicator by eliminating barriers, there would be a corresponding positive impact on earlier access to prenatal care, as well as an improved opportunity for a healthier pregnancy and healthy baby. The project goal was to improve the in-process indicator from a baseline of 4% in December 2011 to 75% at the end of the QI initiative project period.
The data source used to capture information about the in-process measure was the eligibility tracking log that was already in place to document the date of the pregnancy test and the date of eligibility determination and payer source. The eligibility department manager, a member of the QI team, suggested that by adding an additional data point to the eligibility tracking log, the team could capture the date of the patient’s initial provider visit. This small process improvement enabled the team to capture on the one log all the data needed to evaluate performance.
Supplemental Materials:
Sample of materials produced
Storyboard
Supplemental Files:
| Attachment | Size |
|---|---|
 COPPHI QI Award_Storyboard_OsceolaCHD.pdf | 599.55 KB |
Results
Measurable QI Outcomes:
The data the QI team used to monitor the in-process indicator; that is, the percentage of first prenatal exams within 2 weeks of a positive pregnancy test, have shown monthly fluctuations during the project period. The monthly data along with a timeline for improvement interventions and other comments include the following:
December 2011: 4%. Baseline established. Dropped nurse work-up visit.
January 2012: 17%
February 2012: 15%
March 2012: 13%. This was the official start of the QI initiative; added one eligibility staff member.
April 2012: 11%. Revised eligibility appointment schedules to open available prenatal slots.
May 2012: 22%. Started Early Access Prenatal Clinic (provider schedules new patients only).
June 2012: 25%. Staff retrained not to use prenatal slots for well-woman gynecology visits.
July 2012: 32%
August 2012: 45%
September 2012: 26%. Note: One obstetrics provider on extended leave during September to October.
October 2012: 22%
November 2012: 39%. Full obstetrics provider staffing; one provider will again be on extended leave after this month. Senior management decided to hire additional obstetrics provider.
Although OCHD has not reached its aim statement goal of 75%, it has made an overall improvement of 35% over the baseline. Additional in-process data that OCHD monitored showed a significant reduction (improvement) in the average number of days in the process from pregnancy test to the eligibility determination appointment; that is, from a baseline of 23 days in December 2011 to 8 days in November 2012. OCHD was able to achieve this significant improvement by revising eligibility appointment schedules to increase the number of slots available for prenatal patients. The eligibility manager and supervisor also changed individual eligibility staff assignments so that some could specialize in prenatal eligibility, which resulted in faster processing through this step.
Conversely, the average number of days in the prenatal access process from the eligibility determination until the first prenatal provider exam has shown only a 4-day improvement—from a baseline of 16 days in December 2011 to 12 days in November 2012. The root cause was determined to be inconsistent provider availability as discussed in intervention 3, which has resulted in the decision to hire another obstetric provider.
Other QI Outcomes:
A significant accomplishment that resulted from the QI initiative was that, based on prenatal access data that showed inconsistent provider staffing was influencing timely prenatal access, the QI team was able to demonstrate to senior management the need for an additional obstetric provider. As a direct result, senior management initiated a recruitment process to hire another obstetric provider to help ensure timely access to early prenatal care.
Lessons Learned, Observations and Insights:
The QI team completed all the proposed activities during the project period. Although it did not reach its target goal of 75% of pregnant women receiving their first prenatal exam within 2 weeks of a pregnancy test, the team did see a 35% improvement over the baseline as it implemented improvement interventions based on the PDCA cycles.
Barriers the team faced included the lack of consistent prenatal provider availability, due to frequent leave time of one of the providers. When provider schedules were available and consistent, the process controls worked well. The team was able to use the data to show the need for appointment availability so that it could ensure early access to prenatal care, which has resulted in the decision by senior management to hire an additional provider. Plans are for the additional provider to be hired by January 2013. The QI team will continue to monitor the early access data to ensure improvements continue toward the target goal.
A challenge has been in determining whether the in-process indicator (first prenatal visit within 2 weeks of a pregnancy test) is the best measure of process improvement. The team selected this indicator initially (as the only one it considered) because the team determined it was a valid predictive indicator that could be measured “in-process,” could be collected at regular and frequent intervals, and would be predictive of the outcome indicator (percentage of women obtaining prenatal care during their first trimester of pregnancy). The in-process measure was also Simple, Measurable, Achievable, Reportable, and Time-Bound (SMART). Additionally, the indicator was aligned with OCHD’s organizational goals included in the formal strategic plan.
As the team proceeded in its process management, it realized that the in-process indicator did not account for patient-imposed variables such as no-show rates or whether the patient selected a later appointment date (for her convenience) than what was actually available. As the team continues monitoring the access data, it will revisit the in-process performance indicator to determine whether it should change it, for instance, to measure the next available appointment in order to negate patient-imposed variables. The QI team also will consider keeping the current in-process indicator, while adding other measures that might further clarify performance variations, such as the next available appointment and no-show rates.
Future Plans:
The last phase of the 9-Step Process Management Model with PDCA is the "Act" cycle where action is taken to make further improvements and/or maintain the improvements achieved. Once the team achieves its established performance indicator target (75% of pregnant women receive their initial prenatal medical exams within 2 weeks of a positive pregnancy test), we will ensure its process documentation is updated and train staff to permanently standardize the process.
The QI team will continue monitoring prenatal access as a routine QI indicator, including it in the Scorecard of Clinical Performance Indicators. This scorecard reports baseline and actual performance against the established target for each of OCHD’s Clinical Performance Indicators. The data are presented quarterly in a dashboard format using red/yellow/green color coding to visually depict the progress of each measure against its target. The scorecard is presented to senior management and the Board of Directors and is shared with staff. In this manner, the QI team will continue measuring performance of its Early Access Prenatal project past the end of this project period as the team works to standardize performance achievements.
OCHD’s mission is to "protect and improve the health of all residents in Osceola County." Additionally, three strategic objectives in OCHD’s 2011–2013 strategic plan link directly to this Early Access Prenatal QI Initiative: (1) monitoring/improving health status indicators, (2) improving access to health care services, and (3) integrating a culture of performance excellence/QI throughout the organization. This linkage further enhances OCHD's ability to continue this QI initiative and make it part of our Scorecard of Clinical Performance Indicators.
Training and Preparation
Technical Assistance Received:
This QI project was conducted as part of the National Network of Public Health Institutes (NNPHI) QI Award Program, a competitive initiative that provides a small financial award and 15 hours of distance-based and in-person coaching from a designated QI consultant. The program is part of the Community of Practice for Public Health Improvement (COPPHI), supported by the Robert Wood Johnson Foundation.
QI Related Training Received:
The QI team received the QI training that was provided during the QI initiative via Web conference with consultants provided by the National Network of Public Health Institutes (NNPHI)/Strengthening the Community of Practice for Public Health Improvement (COPPHI) staff. This training included four sessions on different aspects of QI. The link to NNPHI's performance improvement toolkit database is www.nnphi.org/phpit.
Information about the Community
Population Size:
Population Characteristics:
Osceola County, located in east central Florida, is part of the Orlando-Kissimmee metropolitan statistical area. Osceola is the sixth largest county in land mass in Florida; much is vast, sparsely populated rural expanse. The majority of the population is in the urban/suburban areas in the northwest quadrant of the county, which includes Kissimmee, St. Cloud, Poinciana, and Celebration. Because of the proximity to Walt Disney World (located across both Osceola and neighboring Orange County), there is a daily average of 100,000 overnight visitors. This average represents a 37% increase to our resident population of 276,163. There is an ever-present potential that these worldwide tourists could have a tremendous impact on Osceola’s public health system with an increase in the number of people who require epidemiological, environmental, and public health preparedness services.
Socioeconomic demographics include a population of 40% white, 13% black/African American, and 46% Hispanic ethnicity. The combined Hispanic and Black/African American populations represent a 59% majority, which is of significance as these population subsets are considered at greater risk of health disparities. Forty-four percent of residents older than 5 years of age speak a language other than English at home. Eleven percent of residents indicate language barriers or cultural differences make it difficult for them to get medical care. Although Osceola County’s unemployment rate dropped from 12% in 2011 to 9% in 2012, it remains worse than the surrounding counties. Twenty-seven percent of residents have no health insurance and 41% live below 200% of the federal poverty level.
Information about the Health Department
Local/State Relationship:
Centralized
Local Health Department Governance:
State Governance- all LHDs in the state are units of state government
PHAB Accreditation Status:
Planning to submit application for accreditation in the next 3 years
Annual QI Initiative Frequency:
QI activity level:
Organization Type:
QI Staff Information
Total number of Staff on QI Team:
6
Total number of FTEs on QI Team:
0.75
QI team members:
Role in the Initiative:
QI Project Coordinator
Role in Organization:
Quality Management Consultant
FTE:
0.20
Name (Optional):
Susan Crawford
Role in the Initiative:
QI Champion
Role in Organization:
Administrator/Public Health Officer
FTE:
0.05
Name (Optional):
Belinda Johnson-Cornett
Role in the Initiative:
Clinical Lead
Role in Organization:
Assistant Nursing Director
FTE:
0.10
Name (Optional):
Shannon Whitston
Role in the Initiative:
Eligibility Process Owner
Role in Organization:
Eligibility Department Manager
FTE:
0.10
Name (Optional):
Donna Parker
Role in the Initiative:
Eligibility Process Lead
Role in Organization:
Eligibility Supervisor
FTE:
0.20
Name (Optional):
Hector Gonzalez
Role in the Initiative:
Messaging to Patients and Data Analysis
Role in Organization:
Public Information Officer
FTE:
0.05
Name (Optional):
Camille Bissainthe
Role in the Initiative:
Data Collection and Analysis
Role in Organization:
Data Analyst
FTE:
0.05
Name (Optional):
Jason Martinez
Accreditation Details
PHAB Standards:
Domain 7: Promote strategies to improve access to health care services›Standard 7.1 Assess Health Care Service Capacity and Access to Health Care Services›Measure 7.1.2 A Identify populations who experience barriers to health care services
Domain 7: Promote strategies to improve access to health care services›Standard 7.2 Identify and Implement Strategies to Improve Access to Health Care Services›Measure 7.2.2 A Collaborate to implement strategies to increase access to health care services
Domain 9: Evaluate and continuously improve health department processes, programs, and interventions›Standard 9.1 Use a Performance Management System to Monitor Achievement of Organizational Objectives›Measure 9.1.1 A Engage staff at all organizational levels in establishing or updating a performance management system
Domain 9: Evaluate and continuously improve health department processes, programs, and interventions›Standard 9.1 Use a Performance Management System to Monitor Achievement of Organizational Objectives›Measure 9.1.2 A Implement a performance management System
Domain 9: Evaluate and continuously improve health department processes, programs, and interventions›Standard 9.1 Use a Performance Management System to Monitor Achievement of Organizational Objectives›Measure 9.1.3 A Use a process to determine and report on achievement of goals, objectives, and measures set by the performance management system
Domain 9: Evaluate and continuously improve health department processes, programs, and interventions›Standard 9.2 Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions›Measure 9.2.1 A Establish a quality improvement program based on organizational policies and direction
Domain 9: Evaluate and continuously improve health department processes, programs, and interventions›Standard 9.2 Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions›Measure 9.2.2 A Implement quality improvement activities
Contact Information of the Submitter
First Name:
Susan
Last Name:
Crawford
Organization:
OCHD
Submission Status:
Completed
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Good job, everyone. I'm very
Good job, everyone. I'm very interested to see how much more improvement you've been able to make since you hired on the additional person. It would be interesting to follow your team's efforts with this through submitting ongoing updates on the improvements you continue to make, and to see if you unearth other issues as you work to improve access to prenatal care and ultimately health outcomes. Keep up the great work!