North Carolina Maternal, Infant, and Early Childhood Home Visiting Program Climbs the Data Peak

The QI team would assess the current data processes used by two pilot sites to determine the effectiveness and usefulness of the process. The QI team also wanted to examine how the state team was using the data to identify system barriers and determine opportunities for process improvement through skills trainings, technical assistance, and program consultation while improving the communication feedback loop to programs to efficiently make site-level changes. 1. Increase the percentage of sites using monthly data discussion forms with local staff from 0% to 100% (please refer to the attached QI tools). This goal would assist sites in learning to be comfortable with incorporating data into their routine staff meetings. This goal would generate accountability for staff and supervisors to focus on specific areas of programming monthly, such as capacity, client engagement and retention, and program outreach. After developing the data discussion form, Plan, Do, Study, Act (PDSA) cycles were conducted with both pilot sites to assess the forms' relevance and ease of use during local team meetings. The PDSA cycle was expanded to all seven sites, and the form was adopted after several revisions. 2. Increase the percentage of sites submitting monthly data updates on time from 91% to 100%. Increase the percentage of monthly data update submissions without errors from 66% to 90%. The QI team wanted to revise the monthly data update report so that it was useful to sites in meeting multiple reporting requirements for various funders while also tracking program productivity so that supervisors can monitor and improve services where needed. Value-stream mapping indicated that sites had multiple handoffs when completing monthly reports and inefficient reporting systems, which led to inaccurate and late reporting to the state team (please refer to the attached QI tools for PDSA on resubmissions and handoffs). The QI team believed that if reports were more useful and relevant to sites, they would not only use the reports for QI purposes, but they would also take more ownership of their data. This would increase timeliness and accuracy of the data. Because the MIECHV program funds two separate home visiting models, the QI team first conducted a data crosswalk to ensure that data points were program specific (please refer to the attached QI tools for PDSA cycles on the crosswalk and revised reports). The data crosswalk also assisted in identifying proper reports to be used within each model's data system because data points were redefined and clarified for sites through development of a data definitions document. The state wanted this monthly report to be a full representation of how sites were performing; therefore, PDSA cycles were conducted to test report revisions. Revisions were made to the report format, data points, and general language to be more program specific and user friendly. After several revisions to the report, the QI team developed and adopted two separate monthly reports (one for each model). 3. Develop surveys to assess the level of site satisfaction with the relevance and usefulness of monthly data reports. The QI team wanted to assess whether sites were satisfied with not only the data collection process in place, but also with how relevant and useful the monthly reports were. The survey also measured the percentage of sites that indicated they were using the monthly data to improve services.

As part of the Center for Public Health Quality (CPHQ, http://centerforpublichealthquality.org/) QI 101 program, the QI team created a detailed measurement plan consisting of a balanced set of process, outcome, and balancing measures that were tracked throughout the project. These data were displayed in run charts to assess progress toward the measurable goals outlined in the aim statement. In addition, the QI team collected qualitative and quantitative data demonstrating the need for the project at the beginning, as well as before-and-after data specifically related to the PDSA cycles throughout the project. For detailed documentation, please refer to the attached QI tools.