Quality Improvement and Communicable Disease Reporting

Summary

Impact Statement:

Because surveillance for communicable disease had been provided by the state, the Red Cliff Community health department had limited knowledge of communicable diseases in their community. They used quality improvement to bring communicable disease reporting, surveillance, control and prevention back to the health department. Partnering with other PH departments provided t lessons and best practices. Current and new process maps were created, followed by the identification of gaps and improvement solutions (5 Whys and Radar Charts were used). An action plan and bi-weekly team time was used to monitor implementation of the solutions, learnings, and modifications. Project outcomes included reporting and completing follow-up for 100% of communicable diseases and team member knowledge testing improved from an average score of 84% to 96%. The benefits extended beyond communicable disease – it increased collaboration and partnerships with Ashland and Bayfield Counties.

Summary:

The Red Cliff reservation is approximately 1 mile wide and 14 miles long and is located at the top of the Bayfield Peninsula, on the shores of Lake Superior in northern Wisconsin. The reservation population is 924, primarily Native American. Red Cliff Community Health Center includes family practice, community health, dental, laboratory, pharmacy, and alcohol and other drug abuse services. Red Cliff Community Health Center started the accreditation process with a grant from Wisconsin’s Public Health Quality Initiative (WIQI). A team was developed to complete the public health self-assessment. From there, the team discovered that communicable disease reporting, along with other areas, was a weakness. The team applied for funding from the National Network of Public Health Institutes (NNPHI) to develop a multidisciplinary, community-based approach to communicable disease reporting and surveillance for the Red Cliff community. First, the team developed an aim statement, which has been revised many times and has been fully accomplished. Five staff members have access and competency in reporting communicable diseases to the Wisconsin Electronic Disease Surveillance System (WEDSS), and the team is in the process of reporting its first case.

Organization that conducted the QI initiative:

Red Cliff Community Health Center

Citation:

Elza, J. Public Health Quality Improvement Exchange. Quality Improvement and Communicable Disease Reporting. Mon, 10/05/2015 - 14:03. Available at https://www.phqix.org/content/quality-improvement-and-communicable-disease-reporting. Accessed September 15, 2024.

Background and Aim

Planning and Execution Details

QI Implementation:

The Public Health Accreditation Team (PHAT) was developed, QI training was completed, and leadership was brought on board with the QI project. The team consisted of the community health nurse supervisor, the community health nurse, the QI nurse, environmental health staff, the maternal child health nurse, the laboratory technician, and the Women, Infants, and Children (WIC) program technician. The team started with Plan, Do, Study, Act (PDSA) test cycles and action plans. They examined the current approach and created an initial process map, which had a lot of gaps. A nurse from Bayfield County was then added to the team. Additional gaps and areas for improvement presented themselves with further investigation into the current process through the use of the process map. When it came time to start “doing” the project, the team used an action plan to keep on task and organized. The team held biweekly meetings to study and reflect on the QI project and make adjustments to the plan based on problems and other observations. During this time, the aim statement was also being updated. The aim statement changed three times based on information gathered during the PDSA cycles. Some issues arose that the team did not foresee, which made the process take longer than anticipated. One issue was related to the community's jurisdiction and reporting system. Red Cliff Community Health Center is in Bayfield County and would need to have the system set up with them. The Wisconsin state reporting system made Red Cliff its own jurisdiction with a connection and agreements with Bayfield County. Five staff members belonging to the team have access and have had training on the reporting system.

Focus activities

Data collection, Epidemiology and Surveillance:

Communicable/infection diseases

QI Methods:

Model for Improvement

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

Rapid Cycle Improvement

QI Tools:

QI Tool Documentation:

WIQI_PHAB.xlsx

Initiative Dates:

12/30/12

Initiative Duration:

Between 6-12 months

Methods of evaluation:

Because this QI project is just being implemented, there were no baseline data related to reporting the diseases themselves. The team added a measurable component to the aim statement regarding staff members’ knowledge level of communicable diseases. The aim statement also stated that the team would report all communicable diseases, which it has also set up and is starting to do.

Supplemental Materials:

Sample of materials produced

Results

Measurable QI Outcomes:

Red Cliff Community Health Center is now reporting and completing follow-up for 100% of its patients' communicable diseases. Each team member completed a pre-test, with an average score of 84%. The team completed PowerPoint training and took a post-test, with an average score of 96%.

Other QI Outcomes:

The intangible benefits of working on this QI project extended far beyond Red Cliff Community Health Center. The biggest benefits were the collaboration and increased partnerships with Ashland and Bayfield Counties. Before this QI project, there was little contact, and it now occurs frequently. Ashland and Bayfield Counties have provided training and shared their policies and procedures on disease reporting. They have also received training from the state reporting site, and through that process, individuals were being identified as belonging to Ashland County because they went through Memorial Medical Center in Ashland County but were residing in Bayfield County. The team has completed an emergency preparedness planning collaboration with Ashland and Bayfield Counties. The Red Cliff Community Health Center staff have also broken down barriers and successfully created a multidisciplinary, community-based team approach to communicable disease outbreaks. The team included members from Community Health, Family Practice, Administration, Laboratory, Pharmacy, Medical Records, Bayfield School, Bayfield County, and the Early Childhood Center.

Lessons Learned, Observations and Insights:

This initiative will improve staff members' knowledge of disease prevalence in the Red Cliff community, so staff are able to better serve the community to which they provide care. They are looking to take a more proactive approach to providing care. The team learned to make time for meetings and to document, document, document!

Future Plans:

Staff are working toward a QI culture at Red Cliff Community Health Center and plan to continue QI efforts in every department and make QI part of all daily activities. Currently, the maternal child health nurse has been selected for the second round of mini-grant recipients. This QI project is intended to increase the number of women served by the prenatal nurse care coordinator who have a postpartum contraception plan in place before the birth of their child. Future plans for communicable disease reporting are to finalize the draft policies and procedures related to reporting, follow-up, and surveillance. When staff have baseline data for the prevalence of communicable diseases, they plan to create programs for preventing and managing the diseases. Currently, the QI nurse is working on a performance management system for public health. Staff have started measuring the number of communicable diseases reported and processed. This will be the first measure they will track, but they intend to measure and report many other performance measures.

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Submission Status:

Completed

Comments

Communicable Diseases and QI

Jenelle Elza

Of the cases you are

Of the cases you are reporting and doing follow up for, are these cases that are identified in house or reported to you from another source, such as hospital, lab, school? To whom are you reporting these cases? Are you doing the disease investigations or passing on to a local or state health authority? Thanks.

Under your Measurable QI

Under your Measurable QI Outcomes you mention a pre-test and power point presentation on Communicable Disease. Just wondering if you would be willing to share this information? We are also new to WEDSS and these training tools would be great for our Community Health Nursing staff.

Thanks,

Lorrie Shepard, Community Health Outreach Director, Forest Co. Potawatomi Community Health Department

Link to the resource where this submission is also published:

No.

Quality Improvement and Communicable Disease Reporting

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

Communicable Diseases and QI

Of the cases you are

Under your Measurable QI

QI Spotlight

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Quality Improvement and Communicable Disease Reporting

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

QI Spotlight