Denver Public Health Center for Public Health Preparedness

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Denver Public Health Center for Public Health
Preparedness
Public Health Services Research, Moving to the
Mainstream Public health performance and quality
improvement, one states experience A.
Davidson, MD, MSPH

• AcademyHealth, Annual Research Meeting
• Hynes Convention Center
• Boston, MA
• June 26, 2005

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Outline

• Historical context
• Current efforts

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Outline

• Historical context
• CO Health Data Advisory Committee (CoHDAC)
• Colorado PH Education Committee
• CO PH Capacity Building Steering Committee
• Denver Center for Public Health Preparedness
• Public Health Performance Improvement
  Collaborative (PH-PIC)

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Colorado Health Data Advisory Committee (CoHDAC)

• Vision Access to health data on as needed basis
  with an analytic toolset to generate information.
  
• Result
• 1994-present created a competent, committed,
  collaborative (local/state) problem-solving group
• 1995 Colorado Health Information Dataset
  (CoHID) CD-version, Weld County
• 1998 present Colorado Health Information
  Dataset (CoHID) on-line SAS IntrNet query tool
  (CDPHE), GIS capacities

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Colorado PH Education Committee

• Charge Create a strategy for improving education
  and training of Colorados PH workforce.
• Results
• April 2001 Colorado PH Professional Education
  Plan Life-long Learning System,.
• April 2002 Workforce educational needs
  assessment (UCHSC SON survey) to set training
  priorities by gauging
• How important a skill area was to job,
• How prepared staff felt in each skill area, and
• What interest existed around training
• 2004 Implementation CO-TRAIN, (PHF)

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CO PH Capacity Building Steering Committee

• Charge Workforce development was only a part of
  PH essential services delivery capacity convened
  committee to create a strategy for enhancing
  Colorados capacity to do PH work.
• Result
• 2001 The committee recommended the use of the
  NPHPS.
• Post Sept 11, 2001, enabled NPHPS assessment
  funding.
• OLL coordinated implementation of NPHPS
  assessment
• February 2003. NPHPS study completed for
  Colorado

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Denver Center for Public Health Preparedness
(CDC-funded Advanced Practice Center )

• Mission toenhance operational readiness
• dual use perspective, operational readiness
  related to organizational capacity
• parallel skills for BT readiness and routine ES
  capacities
• operates at organizational or system level
• PH community had individual readiness
  competencies (Columbia SON)
• Issues
• Have we defined organizational competencies? How
  are they measured? Are they being used? How would
  combined (individual and organizational)
  competency measures better evaluate our essential
  services delivery or BT readiness capacities?

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BT Supplement Challenge PH Needs Dual Use
Operational readiness
Organizational capacity
BT
Routine
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Denver Center for Public Health Preparedness
(cont.)

• Result June 2003, Conference Started the QI
  Collaborative
• Goals
• Cultivate within Colorados PH community a
  culture of learning and QI
• Facilitate PH quality improvement, capacity
  building and all hazards preparedness in CO
• Members representatives of local/state public
  health departments (e.g., OLL, data, QI,
  academics)

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Merger QI Collaborative the Capacity Building
Steering Committee (2003).

• Articulated a new group identity (mission, vision
  and new name PH-PIC).

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Public Health Performance Improvement
Collaborative (PH-PIC)

• What is PH-PIC? A workgroup from local/state
  health departments which adapts national
  initiatives to expand and improve local public
  health performance and all-hazards preparation
  and capacity.
• PH-PIC Premise The process of setting priorities
  for performance improvement and all-hazards
  preparation should be driven by current Colorado
  data.

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Merger QI Collaborative the Capacity Building
Steering Committee (2003).

• Articulated a new group identity (mission, vision
  and new name PH-PIC).
• Analyzed and distributed the NPHPS Colorado
  results and other assessment data.

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NPHPS Opportunities for Colorado

• To use results to improve public health practice
  and the public health system performance as a
  whole
• To provide a foundation for continuous quality
  improvement activities
• Encourages stakeholder communication and
  collaboration
• Promotes greater understanding of the available
  capacity and resources within a region
• Promotes the development of new and/or stronger
  partnerships
• Encourage greater inter-jurisdictional cooperation

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(No Transcript)
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Proportion of NPHPS Standards Being Met
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Importance Intent for QI (Survey)
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Workforce Proficiency (SON Survey)
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NPHPS Priority Matrix
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Merger QI Collaborative the Capacity Building
Steering Committee (2003).

• Articulated a new group identity (mission, vision
  and new name PH-PIC).
• Analyzed and distributed the NPHPS Colorado
  results and other assessment data.
• Created a BT-focused training opportunity in Feb
  2004 to learn QI/PI process and use the NPHPS
  data.

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Denver Public Health Department

• Performance topics
• Emergency notification system
• System to divert workforce to function in
  specific emergency response roles, while
  maintaining core public health functions
• Selection of sites for dispensing mass
  vaccinations/prophylaxis

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Denver Public Health Department

• Performance topic
• Emergency notification system
• How decided is important
• Contractual obligation (BT preparedness)
• No current system
• Specific aim or purpose
• Develop an alert/notification system
• Inform PH workforce of roles/responsibilities
• Insure a functioning system
• Desired outcome or target improvement
• 100 of employees aware of emergency number
• 98 of employees contacted within 24 hours
• 100 of contacted employees follow emergency
  notification procedures
• Quarterly test of efficiency system

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Denver Public Health Department 2/11/04

• Results
• Total employees
• Employees contacted
• Performed action
• Employees not contacted
• Employees beneath 1 caller
• Mean contacts per employee
• Mean time to contact
• Mean time to return call
• No. corrected phone numbers
• No. of alternative numbers

• Number
• 101 (68)
• 98 (97)
• 48 (32)
• 34 (23)
• 1.2
• 2.2 hrs
• 3.1 hrs.
• 37
• 23

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Merger QI Collaborative the Capacity Building
Steering Committee (2003).

• Articulated a new group identity (mission, vision
  and new name PH-PIC).
• Analyzed and distributed the NPHPS Colorado
  results and other assessment data.
• Created a BT-focused training opportunity in Feb
  2004 to learn QI/PI process and use the NPHPS
  data.
• Presented PH-PIC methods, activities the
  Primer on PH-PI at CPHA (September 2004).

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Quality Improvement

• What are we trying to accomplish?
• How will we know that a change is an improvement?
  
• What changes can we make that will result in an
  improvement?

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Four Steps of Improvement (IHI Model)

• Plan
• Do
• Study
• Act

Plan
Act
Study
Do
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Team Specific Process and Quality Improvement
Projects   Team _________________________________
____ Date________________________________  
Example of a Basic Plan
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Repeated Use of the Cycle
?
?
DATA
?
Changes that result in improvement
?
Hunches, theories, ideas
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Denver Public Health Department 6/24/04

• Results
• Total employees
• Employees contacted
• Performed action
• Employees not contacted
• Employees beneath 1 caller
• Mean contacts per employee
• Mean time to contact
• Mean time to return call
• No. corrected phone numbers
• No. of alternative numbers

Number 11 11 (100) -- 0 -- 1 NA 4.1 hrs. -- --
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Merger QI Collaborative the Capacity Building
Steering Committee (2003).

• Articulated a new group identity (mission, vision
  and new name PH-PIC).
• Analyzed and distributed the NPHPS Colorado
  results and other assessment data.
• Created a BT-focused training opportunity in Feb
  2004 to learn QI/PI process and use the NPHPS
  data.
• Presented PH-PIC methods, activities the
  Primer on PH-PI at CPHA (September 2004).
• Created the Colorado Public Health Performance
  Improvement Plan. http//www.cdphe.state.co.us/as
  /ollhom.asp

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Colorados PI choices clustered around three
Essential PH Services

• Monitoring
• 3 state system plans
• 27 local system plans
• Diagnosing
• 29 local system plans
• 5 state system plans
• Evaluating
• 12 state system plans
• 5 local system plans
• 39 local and state plans targeted All-Hazards

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PH-PIC Assessment (Fall 2004/Winter 2005)

• Clustering of PI priorities
• Results of NPHPS matrix

Should Learning Communities be developed to
support quality improvement/ performance
improvement in Colorados Public Health systems?
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Outline

• Current efforts
• Learning communities
• Regional Health Information Organization (RHIO)

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What might we accomplish today?

• Hear and log our stories
• Recognize common statewide issues
• Work to define and solve problems
• Assure dual purpose/use of our efforts
• Consider developing a learning community
• Use as opportunity to guide new BT supplemental
  planning process

June 2, 2003
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Learning Community
Learning communities are developed where
groups of people, linked geographically or by
shared interest, collaborate and work in
partnership to address their members learning
needs Learning communities facilitated through
adult and community education are a powerful tool
for social cohesion, community capacity building
and social, cultural and economic
development. Department of Education, 2003, p 12.
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Barriers to Organizational Learning

• Silo style of work and work groups
• Unsupportive leadership
• Lack of legitimacy
• Failure to build in time and structures for
  learning
• Defensive communication patterns
• Limited ability for reflection and generative
  learning
• Lack of the 6 Cs in group members

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What It Takes to Create and Sustain A Learning
Community

• Capability have the skills, knowledge and
  personal qualities to renew themselves and
  reinvent a future through skillful discussion
• Commitment people are an integral part of
  creating a community they value together
• Contribution members must see how their work
  contributes to community provide opportunities
  for diversity of talents and contributions

(Brown and Isaacs, Fifth Discipline Fieldbook,
1994, p 508-517)
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Creating and Sustaining Learning Communities
(cont.)

• Continuity develop an institutional memory,
  careful orientation of new members
• Collaboration develop interdependence, share
  vision and strategy, free flow of information,
  able to act autonomously to achieve common goals
• Conscience guiding principles, ethics, values
  (e.g., trust, mutual respect)

(Brown and Isaacs, Fifth Discipline Fieldbook,
1994, p 508-517)
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EVALUATION LEARNING COMMUNITY CPHA Abstract
Draft June 3, 2005

• PUBLIC HEALTH PERFORMANCE IMPROVEMENT
  COLLABORATIVE
• Title Demonstrating success User-friendly
  evaluation for public health programs
• Learning objectives
• Increase familiarity with useful evaluation
  terminology.
• Identify evaluation resources.
• Practice using basic evaluation skills
• Short Description
• This user-friendly, interactive workshop will
  allow participants to gain knowledge and skills
  to demonstrate the success of their programs.
  Commonly used evaluation processes and resources
  will be presented with opportunities for practice.

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MONITORING LEARNING COMMUNITY

• Initiating work around cataloguing available data
  sources and identifying data gaps.
• Adjunct work by Colorado Health Information
  Exchange

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Colorado Health Information Exchange 2
Complementary Initiatives
Goal Create a local health information
infrastructure for clinicians to access patient
information across individual health care
institutions
Build upon what exists

• Denver Health (DH)
• 150,000 residents (25 of population)
• Kaiser Permanente of Colorado (KPC)
• 3rd largest CO HMO (350,000 members)
• The Childrens Hospital (TCH)
• Largest pediatric specialty care provider
• University of Colorado Hospital (UCH)
• Largest Metro area teaching hospital

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COHIE to CORHIO
COHIE Learning Laboratory
PROJECT (10/2004)

• Working groups
• Technical
• Clinical
• Evaluation
• Legal
• Organizational

Steering Committee
Community Advisory Council
Colorado Regional Health Information
Organization A sharing, self-sustaining
non-profit structure that
VISION (10/2009)
Promotes legal agreements for participation and
access
Maintains a robust technical environment
Defines clinical value through policy and
procedures
Manages the budget and sustainable business model
Supports national standards and public health
interfaces
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COHIE 2005 plan
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COHIE Linking independent clinical data into a
virtual patient-centered view 1. Accountable
and OPEN participation 2. Clinical data
sharing between different platforms 3. Data
sharing and degree of participation remains under
local control
Larimer
Clinical Data Contributor TBD ?
Payor 1 RMHP ???
Boulder
Weld
RxHub ???
COHIE Community patient index common
(standard) messaging Vendor independent (neutral)
Exempla
Rural small MD access ?
The Childrens Hospital
CHCN - Health Center?
Mesa County
Kaiser Permanente
Colorado Care Collaborative (RMD)
Denver Health
University Hospital
MedSouth IPA
El Paso County
Rose Medical Group
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CORHIO Process

• Colorado Health Institute (neutral convener)
• Legal support
• Explore/define relationship COHIE ? CORHIO
• Working Group
• Business plan
• Articles of incorporation (501c3)
• Defining the board
• Education/public relations
• Community Advisory Council (greater than 40
  members, most HIT projects going on in Colorado

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Future activities/use cases

• Public Health
• Registries and evaluation of care quality
• Active surveillance due to recent events
• Immunization tracking and reminder/recall
• Others ??
• Use of global-level decision support
• Continuity of care record (CCR) for effective
  care transitions (acute -gt treatment centers -gt
  home)
• Patients controlling EHR access

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COLORADO TEAM - VISUAL MODEL National Public
Health Leadership Institute Draft V1.1, June 20,
2005
And then tools/methods and measures will evolve
to support/revise the
If the conceptual work is successful, we should
focus on.
Conceptual Framework

• 10 Essential Services
• Clear PH message

Leadership Development
Performance Improvement

• Systems thinking
• Change management

• Accountability targets
• Unified measurement process

And if true leaders emerge, we should generate .
Then partners will agree to emphasize
State/Local Partnerships

• Respectful relations
• Inclusive planning