Cathy Bambrick Administrator

1
Chlamydia Quality ImprovementWorkgroup (CTQI)

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• LPHI Improvement
• Skagit County Public Health Department
• Mount Vernon, WA
• Population 115,300 people
• Kitsap County Health Department
• Bremerton, WA
• Population 244,800 people
• Washington State Department of Health
• Sexually Transmitted Disease
• Olympia, WA

2
Workgroup Members

• Mark Aubin, STD Section Manager, DOH
• Dana Brainerd, Nurse Epidemiologist, Kitsap
  County
• Kerry Dobbelaere, Clinical Services Program
  Manager,
• Kitsap County
• Katherine Gudgel, Infertility Prevention
  Project, DOH
• Alba Gutierrez, PA, Skagit County
• Marni Mason, Consultant, MCPP Healthcare
  Consulting
• Hilary Metcalf, Regional Surveillance
  Coordinator,
• Kitsap County
• Sandi Paciotti, CD Supervisor, Skagit County
• Beth Phipps,RN, BSN Outreach Education, Kitsap
  County
• Cathy Smith, ARNP, Skagit County
• Kim VanEpps, Health Educator, Skagit County

3
Plan

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• State and local public health experts defined
  32
• local public health indicators
• Two of these dealt with chlamydial infection
  (CT),
• a common communicable disease
• Indicator reported CT infections documented
• as being treated among 15-24 year old females
  
• selected because it is easily measurable and
  could
• change quickly (as opposed to disease
  incidence
• rate)
• 2004-06 data 89 of Skagit County cases
• treated, 94 of Kitsap County cases treated
• Made fishbone diagram of possible factors
• contributing to failure to treat

4
Plan Analyze the reasons CT clients arent
treated

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

5
Plan Define the opportunity

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• We are seeking to improve the proportion of CT
• cases that are treated by the providers
  responsible for
• 43 (Kitsap) or 64 (Skagit) of untreated
  cases by
• 20 in Kitsap and Skagit counties by January
  2008
• If these 4 providers increase the proportion of
  cases
• treated to 20 the overall treatment rate will
  improve
• by 18 in Skagit County and 10 in Kitsap
  County
• Therefore, revise AIM statement to increase the
  
• proportion of cases treated by 60

6
Plan

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

Health Issue/Goal Short Term Goal Mid
range Goal Long Term Goal
Process Results
Outcome

• Improve of
• Chlamydia (CT)
• cases receiving
• treatment by
• specific
• provider type

• Assess
• educate
• providers
• through survey
• Develop a
• model to
• educate
• providers
• Document
• targeted
• providers
• educated

• Monitor
• of cases
• missing treatment reported
• by target
• providers
• Increase
• of
• patients
• and
• partners
• treated

• Decrease
• rates of
• Chlamydia
• Decrease
• rates of
• infertility

7
Plan What data or information is needed

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• State generated data of reported and treated
• cases by provider
• Project designed interview script to learn
  about
• provider treatment protocols
• Skagit and Kitsap counties picked two providers
  
• who were excellent performers and two weak
• performers in CT treatment and queried them
  for
• patient treatment protocols
• Improvement will be evaluated using state
• statistics for July1, 2008 - June 30, 2009
  once
• provider education has occurred

8
Plan

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• Hypothesis emergency departments responsible
• for most untreated cases
• Finding EDs not a big player in Skagit
  County,
• 1 of 3 big players in Kitsap

N2
N1
N1
N3
N1
N1
N2
N2
N2
Hospital
HD
OB/GYN
Other
PP
Com/Mig
9
Do Select and develop a theory for improvement

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• Round 1
• P Plan for analysis of
• determining what
• clinics are not treating
• D Conduct analysis
• S Review data who
• is responsible for most
• missing data
• A Identify target
• population and small
• scale

• Round 2
• P Plan interviews to
• understand current
• procedures of each
• provider type
• D Conduct interviews
• S Collate and review
• interview/survey
• results
• A Design education/
• intervention

10
Study Study the results

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• Skagit County
• All providers used the phone to contact
  positives
• Poor performers charged patients for follow up
• visit
• Poor performers usually gave Rx instead of
• medications
• Providers do not call pharmacy to see if Rx was
  
• filled
• 50 of providers had standing orders
• All providers suggest re-screening at 3 months
• Providers assumed HD was following up on all
• untreated cases

11
Study Study the results

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• Kitsap County
• All use the phone to contact positives
• All reported charging for follow up visits and
• treatment (and all had exceptions)
• Providers gave a mix of Rx or medications
• None reported contacting the HD if they werent
  
• able to contact the patient for treatment
• 50 do not have standing orders for medications
• 75 do not re-screen all positive patients
  after 3
• months
• Providers assumed HD was following up on all
• untreated cases

12
Study Conclusions

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• We were successful in identifying the following
  target points for providers
• Treat with medications, not prescriptions
• Develop a system for contacting patient if
  clinic is
• unable to follow up
• Treat without charging for follow up visit
• Encourage standing orders
• Re-screen patients at 3 months
• Treat partners
• Test every patient age 15-24

13
Act

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• An education card for providers was developed
• and highlights treatment pitfalls discovered
• through survey
• Education card will be piloted with providers
  who
• were already surveyed
• If found to be useful, education card will be
• distributed to all internal medicine, OB/GYN,
• pediatric and family practice providers

14
Act Lessons learned

• Cathy Bambrick Administrator
• Bonnie Corns Community Health Services
  Director
• Linda Navarre Public Health Nurse
• Sage Park Former Environmental Health Director
• Sara Burnet Assessment Coordinator / Health
  Promotion Manager

• We pooled our abilities to analyze data and
• develop interventions
• We learned how to apply QI tools including
  Pareto
• charts and fishbone diagrams and learned that
• RCI works well to address the highly
  measurable
• type of change we sought
• Was imperative to apply tools immediately and
• have access to experts to assure we were
• applying principles correctly
• Scale (DOH 2 counties) was just right for the
  
• timeline desired by funder new teams could
• easily be formed and achieve success