Regional Health Quality Improvement Coalitions Lessons Across the Life Cycle (original) (raw)
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Health Districts as Quality Improvement Collaboratives and Multijurisdictional Entities
Journal of Public Health Management and Practice, 2012
MEd, EdD, MPH r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r Context: Local health departments are increasingly challenged to meet emerging health problems at the same time that they are being challenged with dwindling resources and the demands of accreditation. Objective: To assess the capacity of Multicounty health districts to serve as "Quality Improvement Collaboratives" and support local health departments to meet accreditation standards. Design: The study used an online survey tool and follow-up phone calls with key informants in health districts and county health departments in Georgia. Data collection was primarily based on an instrument to measure Quality Improvement Collaboratives that was adapted and tested for use with public health agencies in Georgia. Setting: The Georgia PBRN conducted this study of health districts and county health departments. The Georgia Department of Public Health supports 18 health districts and 159 county health departments (GA DPH, 2011). The health districts range in county composition from 1 to 16 counties in each district. Participants: Key informants comprised district and county health department staff and county health department board members were identified by 13 participating health district offices. Results: Key opinion leaders from both the rural and nonrural counties agreed that the Districts were important for providing essential services and supporting quality improvement collaboration. Psychometric testing of the Quality Improvement Collaborative assessment public health instrument yielded high scores for validity and reliability. Conclusions and Implications: Regionalization of local public health capacity is a critical emerging issue for public health accreditation and quality improvement. This study demonstrated the utility of regionalization across traditional local geopolitical boundaries.
Regional Collaboration as a Model for Fostering Accountability and Transforming Health Care
Seminars in Thoracic and Cardiovascular Surgery, 2009
An era of increasing budgetary constraints, misaligned payers and providers, and a competitive system where United States health outcomes are outpaced by less well-funded nations is motivating policy-makers to seek more effective means for promoting costeffective delivery and accountability. This article illustrates an effective working model of regional collaboration focused on improving health outcomes, containing costs, and making efficient use of resources in cardiovascular surgical care. The Virginia Cardiac Surgery Quality Initiative is a decade-old collaboration of cardiac surgeons and hospital providers in Virginia working to improve outcomes and contain costs by analyzing comparative data, identifying top performers, and replicating best clinical practices on a statewide basis. The group's goals and objectives, along with 2 generations of performance improvement initiatives, are examined. These involve attempts to improve postoperative outcomes and use of tools for decision support and modeling. This work has led the group to espouse a more integrated approach to performance improvement and to formulate principles of a quality-focused payment system. This is one in which collaboration promotes regional accountability to deliver quality care on a cost-effective basis. The Virginia Cardiac Surgery Quality Initiative has attempted to test a global pricing model and has implemented a pay-for-performance program where physicians and hospitals are aligned with common objectives. Although this collaborative approach is a work in progress, authors point out preconditions applicable to other regions and medical specialties. A road map of short-term next steps is needed to create an adaptive payment system tied to the national agenda for reforming the delivery system. Semin Thorac Cardiovasc Surg 21:12-19
Preventing Chronic Disease, 2004
Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project.In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases.The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.
Opportunity for Regional Improvement: Three Case Studies of Local Health System Performance
2014
Case studies of three U.S. regions that ranked relatively high on the Commonwealth Fund's Scorecard on Local Health System Performance, 2012, despite greater poverty compared with peers, revealed several common themes. In these communities, multistakeholder collaboration was an important factor in achieving community health or health system goals. There were also mutually reinforcing efforts by health care providers and health plans to improve the quality and efficiency of care, regional investment and cooperation to apply information technology and engage in community outreach, and a shared commitment to improve the accessibility of care for underserved populations. State policy and national and local funding programs also played a role in expanding access to care and providing resources for innovation. The experiences of these regions suggest that stakeholders can leverage their unique histories, assets, and values to influence the market, raise social capital, and nudge local health systems to function more effectively. INTRODUCTION Research has documented pervasive geographic variations across the United States in the accessibility, quality, and use of health care services, as well as in health outcomes and disparities. 1 The Commonwealth Fund's Scorecard on Local Health System Performance, 2012, estimated substantial gains if all regions of the country performed as well as the top-performing regions. 2 While many communities are engaged in efforts to build local capacity for improvement, 3 they have unique histories and circumstances with complex and evolving relationships among stakeholders with varying characteristics. Nevertheless, regions and communities may find it useful to learn from each other's experiences, not only to identify promising approaches to common challenges but also to understand how particular circumstances influence a community's choices and success. With this goal in mind, we conducted case studies of three regions-Western New York, West Central Michigan, and Southern Arizona (Exhibit 1)-that To learn more about new publications when they become available, visit the Fund's website and register to receive Fund email alerts.
Health Care Improvement in Akron, Ohio: Moving from Collaboration to Coordination
2017
Summit County as well as parts of nearby counties stands out, along with Stockton, Calif., for having improved on more performance measures (19 of 33) than any other region on the Commonwealth Fund’s Scorecard on Local Health System Performance, 2016 Edition. The region has made notable progress expanding access to care. Health systems also have strengthened primary care and improved care transitions, which may explain reductions in potentially avoidable hospitalizations and unplanned readmissions. Collaboration across health and social service sectors is a hallmark of the region, exemplified by use of a shared set of measures assessing residents’ quality of life. But to address deep-seated problems, such as the high black infant mortality rate, leaders say the region also will need to make specific commitments and potentially reallocate resources to see improvement. CASE STUDY AUGUST 2017
A Regional Health Care System Partnership With Local Communities to Impact Chronic Disease
Preventing chronic disease
Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project. In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and inter...
2010
Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. common quality measures and shared data system; (2) rapid cycle improvement principles; (3) quality-improvement consultants (QICs), or practice facilitators; (4) learning networks; and (5) alignment of incentives. We emphasized a community-based strategy and developing a statewide infrastructure. Results are reported from the first 2 years of the North Carolina Improving Performance in Practice (IPIP) project.
Assessing Quality Improvement in Local Health Departments
Journal of Public Health Management and Practice, 2012
This study examined changes in quality improvement: (1) over a 3-year period, (2) among mini-collaborative participants, and (3) among agencies that were classified in the lowest QI performance quartile. Methods: A QI Maturity Tool was administered to all local health departments in the Multi-State Learning Collaborative states. Factorial ANOVA was performed to determine differences in composite factor scores and interaction effects were explored. Results: The results revealed a significant increase in the percent of agencies that reported ever implementing a formal QI process from 2009 to 2011 and agencies that participated in a mini-collaborative were more likely than their non-mini-collaborative counterparts to report QI implementation. The findings also suggested significant changes in QI capacity and competency as well as alignment and spread over the course of the grant, among mini-collaborative participants, and among agencies that were originally identified in the lowest QI maturity quartile. No significant changes in organizational culture were revealed by year or among mini-collaborative participants. However, agencies in the lowest quartile saw significant changes in organizational culture during the project period. Conclusions: Significant changes in specific QI domains are possible to detect during a 3-year period. Our research gives us confidence that the QI Maturity Tool measures the right domains and is an important contribution to quantifying the adoption and spread of QI in public health. However, further refinement is needed to better standardize language and definitions of the component parts of a QI system.