Lead States in Public Health Quality Improvement: New Hampshire

1
Lead States in Public Health Quality
Improvement New Hampshire

• Lea R. Ayers LaFave, PhD, RN
• Community Health Institute/JSI
• Bow, New Hampshire
• August 2008

2
Participants in Attendance

• Joan Ascheim, MSN
• Bureau Chief
• NH Division of Public Health Services
• Bureau of Policy and Performance Management
• Concord, NH
• Amy Cullum, MPH, MA
• Community Health Institute/JSI
• Bow, NH
• Lindsey Vacek, MPH
• Mascoma Valley Health Initiative
• Canaan, NH

3
Preparing for Accreditation

• Regionalization and building the public health
  infrastructure
• Overall Goal A performance-based public health
  delivery system, which provides all 10 essential
  public health services throughout New Hampshire
• Repeat National Public Health Performance
  Standards State Level Assessment

4
Existing NH Public Health Infrastructure

• 234 cities and towns
• Health Officer required by statute
• 5 communities with public health departments
• No county health departments
• Strong community-level informal public-private
  partnerships
• State level
• DHHS (lead agency),
• Department of Environmental Services
• Department of Education
• Department of Safety

5
Our Vision

• The evolution of a 2-tiered public health system
  based on standards for agency infrastructure and
  performance
• Capacity, expertise, leadership to assure a
  fundamental public health presence
• Performs some level of each essential service
• Collaborates with
• regional partners
• State DPHS
• Will require statutory changes.

6
Regionalization Process

• April 2008 consolidated 19 All Health Hazards
  Regions to 15 Public Health Network (PHN) regions
  
• 3 assessments
• Financial
• Capacity - modified NACCHO Assessment Tool
• Governance
• Next Steps
• PHNs in selected regions develop detailed plan to
  implement proposed new model June 2008-June
  2009

7
Modified NACCHO Self-Assessment Tool DRAFT
8
Quality Improvement Learning Collaboratives
(QuILTs)

• QuILTS
• 2 cohorts, 3 each, 15 months
• Interest areas
• Capacity
• Culturally appropriate care, health improvement
  planning, competent workforce
• Health Status
• Chronic disease, tobacco-related disease,
  alcohol-related disease and injury
• Linkage health status to capacity indicators
• Aligned with state health priorities and
  strategic plan
• Kickoff

9
Kickoff EventSeptember 26th, 2008

• Keynote Speaker
• Bonnie Zell, MD. MS
• Senior Advisor for Partnership Development
• Division of Healthcare Quality Promotion,
  Office of the Director, CDC
• IHI George W. Merck Fellow, 2006-2007
• Work Session
• Sharing of work to date
• Content Expert Speakers
• Tracking Tool Training

10
Most interesting

• Including other groups in our QI initiative
• DHHS Public Health Improvement Team (PHIT)
• Links with other work
• PHIT Tracking Tool
• To simplify process of tracking improvement
  initiatives
• Create performance measures
• Record data
• Create performance reports
• Download data into MS Excel format
• Partnering with University of New Hampshire
  through the CDC Assessment Initiative
• Develop web-based performance measure module in
  HealthWRQS application

11
PHIT Tracking Tool
12
Most exciting

• Work with Quality Improvement Learning
  Collaboratives
• Ayers, LR, Beyea, SC, Godfrey, MM, Harper, DC,
  Nelson, EC, and Batalden, PB (2005). Quality
  Improvement Learning Collaboratives. Quality
  Management in Health Care, 14(4), 234-247.
• Developing relationships with international QI
  experts at The Dartmouth Institute for Health
  Policy and Clinical Practice
• www.dartmouth.edu/cecs/

13
Hopes and Long Term Goals

• Demonstrate the value of public health through
  evidence
• Build capacity
• Create a culture of QI simultaneously through
  regionalization
• Resulting in.
• an accreditable public health system built from
  the ground up