Healthy Start Interconception Care Learning Community (ICC LC) Using Quality Improvement for Better Preconception Care Preconception Care Summit June 14, 2011 Lisa LeRoy, PhD Abt Associates Kay Johnson, MPH, Johnson Group Consulting

Healthy Start Interconception Care Learning Community (ICC LC) Acknowledgements  This Project is funded by the Division of Health Start and Perinatal Services, HRSA  Project Team:  Deborah Walker, EdD  Cheryl Austin, RD, MPH  Sarah Ball, DrPH  Vonna Drayton, PhD  Meredith Pustell  Kay Johnson, MPH  Lisa LeRoy, PhD

Healthy Start Interconception Care Learning Community (ICC LC) Overview of Presentation Goals of the Healthy Start Interconception Care Learning Community (ICC-LC) The Quality Improvement Model Examples of ICC LC change projects Challenges Lessons Learned

Healthy Start Interconception Care Learning Community (ICC LC) Goals of the Healthy Start ICC-LC The Healthy Start Interconception Care Learning Community (ICC-LC) was developed by the Maternal Child Health Bureau (MCHB) to:  Improve the quality of Healthy Start interconception care (ICC) components  Use the Model for Improvement  Develop a toolkit to guide MCH programs in their quality improvement activities

Healthy Start Interconception Care Learning Community (ICC LC) Why interconception care focus? In Healthy Start, interconception period is 24 months after one pregnancy for high-risk women. ICC is a required component for all Healthy Start projects. Evidence-based practices can be implemented or promoted by Healthy Start grantees. Content of ICC had not been operationalized for women in Healthy Start.  Work with infants and toddlers is better defined.  This is a chance for grantees to apply new evidence.

Healthy Start Interconception Care Learning Community (ICC LC) What’s new about ICC LC? Implementing a quality improvement (QI) “learning collaborative” model in all 104 Healthy Start projects Applying a QI model to improve non- clinical, community-based services Translating ICC research to practice

Healthy Start Interconception Care Learning Community (ICC LC) The “Model for Improvement” for ICC-LC Change Projects

Healthy Start Interconception Care Learning Community (ICC LC) The Model for Improvement What are we trying to accomplish? How will we know that a change is Improvement? What changes can we make that will result in Improvement? Plan Do Study Act The Improvement Guide, 1996 Jossey-Bass

Healthy Start Interconception Care Learning Community (ICC LC) ACT: - Adapt? - Adopt on wider scale? - Abandon? - Next cycle? PLAN: - Objective, aim, change - Questions (why) - Plan to carry out the cycle (who, what, where, when) DO: - Carry out plan on small scale, rapid cycle - Document problems and unexpected results - Begin analysis STUDY: - Complete analysis of data - Compare results to predictions - Summarize lessons learned PDSA Cycle for Learning and Improvement

Healthy Start Interconception Care Learning Community (ICC LC) ICC LC Process Each Healthy Start program chose a topic area and a change concept  Fit with Healthy Start grantee capacity and readiness  Doable and measurable in a 9-month time period Teams with similar kinds of change projects grouped together into Learning Collaboratives  15 Learning Collaboratives in Learning Community  Learning Collaboratives meet bimonthly to discuss the process and share information Web-based tools and telephone conference calls facilitate exchange of information

Healthy Start Interconception Care Learning Community (ICC LC) Modalities for Learning Face-to-face learning through ICC LC meetings among the 102 teams Action periods (9 months) between meetings  Teams work at home on change project and PDSA Learning Collaboratives  5-8 teams working on same topic & change concept  Meet by telephone (bimonthly) Technical assistance and support through web- based communication tools

Healthy Start Interconception Care Learning Community (ICC LC)

Framework for ICC LC Change Strengthening Linkages & Partnerships Advancing Use of Evidence-Based Tools & Data Collection Improving Healthy Start Staff Skills & Protocols Case Management Screening & Assessment Family Planning Primary Care Maternal Depression Healthy Weight

Healthy Start Interconception Care Learning Community (ICC LC) Examples of Projects 5 Programs in Texas chose the same Maternal Depression screen (Edinburgh), implemented shared training and data system redesign and are now able to report meaningful results to the state Indianapolis developed a standardized protocol to measure height & weight, calculate BMI Educated women as to the meaning of their BMI number and associated health risks Refered those ≥ 25 to appropriate services

Healthy Start Interconception Care Learning Community (ICC LC) Examples of Projects Many HS Projects implemented a Reproductive Life Plan with ICC clients and instituted intensive follow-up on birth control methods Some teams trained staff on contraceptive methods; conducted sensitivity training around their own family planning values and how to talk with clients about the topic Oregon and Milwaukee provided family planning baskets to clients (include condoms, Plan B, education materials, lists of acceptable providers)

Healthy Start Interconception Care Learning Community (ICC LC) Examples of Projects Chicago programs focused on identifying a medical home for clients SE Chicago ensured that clients had a PP visit within 60 days of delivery Many sites implemented an evidence-based screening and assessment protocol to identify women at risk for maternal depression, chronic conditions, etc.

Healthy Start Interconception Care Learning Community (ICC LC) Summary

Healthy Start Interconception Care Learning Community (ICC LC) Challenges Encountered Staff turnover in HS projects Limited resources (including time)  Within the project to follow through with the PDSA plans  Outside of the project (health center partners, providers, etc) “Buy-in” of staff & clients Learning curve for technologies used as foundation for learning community Accountability to Learning Collaborative teams

Healthy Start Interconception Care Learning Community (ICC LC) Challenges Encountered, continued Limits on data systems and lack of control that would enable changes (e.g., contractor developed data system) Having an adequate number of women (clients) to complete the change project on schedule Competing demands between ICC and PDSA tasks and other Project work

Healthy Start Interconception Care Learning Community (ICC LC) Lessons Learned QI using PDSA can help improve Healthy Start interconception services Staff and participants were satisfied with LC processes; unidentified and unmet needs were discovered and tools to take action were shared and implemented Evidence-based and promising practices exist for use within a variety of areas of ICC care QI study/PDSA is different than evaluation and performance monitoring

Healthy Start Interconception Care Learning Community (ICC LC) Lessons Learned, continued Focusing intently on making one change at a time within a topic has allowed projects to accomplish more PDSA processes helped projects be systematic and consistent in applying their change Projects have shared protocols, instruments, tools, data, and methods with each other, allowing them to be more efficient and effective

Healthy Start Interconception Care Learning Community (ICC LC) Questions? Comments?

Healthy Start Interconception Care Learning Community (ICC LC) For More Information: Lisa LeRoy, PhD, ICC LC Project Director Abt Associates, Inc.