Healthiest Wisconsin 2020 Objective: Improving Birth Outcomes

Summary

Impact Statement:

Increasing participation in public health programs is a goal of many agencies. In this QI project, the Kenosha County Division of Health sought to expand and enhance its prenatal care coordination (PNCC) and reproductive health services. QI resulted in changes in the process with the addition of a part-time public health nurse and a public health technician to enable a quicker response to WIC referrals, and work with SPHERE administrators to update staff. This resulted in increased women in PNCC and increased referrals from the Women, Infants, and Children program and other day clinics.

Summary:

The Kenosha County Division of Health (KCDOH) wanted to expand and enhance its prenatal care coordination (PNCC) and reproductive health (RH) services. Specifically, KCDOH sought to increase the number of healthy birth outcomes by providing women with life action planning tools that included education resources and referral information to help them attain timely RH care, access to local prenatal services, and essential early intervention services. This initiative demonstrated an increase in PNCC participation and improved the number of referrals from the Women, Infants, and Children (WIC) program and Nurse of the Day Clinics.

Organization that conducted the QI initiative:

Wisconsin Division of Public Health

Citation:

Cohen, R. Public Health Quality Improvement Exchange. Healthiest Wisconsin 2020 Objective: Improving Birth Outcomes. Wed, 05/28/2014 - 22:07. Available at http://phqix.org/content/healthiest-wisconsin-2020-objective-improving-birth-outcomes. Accessed April 25, 2024.

Background and Aim

Aim statement:

Aim statement: Expand and enhance PNCC/RH services. The focus areas are as follows: • increase PNCC client load from initial to postpartum visit, • increase third trimester life action planning visits, and • increase the number of clients who sign up for PNCC. The Family RH Team focus areas are as follows: • increase the number of women who apply for temporary enrollment/family planning only services (FPOS), and • increase the number of referrals for PNCC services. Aim statement: KCDOH will increase the number of healthy birth outcomes by providing women with life action planning tools, which will include education resources and referrals to help them attain timely reproductive health care, access to prenatal local services, and essential early intervention services.

Need For The QI Initiative:

KCDOH had management-level discussions of the fiscal downturn and the potential local impact on direct services and programming. Several brainstorming strategic sessions during management meetings led to the development of interventions and activities that could offset revenue in direct services, especially for the current RH services programming. Kenosha County, a leader in advocacy for continuous care of women and families within the community, and providing a safety net of direct services was threatened with decreased revenue. Recommendations were developed to restructure the programs and projects to reflect the change in infrastructure and fiscal reductions. Potential grant opportunities were explored to provide an avenue to support lost levy and reduced state/federal revenue. One such project was the expansion of RH services, using grant resources and the quality improvement (QI) process for staff leadership development.

Area for Improvement:

The goals of this initiative were as follows: • build capacity to disseminate dual protection supplies for unplanned pregnancies and sexually transmitted diseases (STDs), • incorporate life action plans, • improve delivery of PNCC services, and • identify and test indicators using the Secure Public Health Electronic Record Environment (SPHERE) to reach goals in Healthiest Wisconsin 2020.

Planning and Execution Details

QI Implementation:

The indicators developed by the QI team were examined to determine whether data could be obtained either through the state SPHERE data system, agency-generated data systems, both, or neither. Local teams members worked with the Wisconsin SPHERE system administrators to incorporate the 12 indicators within the SPHERE data system. The SPHERE system had many of the essential components for data analysis. The QI Initiative was approved for start-up revenue to work through the State Department of Public Health and Family Planning. The QI team presented an overview of the grant (Wisconsin Public Health Improvement Initiative [WPHII]) to nursing staff during a quarterly all-staff meeting, including explaining the conceptual framework of life action plan counseling and expanded dual protection supply packets. KCDOH hired a part-time public health nurse (PHN) and public health technician (PHT) to enhance staff, enable a quicker response to WIC referrals, work with SPHERE administrators to update staff, address the system on data entry concerns for the duration of the Kenosha County WPHII and train staff accordingly. The PHT relieved the PHN of technical duties to increase opportunities for counseling and distribution of expanded supplies. There are three distinct nursing teams within the department: the School District Nurses, Clinical Services PHN, and the Family RH Team. Meetings were held with the latter two groups to identify perceived and actual barriers or challenges that clients had in using Family Planning Only Services (FPOS) and BadgerCare for pregnant women. The PHNs completed the review of Just the Basics, a required online training course offered through Health Care, Education and Training, Inc., to ensure that all levels of personnel had the skills, knowledge, and abilities necessary for effective and efficient delivery of high-quality family planning services. The focus of the training was job-specific skill development for personnel who would be working to enhance RH services and promoting and improving the delivery of the family planning services.

Focus activities

Maternal and Child Health Services:

Family planning

Prenatal care

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Brainstorming

Cause and Effect Diagrams

Fishbone Diagram

Initiative Dates:

1/1/11 to 9/29/12

Initiative Duration:

Between 18-24 months

Methods of evaluation:

Improvement will be measured by the following: • number of PNCC clients; • percentage of PNCC-eligible, positive pregnancy test clients enrolled in PNCC; • percentage of FPOS-eligible, negative pregnancy test clients enrolled in FPOS; • percentage of PNCC clients enrolled in first trimester services; • percentage of third trimester clients receiving dual protection supplies; • percentage of third trimester clients with life action plan; • percentage of PNCC clients with postpartum visit; and • number of PNCC referrals from WIC.

Supplemental Files:

Attachment	Size
PHQIX_Kenosha_Outcomes Table.docx	14.21 KB
WPHII Kenosha Logic Model_Year2_final-112211.doc	45 KB

Results

Measurable QI Outcomes:

Please see the list of measurable outcomes noted in the attached table. PNCC client participation increased, as did the number of PNCC referrals from WIC and the Nurse of the Day Clinic. Several different cycles of Plan, Do, Study, Act (PDSA) were used to accomplish the outcomes noted in the table. Select staff worked with the SPHERE administrators to clean data. In Year 2, the focus was access to expanded supplies for nonpregnant women of reproductive age and counseling at all points of client contact. The team tried to ensure screening for eligibility for FPOS; however, the rate continued to remain low despite clients using economic support services within the building. Beginning in the second quarter of 2012, the PHT was re-hired and prioritized duties to assist clients who are eligible for completing forms while they are in the clinic. This work was piloted in Year 1 with success; however, personnel changes led to a decrease in the completion rate of the application. Despite efforts to increase the rate of completion, the requirement changes made by the state and documentation of income and residency in some cases led to another barrier and added to the need for outreach enrollment assistance to help overcome the challenges. The number of clients participating in the PNCC program increased. However, as the program was restructured to incorporate an evidence-based home visitation project, a temporary reduction in enrollment during Period 4 was noted.

Other QI Outcomes:

Other QI outcomes included the following: • advanced work on Healthiest Wisconsin 2020, • identified SPHERE indicators, • improved quality and sustainability of services, and • excited and confident staff.

Lessons Learned, Observations and Insights:

The data surveillance state administrator was open to training the staff and updating the collection system to meet the needs of the local site.

Future Plans:

KCDOH implemented the expanded supplies life action plan counseling and referral division-wide. The QI team will continually evaluate and update the supplies and replenish them as needed. KCDOH will continue to use the PDSA cycle for the areas identified through staff planning. The PDSA cycle will be used both internally and externally to improve the quality of the health department and the services provided to the public. KCDOH is committed to achieving a positive work environment and recognizes the importance of the PDSA cycle as a mechanism for QI and performance evaluation. KCDOH continues to support team-initiated QI projects. KCDOH is in its third year of incorporating a QI review team, and management staff are involved and committed to the process, timelines, and progress of projects.

Healthiest Wisconsin 2020 Objective: Improving Birth Outcomes

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Collaborations

Contact Information of the Submitter

QI Spotlight

quality improvement together.

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Healthiest Wisconsin 2020 Objective: Improving Birth Outcomes

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Collaborations

Contact Information of the Submitter

QI Spotlight