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IMPROVING MCH THROUGH QI: POST-PARTUM CONTRACEPTION PLANS Lori Cannon, RN Red Cliff Community Health Center Red Cliff Band of Lake Superior Chippewa.

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Presentation on theme: "IMPROVING MCH THROUGH QI: POST-PARTUM CONTRACEPTION PLANS Lori Cannon, RN Red Cliff Community Health Center Red Cliff Band of Lake Superior Chippewa."— Presentation transcript:

1 IMPROVING MCH THROUGH QI: POST-PARTUM CONTRACEPTION PLANS Lori Cannon, RN Red Cliff Community Health Center Red Cliff Band of Lake Superior Chippewa

2 RED CLIFF COMMUNITY HEALTH CENTER  Full service clinic for 1,200 Tribal members and residents of surrounding counties  Baminiijaanisag – “support with having a child”  Prenatal Care Coordination – from conception through two years post- partum

3 INTERVALS BETWEEN PREGNANCIES Amount of time after giving birth until next pregnancy Percent of Women >17 months52.6% Within 17 months26.3% Within 11 months15.8% Within 6 months10.5%

4 AIM STATEMENT By July 31, 2013, 30% of women served through the Red Cliff Community Health Center’s PNCC program will have a plan for post-partum contraception in place with their provider prior to the birth of their child.

5 PLAN DO CHEC K ACT Nutrition/food safety Exercise/mobility Post-partum contraception Signs of pre-term labor Doulas Labor & delivery Breastfeeding Bottle feeding Post-partum moods/depression Car seats/infant safety Swaddling/safe sleep 1.What do you know about different birth control methods? -pill -patch -Mirena/IUD -Implanon/Nexplanon -NuvaRing -Diaphragm -Depo 2.Where do you get most of your information on birth control/family planning? 3.What factors affect your decision-making about having children? 4.What would be helpful to you in terms of making decisions about family planning?

6 PLAN DO CHEC K ACT Client A: 15 year old 30 th week School visits Client B: 20 year old 17 th week Home visits

7 PLAN DO CHEC K ACT Clients A and B Contraceptive Technology Conference Conclusion: clients don’t know what they don’t know

8 PLAN DO CHEC K ACT Updated and enhanced information New technology Risks Multi-media Hands-on Video

9 CONTRACEPTIVES  Copper IUD (Paragard)  Hormonal IUD (Mirena)  Implant (Nexplanon/Implanon)  Depo Provera  Oral contraceptives (combined and progestin-only)  Patch (Ortho-Evra)  Ring (NuvaRing)  Diaphragm  Condoms

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11 PLAN DO CHEC K ACT Client A Client B Client C

12 AIM STATEMENT By July 31, 2013, 30% of women served through the Red Cliff Community Health Center’s PNCC program will have a plan for post-partum contraception in place with their provider prior to the birth of their child.

13 Meeker-McLeod-Sibley CHS Quality Improvement Project Increasing WIC fruit and vegetable voucher redemption

14  Meeker-McLeod-Sibley was formed in 1980 and is governed by a community health board through a joint powers agreement.  Staff work in teams across the three counties according to assigned program areas and have identified team leaders.  WIC program is a consolidated program across the three counties. Background

15  Meeker-McLeod-Sibley Community Health Services (MMS CHS) has a total population of 75,177  MMS CHS is categorized as a rural farming community with industrial businesses.  Largest city within 3 counties is Hutchinson with a population of 14,093  Average Hispanic rate for three counties is 5.1%  Average number of monthly WIC participants is 1,900 for all three counties Background

16 Identification of the Problem  Staff were finding unused, outdated fruits and vegetable (f/v) vouchers in WIC folders  State report showed MMS had an average of 75.94% of fully redeemed f/v vouchers Background

17 AIM STATEMENT By July 31st, 2013, the MMS CHS WIC QI team will increase redemption of fruit and vegetable voucher dollars from 76% to 85%. PLAN

18 Getting Started

19 Collection of Data Focus Groups Root Cause Analysis Potential Solutions PLAN

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21 Focus Groups WIC staff WIC participants Local vendors PLAN

22 Root Cause Analysis 5 Why’s Fishbone Diagram PLAN

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24 Identify Potential Solutions 5 How’s Prioritization of interventions by voting Discussion with QI coach to prioritize and chose best potential solutions PLAN

25 Test the Theory Taste Testing May Kickoff Every month in each county Training Collaboration with state and local WIC agencies DO

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27 Assess Results Will compare baseline data with future report to determine if interventions worked. STUDY

28 Taste Testing Comments from WIC participants Comments from the Field

29 Adopt, Adapt, or Abandon based on the results ACT

30 Start with a simple concrete project and apply a simple tool to get the hang of it and to get staff buy in. Then proceed forward with a larger project. Don’t jump to solutions Get buy in from staff People realizing they were doing QI all along, but now have a name for it Gather enough data Plan for adequate time for testing interventions in the PDSA cycle Realize the importance of root cause analysis Crucial to have leadership support Have staff on the same page Lessons Learned

31 Will continue with testing interventions in PDSA cycle Next Steps

32 Continue to create a Quality Improvement Culture Next Steps

33 “Excellent firms don’t believe in excellence- only in constant improvement and constant change.” Tom Peters Next Steps

34 Allie Freidrichs Jessica Remington Contact Information

35 Dual Enrollment of Pregnant Women into WIC and Public Insurance Programs Mary A. Prignano RN, MS DuPage County Health Department Wheaton, Illinois

36 Initiation of this QI Project Pregnant women are seen as priority populations for the WIC Supplemental Nutrition Program. Dual Enrollment

37  Initiation of QI Project Pregnant women were attending the walk-in hours for benefitting, where they could have their applications completed for public insurance, termed Medically Presumed Eligible (MPE). Dual Enrollment

38  Initiation of the Project  The Benefitting (MPE) services and the WIC services were in two different departments of the Health Department  When pregnant women completed MPE first, they needed to return for WIC. Dual Enrollment

39 By Appointment 1. WIC Certification and 2. MPE Application As Walk-In 1. MPE Application only 2. WIC  Appointment if requested  Second trip required  Delay in entry to services

40 Initial data collection demonstrated that some clients:  Received MPE without WIC.  Had delay in WIC enrollment  Had a greater chance of refusal. Dual Enrollment

41 AIM STATEMENT By July 31, 2013, the DuPage County Health Department will implement a benefitting process that results in a 10% increase in the number of pregnant women who are dually enrolled in MPE/ Medicaid public insurance program and the WIC Nutrition Program. Dual Enrollment

42 QI Project Team WIC Service Area  WIC Program Coordinator  WIC Case Manager  WIC Site Supervisor  Quality Improvement Coordinator Client Benefits Area  Customer Service Supervisor  Client Benefitting Specialist Supervisor  Office Supervisor  Client Benefit Specialist

43 QI Project Data MPE application data entered into spreadsheet. To inform the QI team of:  progress toward dual enrollment  locations and # of enrollments

44 QI Project Data

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46 Client Benefit Specialist Interviews  Structured interviews were conducted with the Client Benefits Specialists (CBS)  All 5 health department office locations.  Completed by the QI Coordinator QI Project Data Sources

47  1. Do prenatal clients have tendency to walk-in or to schedule a CBS appointment?  2. Why do some clients decline to make WIC appointment?  3. Is pregnancy testing available/offered onsite before or after MPE visit?  4. If client is leaving CBS visit to go make appointment, where are they instructed to go?  5. Why do you think it is important for these clients to access WIC services? Client Benefit Specialist Interviews

48 Fishbone Diagram

49 Fishbone Diagram Identified: WIC Staff  Pregnancy Testing  Knowledge of MPE  Communication with CBS CBS Staff  Pregnancy Testing  Knowledge of WIC Program  Communication with WIC

50 Review of Factors in Process Change  Changeable?  Strategies?  Priority? Selection for Pilot MPE/ WIC QI Project

51 Who: Client Benefitting Specialists and WIC staff Where: Addison office When: May, 2013 What: Use of instant messaging Engage “Warm Handoff” Complete WIC enrollment or scheduling MPE/ WIC QI Pilot

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53 Process Changes:  WIC staff relocated next to CBS  Instant Messaging  Clients escorted to WIC area  Clients seen regardless of residency MPE/ WIC QI Pilot

54 Client Changes:  Do clients have their documents for enrollment?  Do they wish to stay for WIC? MPE/ WIC QI Pilot

55 Addison Pilot ran for 4 weeks. Two pregnant clients were seen each week  7 of the 8 clients agreed to completion of the WIC assessments (87.5%)- 1 refusal  3 of the 7 clients received their food instruments that same day (43%)  4 of the 7 clients returned to complete their pickup as scheduled (57%) Pilot Results

56  Instant Messaging- Staff needed to be introduced to each other by the supervisory staff, including correct spelling of their names.  Warm “hand off”- Clients expressed appreciation for walking them over  to the next station of the interview Pilot Results

57 Engage the QI Team in deciding next steps:  Pilot expansion from MPE walk-in to appointment?  Pilot expansion to infants and children?  Pilot expansion to other office locations? Pilot Results

58  Opportunity of pregnancy testing  Communication challenge: in person, , instant messaging  Engaging client feedback  Computer limitations Challenges and Opportunities


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