1. PLAN Identify an opportunity and Plan for Improvement 1. Rationale The immunization system that currently exists has been functioning for decades, but is no longer functional. This is in part because the factors that affect childhood immunizations in particular, are multi-faceted and numerous. Addressing these concerns could significantly increase rates of childhood immunizations in communities, thereby preventing illness and improving the health of the communitysmall or large. Using a quality improvement process and working collaboratively, we hope to change the face of immunizations in our communities for the better. 2.Methodology Goal: to determine an appropriate method to increase the number of immunizations in children 0-24 months Three local health departments: Hocking County Health Department Summit County Health District Franklin County Board of Health Utilizing a collaborative approach : Does sharing QI experiences and findings help identify the most efficient and effective techniques to yield meaningful improvements in the practice of QI? 3. Metrics Capacity metrics: Resources (cost and staff time) Process metrics: Decreased 4 th DTaP drop-off rate Improved clinic flow for health department clinics New client vaccination records, additional client contact info, information from a client survey, throughput measure, Moved or Gone Elsewhere (MOGE) criteria Outcome metric: Increased immunization rate for each jurisdiction (Several sources of data were accessed to collect information about the current system, including Impact SIIS and the Kindergarten School-based Retrospective Survey) 5.Develop an Improvement Theory After several group discussions about the shared AIM statements, the underlying processes and the similarities among the LHDs, it was decided that each LHD would alter one component of their childhood immunization clinic process. The changes were different for each health department. DO Test the Theory for Improvement 6. Test the Theory CHECK Use Data to Study Results of the Test ACT Standardize the Improvement and Establish Future Plans Public Health Practice: Evaluating the Impact of Quality Improvement Lets Immunize!A Collaborative Approach Franklin County Board of Health, Hocking County Health Department, Summit County Health District and the Public Health Foundation Susan Tilgner, MS, RS, LD, RD & Elizabeth Pierson, MPH, CPH 4.QI processes and Deliverables Plan-Do-Check-ActForce Field Analysis Current/Future state analysisProcess flow diagram Flowchart summary form (space, equipment, costs, etc.)Cause and Effect diagram (Fishbone) Team surveyClinic/client surveys Summit Franklin Hocking Coming next year! 3a. AIM Statements Hocking: Logan-Hocking County Health Department will increase our current immunization rates of 61% to coincide with Healthy People 2010 goal of 90% with a primary focus on children ages 0-24 months, not up-to- date on vaccinations (particularly one year old immunizations), decrease missed opportunities and decrease the DTaP drop-off rates by June 2011. Summit: Summit County Health Department (SCHD) will identify strategies to improve immunization rates for children in the target population (children birth to 24 months) in Summit County, OH to the Healthy People 2010 goal of 90%, by June 2011 beginning in SCHD clinics which have an immunization rate of 22%. Franklin: Franklin County Board of Health will increase the percentage of children up to date on the 4 th DTaP at 35 months by 10% (25% to 35%). (Measurement of up-to-date occurs at 35 months). Information will be collected from Franklin County Board of Health childhood immunization clinics via Impact SIIS. One of the main challenges was trying to incorporate this [the QI process] into a very busy time when all nurses and clinics were working at full capacity with H1N1 clinics. (Summit County Team) But we did it! Following the QI methodology the Model for Improvement, the project aims to: Identify current immunization rates (including total number immunized), Explore the components of the local immunization system Describe how the components interrelate Examine processes and utilize data to develop or improve processes Implement processes and check outcomes Determine if new processes have the desired effect Share approaches and lessons learned among the collaborative. LHDs, in consultation with the evaluator, selected quality improvement processes they identified as most appropriate for their specific area of improvement and Health district. Specific project outputs are: Increased total immunizations for the identified population of each health district Increased expertise with utilizing the QI process in program delivery. Contact Beth Pierson for project information. E MAIL : bethpierson@franklincountyohio.gov P HONE : 614.462.3746 Team members Hocking County Health Department Doug Fisher Kelly Taulbee Jamie Funk Lisa Castle Summit County Health District Gene Nixon Gillian Solem Anne Morse Traci Barnett Sheila Capone Wendy Brolly Franklin County Board of Health Nancy Pry Milu Nguyen Jane Vanfossen Paul Rosile Beth Pierson And, The Public Health Foundation John Moran Les Beitsch Funding for Lets Immunize!A Collaborative Approach provided by the Robert Wood Johnson Foundation H1N1 alert!