Ohio AAP Brush, Book, Bed Pilot QI Program Action Period Call 1 January 15, 2020
Welcome and Practice Introductions • Roll Call Question: – How has your implementation been going over the past month? – Which topic in the BBB program do you feel is the strongest in your practice? • Early Literacy, Oral Health, Sleep Routines – Which topic has the most room for improvement?
Data Review
Measures/Goals MEASURE NAME TARGET CALCULATION Change in confidence score from pre-work to 85% of providers enrolled will report an post-project repeat survey collected by Participant Confidence Increase increase in confidence in discussion of conducting pre-work surveys at kick-off each individual BBB topic trainings and final surveys at exit interviews 80% of caregivers will have a discussion Charts with 1 of 2 oral health items Oral Health Discussion Attempted attempted documented / total charts reviewed 80% of caregivers will have a discussion Charts with 1 of 2 early literacy items Early Literacy Discussion Attempted attempted documented / total charts reviewed 80% of caregivers will have a discussion Charts with 1 of 2 sleep routine items Sleep Routine Discussion Attempted attempted documented / total charts reviewed 80% of caregivers will be offered Charts with provision of resources Resource Provision resources documented / total charts reviewed 50% of families will report learning Family Knowledge Increase something new about one BBB topic Collected on family feedback surveys during the visits
BBB Learning Collaborative AIM Interventions Key Drivers • Establish baseline data From December 2019 through • Measure documentation of June 2020, participants in the discussion, fluoride varnish BBB program will: Data Measurement and oral health/early literacy supplies provided - 85% report an increase in knowledge and confidence • Connection to Project Team from pre-test to post-test • Provider QI processes - 80% report attempted Resources • Provide materials (books, discussions on BBB topics at toothbrushes, etc.) WCV 6 months-6 years • Assistance with questions - 70% report sustained changes in activities on the 3 month • Learning Session/Training post project survey Education • Web-based resources • Monthly Action Period Calls • New resource notices from project team The Global Aim of the BBB project is to improve health Environmental • Office flow, implementation for Ohio children by changing Factors behaviors of pediatric Strategically enhance • healthcare providers around collaboration oral health, early literacy, and Payment for fluoride varnish • sleep routines.
Collaborative Level Data Core Measures: Discussions 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Baseline Month 1 Goal Early Literacy Oral Health Sleep BBB
Collaborative Level Data Secondary Measures: Discussions 1.2 1 0.8 0.6 0.4 0.2 0 Baseline Month 1 Relationships Flouride Varnish Safe Sleep Bedtime Routines
Collaborative Level Data Supplies Provided: Overall 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Baseline Month 1 Supplies Offered No Supplies Offered Goal
Collaborative Level Data Supplies Provided: By Type 0.6 0.5 0.4 0.3 0.2 0.1 0 Baseline Month 1 Book Oral Health Handouts
PDSA Cycles
The Model for Improvement Model for Improvement Aim What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey- Bass Publishers; 2009.
The Model for Improvement Model for Improvement What are we trying to accomplish? How will we know that a Measures change is an improvement? What change can we make that will result in improvement? Act Plan Study Do Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey- Bass Publishers; 2009.
Why do we measure? Measures facilitate learning – Starting point to r ecognize areas for improvement: • define the gap between where we are and where we need to be – Provide feedback as a means to evaluate: • are the changes we’re making having the desired impact? – Characterize the robustness of change: • how does our practice/clinical environment respond to the changes we’ve made? – Yield evidence that efforts are meaningfully worthwhile
The Model for Improvement Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? Ideas for What change can we make that will result in improvement? Changes to reach Goals Act Plan Study Do Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey- Bass Publishers; 2009.
BBB Learning Collaborative AIM Interventions Key Drivers • Establish baseline data From December 2019 through • Measure documentation of June 2020, participants in the discussion, fluoride varnish BBB program will: Data Measurement and oral health/early literacy supplies provided - 85% report an increase in knowledge and confidence • Connection to Project Team from pre-test to post-test • Provider QI processes - 80% report attempted Resources • Provide materials (books, discussions on BBB topics at toothbrushes, etc.) WCV 6 months-6 years • Assistance with questions - 70% report sustained changes in activities on the 3 month • Learning Session/Training post project survey Education • Web-based resources • Monthly Action Period Calls • New resource notices from project team The Global Aim of the BBB project is to improve health Environmental • Office flow, implementation for Ohio children by changing Factors behaviors of pediatric Strategically enhance • healthcare providers around collaboration oral health, early literacy, and Payment for fluoride varnish • sleep routines.
The Model for Improvement Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan PDSA Cycle Study Do Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey- Bass Publishers; 2009.
Why PDSA Cycle? Take ideas, properly test for improvement and feasibility to make change easier and for sustainability ¤ Increase Confidence ¤ Find Flexibility ¤ Identify Side-effects ¤ Minimize Resistance https://www.nichq.org/insight/4-benefits-testing-implementing-changes
The PDSA Cycle • Scientific/strategic method for action-orientated learning • Framework for learning on a small scale in various, real environments • Answers questions related to each practice’s and project’s aims • Tests , adapts, or implements a change idea based on our current knowledge and specific context • Spreads the changes to the rest of the system Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.
The Big Picture • Intent – test one change with a few patients in one setting on a small scale • Goal – step by step of information gathering to build knowledge – PLAN – Very focused, directed at an immediate test of change (related to project aim) – DO – Carry out the test and document observations – STUDY - Analyze data, compare to predictions – ACT – Determine consequences of change and next steps (future PDSAs) • END POINT – increase scope of PDSA as knowledge increases and lead to embedded practices
Te Testing ing – learning what works on a small scale within your specific environment. More tests over wide range of conditions Im Implem lemen enta tatio tion – after many tests, integration of the change into day-to-day operations https://www.nichq.org/insight/5-tips-testing-optimize-your-next-pdsa
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