Welco elcome! me! Le Learnin arning g Se Session ssion/Summit /Summit Day Two May 26 th , 2017
Rec ecap of Da ap of Day On y One & e & Outline of the Day’s Activities Jennifer Allison 2
Outcome Outcome Data Data Su Succe ccess S ss Stori ories and es and Bra Brain inst storm orming ing Bekah Thomas 3
CS CoIIN Aim CS CoII N Aim Stat Stateme ement nt By May 2018, participants in the CS CoIIN will Decrease the rate of injury-related mortality among 0-19 year Deaths olds by 5.83% relative to the participating state/jurisdiction baseline rate for the CS CoIIN topic areas. Decrease the rate of injury-related hospitalizations among 0- Hospitalizations 19 year olds by 3.81% relative to the participating state/jurisdiction baseline rate for the CS CoIIN topic areas. Decrease the rate of injury-related ED visits among 0-19 year ED Visits olds by 3.74% relative to the participating state/jurisdiction baseline rate for the CS CoIIN topic areas. Source: Hospitalizations estimated from CDC WISQARS query April 2017, 2014 data; and Emergency Department treated and released cases estimated from the Healthcare Utilization Project, Nationwide Emergency Department Sample, 2013. 4
Challe Chal lenge: nge: Coll Collecti ecting ng Real eal-Time Time Data Data Access to timely data helps public health practitioners: identify prioritize evaluate emerging resources and interventions issues strategies Source: Chretien, J., Tomich, N.E., Gaydos, J.C., Kelley, P.W.: Real-Time Public Health Surveillance 5 for Emergency Preparedness. Am J. Pub. Health 99(8), 1360-1363 (2009)
States Stat s Repo porti ting ng Real al-Ti Time me Ou Outc tcome ome Dat Data Sta tate e or or Cause use of of In Injur jury Dea eath th Ho Hosp sp. ED ED Juri Ju risdiction sdiction Vi Visits sits Florida Interpersonal Violence √ √ √ Prevention Indiana Child Passenger √ √ Indiana Interpersonal Violence √ √ Kentucky Interpersonal Violence √ Kentucky Child Passenger √ Massachusetts Suicide and Self Harm √ √ Tennessee Falls Prevention √ √ 6
Epi Epidem demiolog iologists ists AKA your best friends for data 7
Tools t ools to Help o Help Y You ou Star Start Outcome Measure ICD-9 CM to ICD-10- Worksheet CM Crosswalk 8
Dif Differences erences be betw tween een Ev Evalu aluati ation on and QI and QI Evaluation QI • Retrospective • Real-Time • Targeted population, • Small scale often paired with a population, growing as control group knowledge is gained • Perfect Data • Some data is better than perfect data • Formal datasets • Preliminary and direct data sources 9
Potent ntial ial Dat Data a So Sources urces Traumatic Ambulance Brain Injury Medicaid Usage Records Registries Trauma Child Death Infant Fatality Registries Review Review Syndromic Death Poison Control Surveillance Registration Centers System System 10
Trau raumatic matic Bra Brain in Injur Injury y Reg egist istries ries Florida BRAIN AND SPINAL CORD INJURY CENTRAL REGISTRY (2013) Indiana State Medical Surveillance Registry for Traumatic Spinal Cord and Brain Injuries (2007) Minnesota TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY REGISTRY (1991) Missouri Brain and Spinal Cord Injury Registry (1986) Nebraska Brain and Head Injury Registry Act (1992) New Brain and Spinal Cord Injury Registry (2000) Hampshire Tennessee Title 68 Health, Safety and Environmental Protection Ch. 55: Head and Spinal Cord Injury Information System Part 2 (2010) Virginia Spinal Cord and Brain Injury Registry (2008) Source: National Association of State Head Injury Administrators. TBI Registries and Trauma Registries: State by State https://www.nashia.org/pdf/statestbi_registries_trauma_july_2016_revised.pdf 11 Accessed May 18 th , 2017
Disc Discussion ussion How do you What other use outcome data sources data when can you use? you do have it? What barriers to collecting and reporting data are you facing? 12
Spr Spreading eading Chan Change ge Jane Taylor, Ed.D. Improvement Advisor to the Child Safety CoIIN 13
Obje Objectiv ctives es • Identify spread ready changes • State key components of a spread plan • Develop simple tracking method for spread adoption 14
Old Way Old W y Creating a New System Improvement Hold Gains Spread 15
During During T Test esting ing • Test changes under a wide range of conditions (robust design) • Foolproof the new process/procedure • Use technology where appropriate • Learning from failure 16
During During Impl Implementatio ementation • Use multiple PDSA cycles to implement the change • Collect data over time when conditions are expected to change • Redesign support processes for new process • Address the social aspects of change • Seek and use input from others, specially those affected by the change, during testing 17
Ne New W w Way Creating a New System It’s much more organic than we thought Improvement Hold Gains Spread 18
Whe Where re is is Your Chang our Change? e? Successful changes High Degree of belief that the changes will result in improvement Changes still need further testing. Moderate There is a risk of moving to spread. Unsuccessful proposed changes Low Pilot (s) Prototype Spread Source: The Improvement Guide, p. 145 19
Ide Identi ntifyin fying g Spre Spread ad Ready eady Changes Changes Great ideas spread! Characteristics of spread-able ideas It is: • a relative advantage • compatible • easy and simple enough to use Try it (trial-ability) See it (observable) Source: E. Rogers. Diffusion of Innovation 20
Think hink you u what what one ne it item m wor orth thy of f sp spread read in in your ur project. project. Ra Rate th the chan hange ge on n a scale a scale of 1 f 1-5. . 1 1 - very y weak; weak; 3 - ok; k; 5 -very st strong ong Charact aracteri eristics stics Rating Relative Advantage Compatibility Simplicity Trial-ability Observable Source: The Improvement Guide, Pg. 200-201 21
Indiv Individual idual Adop doption of tion of Ideas Ideas 34% 34% 13.5% 16% 2.5% Early Early Late Laggards Adopters Majority Majority Innovators Source: adapted from The Improvement Guide, pg. 212 22
Ma Matc tchin hing Spre g Spread ad Act ctiv ivit itie ies t s to o Stage Stages s of of C Cha hang nge • Broad marketing and communication Awareness • Data feedback Persuasion • Case studies, individualized communication Decision • Tools and resources Implementation • Access to technical expertise • Feedback Confirmation • Leadership Source: adapted from The Improvement Guide 23
Th The e Way y We Com e Communica municate e is Impor is Important tant SHARE SHAPE INFORMATION BEHAVIOR General Personal Interactive Public Publications Touch Activities Events Face-to-face Flyers Letters Telephone Road shows One-to-one Newsletters Cards email Fairs Mentoring Videos Postcards Visits Conferences Seconding Articles Seminars Exhibitions Shadowing Posters Learning sets Mass Modeling meetings Adapted from Ashkenas, 1995 (C) 2001, Sarah W. Fraser 24
Mo Movi ving ng Spr Spread ead Strat Strategi egies es “ to the Lef o the Left ” What infrastructure changes be made to enable adoption? In Infra frastructure structure/r /rollout ollout Indi In divi vidual dual ado dopti tion on Balance of individual Primarily individual Primary infrastructure adoption decisions and decisions to adopt and system level infrastructure/system changes used to changes used to changes used to achieve achieve outcomes achieve outcomes outcomes Source: NICHQ Forum 2007 Cincinnati Children’s Hospital Medical Center 25
Cre Creati ating ng an Orga an Organiz nizati ational onal Cul Cultu ture re tha that t Enables Inno Enab les Innovati ation on 1. 1. Vis isio ion: Declare the importance of innovation; make it part of the project’s self image. 2. 2. For ores esig ight ht: Find out where technologies & people are going. Identify articulated and unarticulated needs of customers or those you serve. 3. 3. Str tretch tch Go Goal als: To make quantum improvements. 4. 4. Em Empowerment erment: Hire or engage good people and trust them; delegate responsibilities, provide slack resources, and get out the way. 5. 5. Com ommuni munica cati tions ons: Open, extensive exchanges according to ground rules in forums for sharing ideas, and where networking is each person ’ s responsibility. 6. 6. Rewar ards ds an and R d Rec ecog ogni nition tion: Innovation is an intensely human activity. Emphasize recognition more than monetary rewards. Source: NICHQ Forum 2007 Cincinnati Children’s Hospital Medical Center 26
Comp Components of a onents of a Spr Spread Pla ead Plan 27
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