Evaluating the Impact of Quality Improvement: Let`s Immunize!

Public Health Practice: Evaluating the Impact of Quality Improvement
Let’s 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
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 community—small or large. Using a quality improvement process and
working collaboratively, we hope to change the face of immunizations in our
communities for the better.
Test the Theory for Improvement
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-todate on vaccinations (particularly one year old immunizations), decrease missed opportunities and decrease the
DTaP drop-off rates by June 2011
6. Test the Theory
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 4th 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.
2. Methodology
Goal: to determine an appropriate method to increase the number of
immunizations in children 0-24 months
4. QI processes and Deliverables
Three local health departments:
•Hocking County Health Department
•Summit County Health District
•Franklin County Board of Health
Force Field Analysis
Current/Future state analysis
Process flow diagram
Flowchart summary form (space, equipment, costs, etc.)
Cause and Effect diagram (Fishbone)
Team survey
Clinic/client surveys
Plan outline
1. Clarify/refine the problem
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?
2. Complete process review, as
related to the problem statement
3. Refine root causes and
review processes for the
purpose of developing targets
and metrics for the evaluation
4. Select
to be evaluated
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.
5. Set targets (both process and
6. Establish data collection
7. Collect and analyze data
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:
8. Determine on a quarterly
basis status in relationship to the
performance targets
9. Refine processes and
as needed
10. Conduct final data analysis
to determine which targets are
11. Conduct customer
satisfaction survey
Increased total immunizations for the identified population of each health
Increased expertise with utilizing the QI process in program delivery.
3. Metrics
12. Develop a report
documenting QI
approaches/methods and status
Capacity metrics: Resources (cost and staff time)
Process metrics:
•Decreased 4th 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
Deliverables/plan detail
Problem statement related to increasing
immunizations by amount in children aged 0-24
Review immunization procedures and practices to
identify root causes of low numbers of
immunizations. Include all program staff to ensure
obtain accurate and complete program information.
Using appropriate QI tools and assistance from
Based on QI processes:
 Review science prior to solution selection
 Identify priority actions for each LHD
 Identify priority actions for collaborative
Identify measurable objectives for each participating
health district for:
 Increase in number of immunizations
 Describe QI methods utilized by each LDH
In collaboration with the evaluator, determine:
 Goal-specific data of interest and process for
data collection and entry.
 Data needed to capture comparative
elements of QI process
If needed, offer training for data collection.
Collect and analyze:
 Results for each jurisdiction as well as a
 Improvements in process for individual and
Exchange information among participating LHDs and
Coming next year!
Use Data to Study Results
of the Test
Standardize the Improvement and Establish Future Plans
Adjust by using PDCA cycle at each LDH, sharing
information with members of the collaborative and
appropriate staff.
Individual and composite
 Develop survey using proven methodologies
 Field survey in target population
 Analyze results
To include sections on each health district and the
composite, also will include lessons learned about
the collaborative approach (i.e. sharing strategies,
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
5. Develop an Improvement Theory
After several group discussions about the shared AIM statements, the underlying processes and the similarities
among the LHD’s, it was decided that each LHD would alter one component of their childhood
immunization clinic process. The changes were different for each health department.
H1N1 alert!
“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!
And, The Public Health Foundation
John Moran
Les Beitsch
Contact Beth Pierson for project information.
EMAIL: [email protected]
PHONE: 614.462.3746
Funding for Let’s Immunize!—A Collaborative
Approach provided by the Robert Wood Johnson

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