Institute for Clinical Systems Improvement (ICSI)
Statewide Health Improvement Program (SHIP)

Overview:
US Health care reform is focusing on disease prevention and health promotion as a strategy to improve overall population health by engaging the patient to adopt healthy behaviors, resulting in the reduction of chronic disease and health care costs. Adequate physical activity, a diet that emphasizes fruits and vegetables, abstinence from tobacco and avoidance of tobacco smoke, are associated with a decade or more of increased life expectancy. Smoking, poor nutrition, inactivity and alcohol abuse factors have been estimated to cause 35 percent of all annual deaths in the United States, or 800,000 deaths each year. Traditionally, the burden of guiding the patient toward healthier lifestyles fell on the medical groups. A broad approach is necessary to achieve and support healthier behaviors in individuals. It requires individual change, health care system redesign, as well as community, employer and payer support. There is a growing recognition and understanding of the role that community networks, physical and social environments, and public policy all play in fostering healthier lifestyles. Partnering with the Minnesota Department of Health, ICSI will assist in development of quality improvement structures and processes to implement health promotion guidelines in clinics and support collaboratives between county public health agencies, community clinics, and health care organizations with the goal of health promotion and prevention redesign, resulting in measurable health improvement outcomes for Minnesota communities.

Collaborative Format:

Mar/Apr 2010 - Sep/Oct 2010: An initial introductory webinar will describe the participant responsibilities and team selection, goals, face-to-face sessions, actions and potential outcomes anticipated through collaborative development. Participant teams will receive readiness assessments to consider prior to the first face-to-face session. Three full-day collaborative and development sessions will follow. Education model includes review of the Primary Prevention of Chronic Disease (PPCD) and Obesity guidelines, didactic presentations, exercises in collaboration, quality improvement infrastructure development, and system redesign and models and tools for implementation and improvement. Global aims and measures will be identified and implemented by the participants in conjunction with state requirements. Between each face-to-face collaborative session, participant teams will be responsible to complete homework assignments and contribute reports, data and collaborate in conference calls.

Oct/Nov 2010 - Apr/May 2011: During this period there will be a focus on process improvement support for the SHIP collaborative. Participants will utilize the PDSA cycle of improvement to test and evaluate strategies and activities supportive to the implementation of the Obesity and PPCD Guidelines and the collaboration between clinic, public health and community resources. This will consist of webinars, conference calls, data collection and progress reporting. Each team will share their successes and challenges throughout the collaborative.

Required Team Composition:

• Physician Champion: The physician champion from each clinic, must be part of the collaborative team and attend as many meetings as possible or find a physician replacement if there is a schedule conflict. Physician champion leads the changes back at the clinic that affects other providers.
  
• Team/Project Leader: This individual will serve as the ICSI contact for progress reports and logistics related to overall team participation. Team leader must attend all meetings.
  
• Data management or quality professional: Each team should designate an individual who will submit data monthly. Accurate and regular data collection is essential for quality improvement initiatives to be successful. The data management or quality professional must attend all meetings.
  
• Nursing Leader: This leader must be the knowledge expert on the clinic processes and implementation of the guidelines. This person is strongly encouraged to attend but could send another RN to the meeting as needed.
  
• County Citizen/Patient: (Highly recommended but not required) This citizen should be a leader in managing their own health and demonstrate an interest in supporting their community health.
  
• Public Health Leader: The public health leader provides SHIP information, direction and support to the team. This support entails meeting with the team, allocating human and/or material resources to the project, and addressing barriers that impede achievement of the aims. The public health leader is required to attend the meetings.

Optional Team Members:

• Marketing/Communication Specialist
  
• Social Worker(s)
  
• Community Government Leaders
  
• Community Health Resource
  
• County Employer
  
• Other

Please keep these criteria in mind when registering for the collaborative and developing a team. In considering team composition, members should be able to provide:

1. rich input regarding the health promotion and disease prevention processes for the clinic patient,
   
2. connections between clinic and public health,
   
3. deep understanding of community health promotion, disease prevention tactics.

Requirements of Collaborative Participants:

• Attend and participate in all meetings.
  
• Implement various strategies and approaches to implement proposed guidelines.
  
• Share strategies, tools, and experiences at meetings and conference calls and over the listserv.
  
• Submit progress reports and data to the designated listserv. Progress reports and data templates will be provided.

Pre-work Requirements: Teams will be required to do some preparatory work prior to the full day collaborative.

• Complete Organizational Readiness Assessment
  
• Complete Obesity and Primary Prevention of Chronic Disease Guideline
  
• Selection of teams for clinic and/or community collaborative
  
• Communicate collaborative participation expectations to all members of team
  
• Prepare to answer questions such as:
  
  • What are current quality improvement structures within your organization?
    
  • In your county, what do you think could be done to improve disease prevention and health promotion between clinical providers and public health, and/or community-based resources?
    
  • What are the barriers to improve disease prevention/health promotion?
    
  • Where do patients have access to information, education and support for nutritional choices, physical activities, smoking cessation, and alcohol use within clinical and public health settings? What other places should be targeted?

Proposed Measures:

Meeting Dates: Region 1 and Region 2 (see attached)

Collaborative Staff Participants:

• ICSI Facilitators: Carmen Hansen and Melissa Marshall
  
• Other ICSI team members: Nancy Jaeckels
  
• Megan Ellingson, MDH, Ruth Tripp, Bloomington, Kim McCoy, MDH; Renee Gust, Hennepin; Kristin Erickson, Otter Tail; Catherine Mains, Wright Cty, Joel Torkelson, Wright Cty, Kari Mattson, Chisago Cty.

Roles/Tasks of Facilitators and MDH

ICSI

• Facilitate all training, conference calls and webinars
  
• Provide guidance and support

MDH/County Public Health

• Support data collection/chart audits
  
• Clinic Site Visits/Meetings
  
• Participate in conference calls/webinars