Background
Use this section to provide a brief introduction to your program to help us better understand your community, the population served, and the opportunity you chose to address.
Kane County is the fifth largest county in Illinois, with an estimated 2014 population of 527,306. It has grown over 30% since 2000 and over 60% since 1990. Kane County is located about 35 miles west of Chicago. Its land area is about 520 square miles, with a density of about 1,000 people per square mile. Most of its urban population is clustered around the Fox River. The largest community is Aurora, the second most populous city in Illinois with an estimated 2014 population of 200,456.
As of 2010, poverty rates had increased to 11.1% in Kane County. When viewed by race/ethnicity, a third of African Americans living in Kane County are below poverty level compared to one in five Hispanics and one in twenty Whites. 17% of children less than 18 years lived below poverty level, while 24% of female-headed households were below poverty level.
Goals and Objectives
Tell us about your goals and objectives. How did you decide to address the need you identified? What goals did you set? What was your timeframe?
Chronic diseases continue to be the most common, costly, and preventable of all health problems in Kane County. Tobacco use contributes to the three leading causes of death in Kane County: cancer, heart disease and stroke. Although smoking rates in the County have decreased to 12%, meeting the Healthy People 2020 objective for the first time, there is a major economic disparity, with those making under $10,000 smoking at rates above 30%.
Our goal was that, by June 30, 2014, we would develop a standardized process for accessing tobacco usage, provide education on the Illinois Tobacco Quitline and Freedom From Smoking (FFS) program to Cancer Care and patients. In addition, we would increase the number of referrals to the Illinois Tobacco Quitline to an average of five per month.
The goal of this practice was to utilize the recent skills developed within the health department to successfully coordinate Quality Improvement projects within clinical settings in the community to increase tobacco quit attempts and increase utilization of the Illinois Tobacco Free Quitline. The emphasis was on reaching those residents of the community who bear a disproportionate burden of tobacco use and the illnesses associated with it.
There were two primary objectives for the health department as staff developed this intervention. First, it was imperative to assure evidence-based practice was being conducted in the community. Second, the health department wanted to expand the culture of quality improvement that had taken hold within the organization and implement formal quality improvement projects in community organizations with staff acting as technical advisors and guides.
We established five main objectives throughout the project itself:
OBJECTIVE 1 - Create a request for proposals to solicit potential partners for this project through a competitive process by November of 2013.
OBJECTIVE 2 - Identify three medical providers by December 1, 2013 that were willing to participate in this quality improvement project from December 1, 2013 through June 30, 2014.
OBJECTIVE 3 - Provide refresher training in November 2013 to health department staff on facilitating Plan, Do, Check, Act (PDCA) process as well as train-the-trainer sessions on a variety of QI tools that could be used as part of the PDCA, such as Force Field Analysis, Flow Charts, and Affinity Diagrams, among others.
OBJECTIVE 4 - Conduct orientation meetings with the designated QI team members for each of the selected vendors by the end of December 2013.
OBJECTIVE 5 - Provide guidance and technical assistance leading to the successful completion of three collaborative PDCAs by the end of June 2014 that result in implementation of evidence-based strategies to promote cessation and Quitline utilization among the vulnerable population.
Description of Activities
In more detail, describe the activities you conducted to meet your goals and objectives. Include specific information about how you created change in your community.
To assure evidence-based practices were used, health department staff utilized Healthy People 2020, the Guide to Community Preventive Services, and the recommendations of the US Preventive Services Task Force to guide their strategy. The strategy selected was to provide small monetary incentives to medical providers that serve low-income populations to participate in a formal Plan, Do, Check, Act (PDCA) to improve how they provide evidence-based interventions to their clients to encourage and support cessation.
The health department utilized tobacco settlement funding from the Illinois Department of Public Health to make grants available to clinical partners in the community. Eligible organizations needed to serve vulnerable populations and commit to forming a QI team within their organization to lead a QI project utilizing Plan, Do, Check, Act (PDCA). Proposals were reviewed and three organizations were selected to each receive $7,500 to implement projects. The health department conducted training on PDCAs and the use of other QI tools and offered technical assistance throughout the process. Resources and materials that had been developed for use within the health department were utilized to increase the QI capacity of participants. The health department held monthly meetings with the providers and walked them through the formal steps of their PDCA. Each group had the autonomy to explore the problem and solutions they would test for themselves.
The Assistant Director of Community Health coordinated training sessions for the tobacco staff that would be interfacing with the community partners. Excellent training materials had been developed by the agency’s QI and Data Coordinator leading up to PHAB accreditation. These tools, including train-the-trainer modules, were shared with staff to increase their confidence and competence to lead the projects with the providers. Each organization designated team members to participate on an internal QI team specific to this project. These teams each met with staff from the health department in December for an initial orientation to the PDCA process. Each of the three providers actively participated in the PDCA process, completed each formal step and participated in monthly meetings with the health department.
Results/Impact
What results did you achieve? Did you meet your goals and objectives? How did you measure this?
The results of the process in each of the three sites was an increase in the utilization of evidence based interventions to promote tobacco use cessation and use of a free quit line.
The health department objective of guiding the community partners through each step of a PDCA was met. Two of the three projects met or exceeded their AIM Statements. The project that fell short, had some staffing changes mid-project that interfered, but they brought their numbers up quickly after the staffing issue was resolved.
The intervention, the implementation of QI projects with medical providers to increase smoking cessation attempts among low-income patients using evidence-based practice, is innovative and improved upon past practice for six key reasons. This project:
- Expanded the QI culture from within the health department, out to other groups within the broader public health system
- Reinforced and enhanced health department staff’s appreciation of and competency in facilitating quality improvement projects
- Utilized existing, evidence-based tools by presenting them to providers in a novel manner, as part of a QI project
- Built a level of evaluation and rapid improvement into clinician’s offices that did not exist around smoking cessation previously
- Yielded positive measurable behavioral results among the target population of low-income smokers
- Catalyzed change within medical organizations that can now be maintained to help patients into the future.
Most notably, our assessment process was recognized in 2013 with a NACCHO Model Practice Award.
What was creative or unique about your approach?
With much community input obtained through webinars, open houses and presentations to community groups, stakeholders identified the top five issues to include in the Community Health Improvement Plan (CHIP). Tobacco use was identified as one of those issues and the health department was identified as the lead organization to coordinate efforts to reduce the burden of tobacco.
Data showed that over half of smokers had made at least one attempt to quit within the past year. Furthermore, tobacco cessation programs already existed and were offered by local healthcare providers.
Therefore, the challenge was carrying out these evidence-based tobacco interventions within the PDCA process.
NACCHO recognized this process in 2013 with a Model Practice Award.
Describe any partnerships that were formed or organizations you collaborated with.
The central aspect of our project was collaboration and outcomes sharing among the three selected healthcare providers. Participating providers reported that the KCHD's support and assistance during the PCDA process helped them focus their efforts on the task at hand, and that this resulted in improved results, as they identified additional areas for improvement within their own organizations.
Which of the following portion(s) of your HCI product was used in your efforts?
- Community Dashboard
- Disparities Dashboard
- Promising Practices
How did these portions of the HCI tool help you achieve your goals?
We anticipate using HCI's Community and Disparities Dashboards in order to feed more targeted information into our PDCA process and continue improvements to the process, and in order to detect new populations for future areas of focus.
Furthermore, we are always interested in sharing the results of our PDCA process with other agencies, and learning new ways to refine our process by comparing with other promising practices.