Let Me Upgrade You: Common Measures in Public Health Accreditation Action Plans

Objectives: The purpose of this study is to understand the success rates for health departments pursuing and achieving accreditation in version 1.0 and 1.5 of the Public Health Accreditation Board (PHAB) standards and measures. During the accreditation process, health departments that present performance gaps are asked to complete an Action Plan to specify how they plan to improve to meet the desired conformity. This study will highlight specific measures that are often included in Action Plans so that health departments pursuing accreditation can be better prepared to address these common pitfalls. Methods: This study is a non-experimental, secondary analysis of cross-sectional PHAB data available as of May 2018. This is a quantitative analysis utilizing logistic regression to determine association between variables. The sampling frame for this study includes 223 accredited health departments from 2013 to May 2018. Results: The five measures most commonly included in public health accreditation Action Plans include 5.2.4 (implementing a Community Health Improvement Plan), 5.3.3 (implementing a Strategic Plan), 9.1.3 (implementing a Performance Management System), 9.2.2 (implementing quality improvement), and 9.1.4 (implementing customer satisfaction process). The top five measures included in Action Plans are all focused on implementation of the associated plans or processes included in Domains 5 and 9. Conclusions: To avoid common pitfalls of public health accreditation, health departments still in pursuit of accreditation that want to avoid getting an Action Plan should allow one to two years between plan development and applying for accreditation to allow enough time to produce at least one annual report evaluating implementation of plan goals and objectives. Small and medium local health departments should consider this specifically for the implementation of their performance management system, which is frequently included in Action Plans

After Initial Accreditation - The PHAB Annual Report

Background: Cobb & Douglas Public Health (CDPH) was the first health district in Georgia to achieve accreditation by the Public Health Accreditation Board (PHAB) (accredited on May 12, 2015). Since then, two additional health districts, DeKalb (3-5) and Gwinnett, Newton, and Rockdale County Health Departments (3-4), have achieved accreditation. Efforts are underway among health districts statewide to become accredited, yet, little is known about life after accreditation. This presentation will highlight CDPH’s approach to submitting the PHAB Annual Report, which is required of health departments in order to maintain their accreditation status. Methods: CDPH will provide an overview of the PHAB Annual Report process and requirements. We will also share the process we used to construct a one-year timeline to prepare for the submission of the Annual Report and organize the Accreditation Team. CDPH will also provide a preview of the electronic submission process using ePHAB. Finally, CDPH will share tips, including lessons learned while preparing and submitting the Annual Report during July-August 2016. We will also discuss our experiences since submission and feedback received from PHAB’s Evaluation and Quality Improvement Committee. Results: CDPH will share knowledge and experiences related to the submission and feedback received of its first PHAB Annual Report, which was submitted August 2016. Conclusions: Health departments devote a tremendous amount of time, money, and energy to become accredited; however, the journey continues through the submission of PHAB Annual Progress Reports and reaccreditation planning. Keywords: Accreditation, PHAB, PHAB Annual Repor

Kaizen: Improving Patient flow

Background: Since Cobb & Douglas Public Health (CDPH) achieved accreditation in May 2015, efforts to mature a culture of quality have been emphasized. In addition, the Adult Health Clinic moved to a new facility in Spring 2016. This move has improved many patient flow issues, but also has had unexpected consequences that spurred interest in doing several quality improvement (QI) projects. Methods: Rather than doing one QI project at a time, a kaizen event was held. Kaizen is a Japanese term for continuous improvement. This workshop allowed the Adult Health Team to plan seven QI projects and implement them simultaneously over the next several weeks. After the first six weeks of implementation, nearly 14 different projects were in various stages of the PlanDo-Study-Act (PDSA) cycle. Baseline average patient flow for 1880 patient encounters was 75.11 minutes. Results: Results are still pending. Preliminary results reflect increased collaboration among clinic staff and an increase in staff members taking the initiative to make improvements. Employee morale has improved, and employee and customer satisfaction seems to be improved. Conclusions: The Adult Health Clinic used the LEAN methodology to reduce waste in the patient flow process and used the PDSA framework to structure their 14 QI projects. A kaizen event allows rapid improvements to be planned and implemented in a short period of time

A 13-County Rural Health District’s Journey to Strategic Planning

On the path to public health accreditation, the North Central Health District, consisting of 13 rural Georgia counties, underwent its very first strategic planning process. This was successful by assistance from Georgia Southern University’s Center for Public Health Practice and Research and the direction of NACCHO’s Guide to Strategic Planning

Let\u27s Do This Together: Expansion of Hearts and Hands Diabetes Care

In summer of 2017, our team of DrPH students taking the Public Health Funding and Grants course assisted the Hearts and Hands Clinic in securing a $50,000 grant from the Healthcare Georgia Foundation to expand the diabetes care and management program. The goal of our service-learning activity was to write a grant proposal to broaden the current abilities of the clinic to include an evidenced-based Team Care approach with a behavioral health component that has high quality and low cost to underserved individuals within Bulloch County. The grant application was funded in fall 2017. Engaging in a service-learning activity not only taught us how to write various components of a grant, but also helped us understand why certain grant applications are funded. This type of learning is not taught in the classroom, and we are grateful for the experience to have a local impact on our own community

Analysis of 3-dimensional arch anatomy, vascular flow, and postnatal outcome in cases of suspected coarctation of the aorta using fetal cardiac magnetic resonance imaging

Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be lifesaving but is notoriously challenging in clinical practice with a high rate of false positives. Novel fetal 3-dimensional and phase-contrast magnetic resonance imaging (MRI) offers an unprecedented means of assessing the human fetal cardiovascular system before birth. We performed detailed MRI assessment of fetal vascular morphology and flows in a cohort of fetuses with suspected CoA, correlated with the need for postnatal intervention. METHODS: Women carrying a fetus with suspected CoA on echocardiography were referred for MRI assessment between 26 and 36 weeks of gestation, including high-resolution motion-corrected 3-dimensional volumes of the fetal heart and phase-contrast flow sequences gated with metric optimized gating. The relationship between aortic geometry and vascular flows was then analyzed and compared with postnatal outcome. RESULTS: Seventy-two patients (51 with suspected fetal CoA and 21 healthy controls) underwent fetal MRI with motion-corrected 3-dimensional vascular reconstructions. Vascular flow measurements from phase-contrast sequences were available in 53 patients. In the CoA group, 25 of 51 (49%) required surgical repair of coarctation after birth; the remaining 26 of 51 (51%) were discharged without neonatal intervention. Reduced blood flow in the fetal ascending aorta and at the aortic isthmus was associated with increasing angulation (P=0.005) and proximal displacement (P=0.006) of the isthmus and was seen in both true positive and false positive cases. A multivariate logistic regression model including aortic flow and isthmal displacement explained 78% of the variation in outcome and correctly predicted the need for intervention in 93% of cases. CONCLUSIONS: Reduced blood flow though the left heart is associated with important configurational changes at the aortic isthmus in fetal life, predisposing to CoA when the arterial duct closes after birth. Novel fetal MRI techniques may have a role in both understanding and accurately predicting severe neonatal CoA