Goyal Neera K, Rome Martha G, Massie Julie A, Mangeot Colleen, Ammerman Robert T, Breckenridge Jye, Lannon Carole M
Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Matern Child Health J. 2017 Feb;21(2):275-282. doi: 10.1007/s10995-016-2206-7.
Objective To pilot test a statewide quality improvement (QI) collaborative learning network of home visiting agencies. Methods Project timeline was June 2014-May 2015. Overall objectives of this 8-month initiative were to assess the use of collaborative QI to engage local home visiting agencies and to test the use of statewide home visiting data for QI. Outcome measures were mean time from referral to first home visit, percentage of families with at least three home visits per month, mean duration of participation, and exit rate among infants <6 months. Of 110 agencies, eight sites were selected based on volume, geography, and agency leadership. Our adapted Breakthrough Series model included monthly calls with performance feedback and cross-agency learning. A statewide data system was used to generate monthly run charts. Results Mean time from referral to first home visit was 16.7 days, and 9.4% of families received ≥3 visits per month. Mean participation was 11.7 months, and the exit rate among infants <6 months old was 6.1%. Agencies tested several strategies, including parent commitment agreements, expedited contact after referral, and Facebook forums. No shift in outcome measures was observed, but agencies tracked intermediate process changes using internal site-specific data. Agencies reported positive experiences from participation including more frequent and structured staff meetings. Conclusions for Practice Within a pilot QI learning network, agencies tested and measured changes using statewide and internal data. Potential next steps are to develop and test new metrics with current pilot sites and a larger collaborative.
目的 对全州范围内的家访机构质量改进（QI）协作学习网络进行试点测试。方法 项目时间为2014年6月至2015年5月。这项为期8个月的倡议的总体目标是评估使用协作式质量改进来吸引当地家访机构，并测试使用全州范围内的家访数据进行质量改进。结果指标包括从转介到首次家访的平均时间、每月至少接受三次家访的家庭百分比、平均参与时长以及6个月以下婴儿的退出率。在110个机构中，根据数量、地理位置和机构领导情况选择了8个地点。我们改编的突破系列模式包括每月进行有绩效反馈和跨机构学习的电话会议。使用全州数据系统生成每月运行图。结果 从转介到首次家访的平均时间为16.7天，9.4%的家庭每月接受≥3次家访。平均参与时长为11.7个月，6个月以下婴儿的退出率为6.1%。各机构测试了多种策略，包括家长承诺协议、转介后加快联系以及脸书论坛。未观察到结果指标的变化，但各机构使用内部特定地点的数据跟踪了中间过程的变化。各机构报告称参与带来了积极体验，包括更频繁和更有条理的员工会议。实践结论 在试点质量改进学习网络中，各机构使用全州和内部数据测试并衡量了变化。接下来可能的步骤是与当前试点地点和更大规模的协作机构一起开发和测试新的指标。
