Measuring What Matters to Children With Medical Complexity and Their Families.

The Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity (CMC CoIIN) was designed with a foundational commitment to partnership with family leaders to codesign and improve systems of care and supports for CMC and their families - this fundamental commitment was essential to the CMC CoIIN's measurement strategy. In this paper, we examine key learnings from partnering with family leaders from interdisciplinary state teams in the CMC CoIIN to identify and define quantitative quality improvement measures to improve care and support for CMC and their families, including quality of life, well-being, and flourishing; unmet health needs; and support systems such as medical home, patient and family engagement, and shared plans of care. Codesigning the CMC CoIIN measurement strategy with family leaders greatly enhanced our measurement approach and provided numerous unique learning opportunities for the CMC CoIIN's project team and state teams.

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms.

Importance: Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment.

Objective: To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size.

Design, Setting, And Participants: This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019).

A Pilot Quality Improvement Collaborative to Improve Safety Net Dental Access for Pregnant Women and Young Children.

Objectives To determine acceptability and feasibility of a quality improvement (QI) collaborative in safety net dental practices, and evaluate its effects on financial stability, access, efficiency, and care for pregnant women and young children. Methods Five safety net dental practices participated in a 15-month learning collaborative utilizing business assessments, QI training, early childhood oral health training, and prenatal oral health training. Practices collected monthly data on: net revenue, no-show rates, total encounters, and number of encounters for young children and pregnant women.

Using the ARCC Model to Implement the 2015 ANCC COA Criteria: A North Carolina Public Health Nursing Project.

In July 2015, the American Nurses Credentialing Center's Commission on Accreditation released updated criteria for continuing nursing education, including updates to the Education Design Process. The primary nurse planner in the Public Health Nursing Approved Provider Unit in North Carolina's Division of Public Health applied the advancing research and clinical practice through close collaboration model and quality improvement strategies to facilitate the adoption and implementation of the 2015 criteria. This article describes an innovative approach to implementation using an evidence-based practice model and quality improvement tools and provides data regarding nurse planners' knowledge of accreditation criteria and role comfort during the first 6 months of implementation.

Using Quality Improvement Methods to Implement an Early Childhood Oral Health Initiative: A Federally Qualified Health Center Pilot Study.

Objectives: To assess the use of quality improvement (QI) methods to implement an early childhood oral health program (Baby Oral Health Program-bOHP) in four federally qualified health center (FQHC) dental clinics.

Study Design: Using a mixed-methods study design, survey responses, administrative data, QI project templates, and focus group measures were collected. Plan-Do-Study-Act (PDSA) cycles as mini-projects to improve the implementation of bOHP were examined.

Improving Culture, One Quality Improvement Project at a Time.

Context: A culture of quality improvement (QI) values collaboration, transparency, and staff empowerment. Organizations exhibiting a culture of QI are more likely to engage in QI.

Objective: We examined whether local health departments' (LHDs') participation in a longitudinal, experiential QI training program changes QI culture.

Translating Clinical Guidelines Into Practice: Challenges and Opportunities in a Dynamic Health Care Environment.

Clinical practice guidelines are evidence-based recommendations with the potential to improve population health, yet they remain inconsistently utilized. In this commentary we discuss barriers and drivers to implementing clinical practice guidelines. We also suggest ways to support their translation into practice.

Lessons Learned From Measuring Return on Investment in Public Health Quality Improvement Initiatives.

Context: The Center for Public Health Quality and its partner, North Carolina State University Industrial Extension Service, used 2 existing, yet similar quality improvement (QI) programs to provide technical assistance to conduct return on investment (ROI) and economic impact (EI) analyses so that they could estimate their QI projects' financial impacts.

Objectives: The objectives of this article are to describe the approach and ongoing learning from applying ROI and EI analyses to public health QI projects and analyze the results in order to illustrate ROI potential in public health.

Design: We used a before-after study design for all ROI and EI analyses, spanning a 3-year time period.

Advancing Quality Improvement in Public Health Departments Through a Statewide Training Program.

Objectives: To examine the effectiveness of an ongoing statewide public health quality improvement training program (PH QI 101) among 4 cohorts of training participants.

Design: We conducted a mixed-method evaluation of the PH QI 101 training program that included measures of participants' satisfaction, learning, behavior change, and participants' translation and spread to their organizations what was learned. Data analysis included descriptive quantitative statistics and qualitative reviews.

The potential impact of the Affordable Care Act on population health in North Carolina.

The need to improve population health is critical. This commentary explores how the Patient Protection and Affordable Care Act of 2010 (ACA) can help us improve population health, highlights some of the actions North Carolina has taken in response to the ACA's provisions, and discusses the value of health investments in the future.

Quality improvement in North Carolina's public health departments.

North Carolina has been a leader in the application of quality improvement (QI) to public health practice. Over the past decade, numerous developments have served to accelerate the adoption of QI in North Carolina's local health departments. The outstanding results from the widespread application of QI should help North Carolina to become a healthier state.

Lessons learned from building a culture and infrastructure for continuous quality improvement at Cabarrus Health Alliance.

This case study describes a local public health agency's multiyear effort to establish an infrastructure and organizational culture for continuous quality improvement, using data from interviews with the agency's senior leaders, managers, and frontline staff. Lessons learned include the importance of setting stretch goals, engaging leaders at all levels of the organization, empowering frontline staff to make changes, providing quality improvement training for staff and leaders, starting with small projects first, spreading quality improvement efforts to involve all parts of the agency, and sustaining momentum by creating a supporting infrastructure for continuous quality improvement and continually initiating new projects.

Applying Lean principles and Kaizen rapid improvement events in public health practice.

This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.

Early evaluation results from a statewide quality improvement training program for local public health departments in North Carolina.

Context: Many state and local public health agencies have developed accreditation systems and are utilizing quality improvement (QI) methods and tools to improve the public health infrastructure. Development of strategies to support and build the capacity of the public health workforce to apply QI can help advance these efforts.

Objective: This article describes the adaptation and creation of a standardized QI training program for local health departments (LHDs), explores the effectiveness of the program in increasing the confidence of the LHD staff to apply QI methods and tools, and discusses lessons learned from the first cohort of the program.

Using quality improvement to promote breast-feeding in a local health department.

In 2008, breast-feeding initiation and continuation rates in Beaufort County, North Carolina, were lower than statewide rates. A quality improvement (QI) project was initiated to increase breast-feeding rates by enhancing the overall environment that supports breast-feeding at the Beaufort County Health Department. This case study describes one of the first QI initiatives implemented through the North Carolina Center for Public Health Quality QI training program, conducted in 2009.

Standardizing environmental health processes at the Iowa Department of Public Health.

Standardized work is the foundation of continuous improvement. Documenting standard processes is a precursor to problem solving and allows an organization to understand work flow, measure performance, and identify opportunities for improvement. Environmental health is an important function of public health departments but is rarely studied systematically.

Applying the model for improvement in a local health department: quality improvement as an effective approach in navigating the changing landscape of public health practice in Buncombe County, North Carolina.

In local health departments across the nation, problem solving and rapid change occur every day. Often, the results of these changes or problem-solving techniques may not be studied or evaluated fully to determine whether desired results were achieved. In fact, program evaluation, research, and technical assistance at the local level may be reduced or eliminated in many states during a time of rapidly diminishing resources and increasing demand for public health services.

A modified healthy steps model to improve resident training in behavioral and developmental care.

Objective: To assess whether implementing a modified Healthy Steps (HS) for young children program in residency clinics could improve resident education and their perception of the quality of care provided for common behavioral and developmental (B/D) issues.

Methods: Residents and faculty blinded to study intent were surveyed to assess perceptions of resident preparedness and the quality of behavioral and developmental (B/D) care at 4 pediatric residency training sites in North Carolina. Initially, Program 1 (with an established HS program) was compared with 3 sites without established programs at baseline (Programs 2, 3, and 4), and then the results before and after implementation at Programs 2 to 4 were compared.

Educational impact of a hospital-based neonatal resuscitation program in Ghana.

Aim Of The Study: To assess midwives' baseline cognitive knowledge of evidence-based neonatal resuscitation practices, and short- and long-term educational effects of teaching a neonatal resuscitation program in a hospital setting in West Africa.

Methods: All midwives (n=14) on the labor ward at Ridge Hospital in Ghana were trained using materials modified from the American Academy of Pediatrics (AAP) Neonatal Resuscitation Program (NRP). This training program included didactic and practical teaching and was assessed by direct observation within delivery rooms and written pre- and post-test evaluations.