Disclosure Objectives Obesity Intervention Funded thru the - PDF document

Framing Your System-Level Disclosure Evaluation Strategies Kristin Erickson has disclosed a relevant financial Second International Conference on Research interest Statewide Health Improvement Program (SHIP) Methods for Standard Terminologies and Clinical and Translational Science Institute (CTSI). Kristin Erickson, MS, APHN-BC, RN There are no conflicts of interest or relevant financial Evaluator and Health Care Initiatives Coordinator PartnerSHIP 4 Health and Otter Tail County Public Health interests that have been disclosed by the remaining Fergus Falls, MN presenters or planners of this activity that apply to this Ngozi Mbibi, DNP, RNC-OB learning session. Adjunct instructor, Bethel University Minneapolis, MN April 15, 2015 Disclosure Objectives Obesity Intervention • Funded thru the Minnesota Statewide Health Improvement Program (SHIP) At the end of this session, the learner will be Obesity Intervention-related Research better able to … • This project was supported by Grant Number 1UL1RR033183-01 from the National Center for Research Resources (NCRR) and by Grant Number  Identify system-level evaluation framework 8UL1TR000114-02 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) to the University components of Minnesota Clinical and Translational Science Institute (CTSI); and by the Minnesota State Health Improvement (SHIP) program. Its contents are solely  Analyze data to show system-level the responsibility of the authors and do not necessarily represent the official views of the Minnesota Department of Health, the CTSI or the NIH. The intervention outcomes University of Minnesota CTSI is part of a national Clinical and Translational Science Award (CTSA) consortium created to accelerate laboratory  Apply a system-level evaluation framework to discoveries into treatments for patients. The authors acknowledge the Omaha System Partnership for Knowledge Discovery and Health Care Quality. system-level work Definition: Today’s Road Map System – Level Practice • Changes organizations, policies, laws, and power • Define system-level practice structures. • 8 Easy Steps to System-Level Practice and Evaluation • The focus is not directly on individuals and • System-Level Framework - Obesity Example communities but on the systems that impact • System-Level Framework - DVT Example health. • System-Level Framework Application • Changing systems is often a more effective and long - lasting way to impact population health than requiring change from every single individual in a community. Minnesota Department of Health. (2001). Section of public health nursing: Three levels of public health practice. Retrieved from http://www.health.state.mn.us/divs/opi/cd/phn/docs/0103phn_levelsofpractice.pdf 1

Eight Easy Steps to System-Level Practice and Evaluation Using the Omaha System 1. Does your practice include system-level 1. Use population health data to identify the health issue interventions? 2. Determine the organizational system(s) or other system(s) that impact the identified health issue 3. Select a system and an evidence-based system-level intervention 2. Have you ever used the Omaha System to 4. Utilize system-level data to determine the gap in the selected system document system-level interventions? in relation to the evidence-based intervention 5. Map the gap to Omaha System signs and symptoms 6. Determine to which Omaha System problem(s) these signs and symptoms belong 3. Have you ever used the Omaha System to 7. Develop an evidence-based Omaha System Care Plan evaluate system-level interventions? 8. Develop Omaha System Knowledge, Behavior, and Status (KBS) scales to reflect the continuum from gap to no-gap Step One: Eight Easy Steps to Use population health data to identify a health issue System-Level Practice and Evaluation • Data: Community Health Needs Assessment* – Community surveys: Using the Omaha System: • electronic survey available to community stakeholders and members • low-literacy 2-page survey in public health waiting rooms Obesity Example – Focus groups – Community Health Needs Assessment Community Conversations – Centers for Disease Control and Prevention – National Center for Chronic Disease Prevention and Health Promotion Kristin Erickson, MS, APHN-BC, RN – Behavioral Risk Factor Surveillance System, etc. Evaluator and Health Care Initiatives Coordinator PartnerSHIP 4 Health and Otter Tail County Public Health • Issue Identified: Fergus Falls, MN – Obesity * Lake Region Healthcare. (2013). Community health needs assessment summary. Retrieved from http://www.netreturns.biz/Client_Files/lrhc/CM/System/LRH_CHNA_2013.pdf Step Two: Step Three: Select a system and an Determine the system(s) that impact this evidence-based system-level intervention health issue • Institutional Systems: • System: Healthcare Setting – Schools System – Communities – Worksites System System • System-level Intervention: – Daycare – Healthcare, etc. Implementation of the Institute of Clinical Systems (ICSI) • Other Systems: Obesity Adult Obesity Guideline – Food System – Transportation System – Legal System – Housing System – Educational System, etc. 2

Step Four: Step Five: Obtain system-level data related to the selected Map to Omaha System signs and symptoms system to identify any gap in relation to the Which signs and symptoms selected evidence-based intervention reflect the identified gap? – Healthcare Setting Data: • Signs/Symptoms: • Literature review • inadequate treatment plan • Chart audit (does not offer evidence- • Clinician surveys based clinical obesity treatment plan) • Administrator surveys • inadequate source of health – Identified Gap: Inadequate implementation of care (is not a source of evidence-based clinical obesity guidelines evidence-based clinical obesity care) Step Six: Step Seven: Determine to which Omaha System problem(s) Develop an evidence-based Omaha System Careplan these signs and symptoms belong • Health Care Setting Obesity Care Plan • Health Care Supervision (Martin, pp. 346-350) – Omaha System Problem – Definition: Management of the health care treatment • Omaha System Signs and Symptoms plan by health care providers – Omaha System Interventions » Omaha System Targets • Omaha System Client Specific Information Martin, KS. (2005). The Omaha System: A key to practice, documentation, and Thorson, D.R., Erickson, K.J., Attleson, I.S., & Monsen, K.A. (2014). information management (Reprinted 2nd ed.). Omaha, NE: Health Connections Transforming evidenced-based adult obesity guideline into clinical practice. Press Retrieved from http://omahasystemmn.org/publications.php Step Eight: Obesity Careplan KBS Rating Guidance Develop Knowledge, Behavior, and Status (KBS) Health Care 1 2 3 4 5 Supervision scales to reflect the continuum from gap to no-gap Knowledge No knowledge Minimal Basic knowledge Adequate Superior (What health care knowledge knowledge knowledge setting knows in regards to evidence-based guideline) No evidence-based care Behavior Not appropriate Rarely Inconsistently Usually Consistently (What health care behavior: appropriate appropriate appropriate appropriate setting does does not behavior: behavior: behavior: behavior: regarding implement 1-2 clinicians multiple clinicians several entire system implementation of guideline implement or 1-2 departments departments implements evidence-based guideline implement implement guideline Evidence-based care guideline) guideline guideline Status Extreme S/S: Severe S/S: Moderate S/S: Minimal S/S: No S/S: (How health care ▪ no supports ▪ minimal ▪ moderate ▪ adequate ▪ numerous setting is in regards ▪ precontemplation supports supports supports supports to support and ▪ contemplation ▪ preparation ▪ action ▪ adoption/ adoption of maintenance evidence-based guideline) 3

System-Level Evaluation in a Nutshell Eight Easy Steps to System-Level Practice and Evaluation Using the Omaha System: DVT Example • Obtain Pre-intervention KBS Ratings • Proceed with System-Level Intervention Evaluation Strategies for Projects in • Obtain Post-intervention KBS Ratings Practice • Analyze Pre- and Post-Intervention KBS Results Ngozi Florence Mbibi PMDNP, RNC-OB RN, Allina Health Adjunct Instructor, Bethel University Step Two: Step One: Determine the system(s) that impact this Use population health data to identify a health issue health issue • Determine the organizational system(s) or other • Data: system(s) that impact this issue http://www.cdc.gov/reproductivehealth/mate – Organizational Systems: • Hospital rnalinfanthealth/pmss.html • Hospital Departments • Clinic • Other Healthcare setting, etc. • Issue: – Other Systems: • EMR System Deep Vein Thrombosis in Pregnant Patients on • QI System Prolonged Bedrest • Orientation System, etc. Step Three: Step Four: Obtain system-level data related to the selected Select a system and an system to identify any gap in relation to the evidence-based system-level intervention selected evidence-based intervention • System: • Data: Mother-Baby Units in the Hospital – chart audit – nurse surveys • System-level Intervention: – organizational surveys – evidence from literature e.g. Kane et al., 2013 compared Implementation of Clinical DVT Guidelines to facility ICD-9 code data • Identified Gap: – Inadequate implementation of evidence-based clinical guidelines 4