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AAP QI TOOLKITFACE Poverty Campaign 2015 SOMSRFT

+Welcome!

Welcome to our 2015 SOMSRFT FACE Poverty Campaign QI Toolkit!

This is a presentation created to help serve you as a medical student, resident, fellow or trainee in identifying and carrying through a QI project from the first step of assessing your individual communities and defining your passions to statistically coding and publishing your data!

This is a toolkit made by us-for us, so please feel free to contact us with any questions/comment/concerns.

We hope you all find your niche within the realm of our FACE Poverty campaign and start amazing QI or advocacy projects in your areas!

Best,2015 SOMSRFT National Advocacy Campaign Tri-ChairsGabriella, Alexandra, Genevieve

+What is the FACE Poverty campaign? Food security: Adequate nutrition is vital to the growth and development of all children. In 2013, 14.3% of households were food-insecure, with 5.6% with very low food security. About 45% of low-income families are food insecure. http://www.foodrecoverynetwork.org

Access to health care: Pediatricians-in-training will work to increase children’s access to a patient-centered medical home, which can lead to improved health and well-being. In addition, ongoing advocacy is needed to maintain and strengthen Medicaid and the Children’s Health Insurance Program, which have led to significant improvement in overall access to health care

Community: Between 1996-2006, most Americans in the bottom 20% never moved up the income ladder. Twenty percent of U.S. children younger than 18 years live in poverty and are likely to remain in poverty as adults. Lack of resources for those in poverty as well as the effects of poverty on child development result in these intergenerational cycles of poverty. The goal of this branch of the campaign is to focus on building family resilience and advocating for positive schooling and neighborhood development.

Education: Early and continued education are strongly associated with income, future employment and overall quality of life. Although early childhood education has improved since 1994, there is still work to be done. In addition, more than 1.2 million U.S. students drop out of high school every year. The campaign will focus on advocating for early childhood education and reducing the high school dropout rate.

http://www2.aap.org/sections/ypn/r/advocacy/facepoverty.html

+What is advocacy? Advocacy is

active promotion of a cause or principle involves actions that lead to a selected goal one of many possible strategies, or ways to approach a problem can be used as part of a community initiative, nested in with other

components. not direct service does not necessarily involve confrontation or conflict

(3)

Advocacy is a set of thoughts or ideas that you want to promote! Visit this helpful AAP website on becoming an advocate: https

://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Medical-Students/Pages/Become-an-Advocate.aspx

For more information on advocacy principles, please visit the website below: http://ctb.dept.ku.edu/en/table-of-contents/advocacy/advocacy-princip

les/overview/main

+What are the different types of advocacy?

Case Advocacy This is an individual based style of advocacy. Usually, a situation is recognized and an

advocacy project is brought upon from that situation. Individual and hospital level Example: youth bullying at a specific middle school and implementing a violence

education class to that school

System Advocacy “initiatives in the context of organizations/agencies or community that will influence

programs and practices to benefit children/youth. “ Community level Example: youth bullying at a specific middle school and implementing an education

plan within all schools in that region on violence and bullying

Policy Advocacy “advocacy tactics, strategies and initiatives which target changes to policies and

legislation. These advocacy initiatives seek to establish new policies, improve existing policies or challenge the development of policies that diminish resources and opportunities for vulnerable groups of people such as children and youth. Policy generally refers to 'social' policy. “

State and national level Example: lobbying for a national anti-bullying initiative to be included in the school

curriculum.

(2)

+Advocacy to QI Levels of change (per the Institute of Health

Improvement): Knowledge and education-this component is relevant to

community outreach projects. The basis is to spread knowledge and education on a certain topic.

Intent to change behavior or actual change of behavior- this is where advocacy meets QI. Advocacy involves the first and second levels of change where first, education is provided to the community and to our community leaders regarding topics of importance, AND secondly, where behaviors are changed or actions in the community are taken.

Measuring outcomes - this is the level of change where QI projects are built. The second level of either intention to change behavior or actual change in behavior is measured and published.

Advocacy differs from QI in that you are NOT measuring an outcome or behavioral change.

A rigorous QI framework can really make an advocacy project better and more effective for your community.

+What is a QI project?

QI is defined as: “The combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.” (1)

The difference between a quality improvement project and a community advocacy project lies in the outcome measure. Knowledge/Education is the first step to QI and is the final and

only step in Community Advocacy or Service projects Changing Behavior or having intent to change behavior is the

second step in QI Measuring an effect or outcome is the third step to QI

List of defined terms you may hear when building a QI project, from Vanderbilt University Medical Center. http://www.mc.vanderbilt.edu/root/vumc.php?site=qicourse&doc=

11718

+Example: How to make advocacy into a QI project?

At the Children’s Hospital of Montefiore, we identified that safe sleep of newborns in the hospital was at risk due to lack of knowledge by faculty, nursing, and families that babies, especially less than the age of 6 mo, should always lay supine per the AAP Back to Sleep campaign AND that they should be in a safe sleep environment with NO objects in their cribs. They should also never co-sleep.

Step 1: Advocacy via education and knowledge Educate all physicians, nurses, social workers, and families on the most

recent AAP recommendations for safe sleep by showing them a video

Step 2: Intent to change/ Change in Behavior Survey parents before and after watching the video for intent to change Survey hospitalized infant sleep environments 1 year into initiative

Step 3: Measuring outcomes and QI Statistically analyzing whether watching a short video and educating

faculty, staff, and families can bring awareness to safe sleep and change behavior

+Where to start?

Decide you want to get involved in QI! We are all busy, but there’s always time for projects to

be headed, whether they are large or small.

Define your passion and base it on surrounding needs Assess your community for opportunities to improve

the lives of our children Are certain AAP policies not being followed? Is unnecessary mortality occurring in this community? Is there a way you can improve quality of life for

impoverished families? Review the pillars of the 2015 FACE Poverty campaign

to asses if your project is helping our poverty stricken communities.

+Want to join an existing project?

Locate an advocacy or QI project near you! Talk to your mentors, program directors, or chiefs and ask them

about local initiatives within your hospital and program. Access your research database or gateway to identify MDs/PhDs

who are already working on something you find interesting (ask your PD how to access this as most academic centers will have one).

E-mail your fellow resident/medical students and inquire if anyone has been brainstorming on ideas.

Locate a state level project! E-mail your chapter president, vice president or executive director

for opportunities! http://www2.aap.org/member/chapters/chaplist.cfm Join the AAP SOMSRFT Advocacy Subcommittee for your district

Locate a national level project! National Google Maps Registry-coming soon! Look out for this on

our website!

+Start your own project!Improvement Model

Step 1: Assess your community for poverty needs and ways you can improve the healthcare of children in that community

Step 2: Assemble a team with a mentor and add residents or students to help define your project Include nursing, social work, and

child life to better involve all health care providers

Step 3: Define a policy and supply background information Do a literature search on your work

and identify gaps in data or previously tested methods to implement into your own project

Apply for a grant!

+The improvement modelBelow is a link to The Minnesota Department of Health QI Toolbox: a great resource for every step of planning and executing a project!

http://www.health.state.mn.us/divs/opi/qi/toolbox/#assess

These specifically highlighted are forms found to be most helpful in QI: Assess a situation

Data and Resources http://www.health.state.mn.us/divs/opi/qi/toolbox/data.html

Make a decision Aim statement

http://www.health.state.mn.us/divs/opi/qi/toolbox/aim.html Plan a project

Quality planning http://www.health.state.mn.us/divs/opi/qi/toolbox/

qualityplanning.html

+Applying for GrantsYour projects can be financially supported through an AAP funded or independent grant. Below you will find a few of the more prevalent Resident-supporting grant submission sites. Your mentors and colleagues may also helpful in finding a grant that fits your work!

Catch Grant: “CATCH supports pediatricians to collaborate within their communities so that all children have access to needed health services and a medical home.” https://www2.aap.org/catch/funding.htm

The Resident Research Grant: “.This program is designed to give pediatric residents with limited research experience an opportunity to initiate and complete research projects related to their professional interests. “ https://www2.aap.org/sections/ypn/r/research.html

Or go to this AAP website for a list of their updated grants! http://www2.aap.org/sections/ypn/r/funding_awards/

Other_AAP_Funding_Opportunities.html

+Continuing your own project!

Step 4: Plan the initiative With the support of your mentors, support staff, fellow residents and

students, initiate a plan and set a start date for your advocacy or QI initiative

Alert those around you on social media and with flyers throughout your hospital/clinic/community

Step 5: Get to WORK! This is the implementation phase This is where most of the work has already been done and your role is to be

a manager. You and your mentor must oversee every aspect of your project but it’s best to also assign minor roles to be overseen by students or other residents.

Step 6: Analyze and publish Many statistical/analytical methods exist and most trainees will use SPSS 19

or the most recent version. Check with your hospital/institution as to whether they have a research

engine to help analyze data (for example: Clinical Looking Glass is a popular NY support system to analyze hospital data)

Publishing into journals can be difficult and require multiple attempts but your mentor can help you in this phase!

+Other QI Toolkits Human Resources and Services Administration

http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/

Institute for Healthcare Improvement http://www.ihi.org/resources/Pages/Tools/default.aspx

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464920/

2. http://provincialadvocate.on.ca/main/en/what/types_advocacy.cfm

3. http://ctb.dept.ku.edu/en/table-of-contents/advocacy/advocacy-principles/overview/main

4. http://qualitysafety.bmj.com/content/16/1/2.extract

5. http://www.health.state.mn.us/divs/opi/qi/toolbox/

6. https://drive.google.com/file/d/14aW-tjEYxGvhwjRTcgHSQd_Jz35Of6zhJyQtucWiN5z0NAZMSDZT2cnBFfoy/view

7. http://www.squire-statement.org/

References & Reading Materials

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Best of luck in all of your endeavors to FACE POVERTY in 2015!

http://www2.aap.org/sections/ypn/r/advocacy/facepoverty.html

THANK YOU!