8/8/2014. Today We Will Discuss. PHF Mission: We improve the public s health by strengthening the quality and performance of public health practice

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1 8/8/2014 How Can Local Boards of Health Facilitate Healthcare and Public Health Partnerships to Improve the Health of Communities? 2014 NALBOH Annual Conference Block August 14, :45-3:45 p.m. Ron Bialek, MPP President, Public Health Foundation Jack Moran, PhD Senior Quality Advisor, Public Health Foundation PHF Mission: We improve the public s health by strengthening the quality and performance of public health practice Healthy Practices Healthy People Healthy Places Today We Will Discuss How Local Boards of Health can facilitate healthcare and public health partnerships to improve the health of their communities. Describe a framework being used to build collaborative healthcare and public health partnerships to impact health issues at the community level. 1

2 8/8/2014 This Framework Supports The Governance Functions 1. Policy Development 2. Resource Stewardship 3. Legal Authority 4. Partner Engagement 5. Continuous Improvement 6. Oversight Exercise 1 What are the driving and restraining forces to developing successful partnerships/collaboration for healthcare and public health to impact the health of a community? Force Field Diagram Driving Forces Restraining Forces Fut In Col ture State: ncreased laboration Current State: Healthcare and Public Health Limited Collaboration 2

3 8/8/2014 Exercise 1 What are the driving and restraining forces to developing successful partnerships/collaboration for healthcare and public health to impact the health of a community? Background of the PHF Project IHI/CDC initiative 8 hospitals Driver diagram for hospitals Year-long collaborative PHF represented PH PHF developed PH driver diagram Implemented in 3 pilot sites Developed one for Oral Health 3

4 8/8/2014 Antibiotic Stewardship Driver Diagram Primary Drivers Timely and appropriate antibiotic utilization in the acute care setting Decreased incidence id of antibiotic-related adverse drug events (ADEs) Decreased prevalence of antibiotic resistant healthcareassociated pathogens Decreased incidence of healthcare-associated C. difficile infection Decreased pharmacy cost for antibiotics Timely and appropriate initiation of antibiotics Appropriate administration i ti and de-escalation Data monitoring, transparency, and stewardship infrastructure Availability of expertise at the point of care Secondary Drivers Promptly identify patients who require antibiotics Obtain cultures prior to starting antibiotics Do not give antibiotics with overlapping activity or combinations not supported by evidence or guidelines Determine and verify antibiotic allergies and tailor therapy accordingly Consider local antibiotic susceptibility patterns in selecting therapy Start treatment promptly Specify expected duration of therapy based on evidence and national and hospital guidelines Make antibiotics patient is receiving and start dates visible at point of care Give antibiotics at the right dose and interval Stop or de-escalate therapy promptly based on the culture and sensitivity results Reconcile and adjust antibiotics at all transitions and changes in patient s condition Monitor for toxicity reliably and adjust agent and dose promptly Develop and make available expertise in antibiotic use Ensure expertise is available at the point of care Monitor, feedback, and make visible data regarding antibiotic utilization, antibiotic resistance, ADEs, C. difficile, cost, and adherence to the organization s recommended culturing and prescribing practices PHF Convened a Panel of Public Health Experts to: Identify the primary and secondary drivers of optimal antibiotic utilization in community health settings, as well as unique and shared responsibility for drivers Identify the elements of a potential change package (i.e., a menu of intervention options) Actions at various handoff points in patient care system Potential policy changes Opportunities for health departments to improve messaging and education, and answer questions Aimed at consumers/customers Within and between community health settings Home health nurses Pharmacists Physicians 4

5 8/8/2014 INDEPENDENCE Health Department Goals of the Initiative CenterPoint Medical Center, one of eight hospitals, began collaborating with the Health Department Reduce the spread of antibiotic resistance Preserve antibiotics for the future Decrease demand by the public for inappropriate use Provide opportunities for collaboration between public health and healthcare Improve patient care Educate Antibiotics not always the answer. NO ANTIBIOTIC PLEASE 5

6 8/8/2014 Connecticut - Goals of the Initiative To strengthen or build partnerships between public health (DPH) and the medical provider community across the spectrum of healthcare To build public health capacity and action in HAI prevention expand from our surveillance role To share and complement public health s strengths with medicine s strengths To build the methods and tools of Quality Improvement into public health as well as medical care To prevent C. difficile and MDROs (MRSA) CAUSES of Increased CDI in LTC Facilities Family/Visitors Documentation Staff Home remedies/ food Denial Failure to follow Precautions Education Lack of Hand Hygiene Language Barrier Sick Visitors Requesting unnecessary antibiotics No Signs No lab results Lack of or inaccurate documentation or from other facilities Lack of follow through No documentation of medical conditions relating to CDI Inaccurate medical history Failure to report Not reporting/responding to Not reading signs symptoms Lack of hand washing/ alcohol Not using PPE properly sanitizer only Lack of environmental cleaning Education with bleach High staff turnover & different staff on Improper stool collection/ different units- cut corners handling Improper disposal/ cross contamination of soiled linens Language Barrier Non-compliance Not cleaning equipment Non compliant treatment Decrease in hand hygiene/ glove use Hand Hygiene/ personal hygiene Inappropriate antibiotic use Non compliant isolation Lack of education Lack of education/ knowledge Frail, cognitive impaired, Lack of use of lab & wandering population coats Lack of testing No policy Increased CDI In LTC No private rooms/ improper room Facilities placement Lack of staffing Community Issues Lack of PPE Building Design Lack of signage Lack of education Lack of communication Lack of supplies Turnover rates of residents Inadequate patient screening Lack of administrator support Poor surveillance practices Physician Patient No commode liner Facility No timely lab results/ lack od specimen pickup Maine - Goals of the Initiative Augusta hospital was first in Maine to report deaths from Clostridium difficile infection (CDI) from virulent strain NAP1 In past 2 years, four of five area nursing homes had reported CDI outbreaks To reduce CDI, this pilot focused on: 1) reducing transmission 2) reducing acquisition of CDI This pilot project used a regional multi-facility cluster approach It involved a hospital, five area nursing homes, and outpatient physicians/medical directors in Augusta The outcome measure is a decrease in the CDI rate for each facility (# CDI/10,000 patient days) and a reduction of CDI outbreaks 6

7 8/8/2014 Driver Diagram Overview Driver diagrams can be used to plan improvement project activities. They provide a way of systematically laying out aspects of an improvement project so they can be discussed and agreed on. A driver diagram organizes information on proposed p activities so the relationships between the aim of the improvement project and the changes to be tested and implemented are made clear. A driver diagram has three columns - Outcome, Primary Drivers and Secondary Drivers. Exercise 2: How Can Local Boards of Health Use A Population Heath Driver Diagram To Impact Population Health Issues? 7

8 8/8/2014 Public Health Foundation Strengthening the Quality and Performance of Public Health Practice TECHNICALASSISTANCE & TRAINING Performance management, quality improvement, and workforce development services Customized onsite workshops and retreats Strategic planning, change facilitation, accreditation preparation LEARNING MANAGEMENT NETWORK The nation s premier learning management network for professionals helping to protect the public s health over 760,000 registered learners and 29,000 courses Tools, case stories, articles, and papers ACADEMIC PRACTICE LINKAGES Furthering academic/practice collaboration to assure a well-trained, competent workforce and LEARNING RESOURCE CENTER strong, evidence-based public health infrastructure Where public health, health care, and allied Council on Linkages Between Academia and health professionals find high quality training Public Health Practice materials at an affordable price Core Competencies for Public Health Comprehensive selection of publications Professionals Many consumer-oriented health education Academic Health Department Learning publications Community Stories and webinars on using the Guide to Community Preventive Services bookstore.phf.org 8

9 ANTIBIOTIC STEWARDSHIP PROGRAM A Public Health and Healthcare Collaboraon The Public Health Foundaon (PHF) is leading an effort to develop and pilot a driver diagram for public health and healthcare to work together to reduce anbioc resistant infecons. Collaboraon across public health and healthcare is necessary to achieve opmal results in this community health challenge. This program grew out of PHF s partnership with the Centers for Disease Control and Prevenon (CDC) and the Instute for Healthcare Improvement (IHI) to develop a framework of key drivers for reducing inappropriate anbioc ulizaon in hospitals. Public Health Anbioc Stewardship Driver Diagram Some drivers of opmal anbioc use fall outside the direct control of public health (e.g., use of anbiocs in livestock food supplies), while others sit squarely within the focus of the public health system. In 2012, PHF led development of a driver diagram illustrang public health s role in promong opmal anbioc use. Based on input from an interdisciplinary team of experts in quality improvement (QI), infecon control, epidemiology, and public health leadership, the driver diagram outlines primary and secondary drivers of opmal anbioc use to help reduce the spread of anbioc resistant infecons. This packet includes: The Public Health Anbioc Stewardship Driver Diagram Case stories from state and local pilot sites 2013 Pilot Acvies PHF is facilitang pilot acvies that use the Public Health Anbioc Stewardship Driver Diagram in collaborave efforts between the public health and healthcare systems. Current pilot sites include: Independence Health Department (Independence, Missouri) Conneccut Department of Public Health Maine Center for Disease Control and Prevenon Success factors in this work included: Use of the Public Health Anbioc Stewardship Driver Diagram. A driver diagram illustrates primary and secondary drivers of a health challenge; each pilot site used the driver diagram as a reference for selecng points of intervenon. Accomplishments of this Work Use of QI Tools and Methods. The work of all three pilots incorporated QI to ensure that improvement strategies were effecvely targeted and adopted. Collaboraon Between Public Health and Healthcare. Each health department funconed as a resource to its healthcare partners, helping them to meet regulatory requirements and address fiscal needs, convening and facilitang producve discussions, and communicang about joint acvies. Details on the pilot programs are provided in the aached case stories. PHF plans to expand the reach of this program by launching addional pilot work around the country, and is developing an intervenon guide to accompany the Public Health Anbioc Stewardship Driver Diagram. mkirshy@phf.org More adopon of best pracces Expanded partnerships and commitment to connue them Educaon on appropriate anbioc use for physicians, pharmacists, nurses, and others

10 Efforts to promote optimal antibiotic use should employ both the public health and healthcare systems. While some drivers of antibiotic resistance fall outside the direct control of public health (e.g., use of antibiotics in livestock food supplies), others highlighted here sit squarely within the focus of public health organizations. This diagram outlines primary and secondary drivers of optimal antibiotic use. It compliments a driver diagram being piloted in eight hospitals by the Institute for Healthcare Improvement (IHI). PHF is actively seeking comments on the driver diagram from healthcare and public health organizations already engaged in efforts to address antibiotic resistance. AIM Promote Optimal Antibiotic Use Goals Preserve antibiotics for the future Decrease demand by the public for inappropriate use Reduce the spread of antibiotic resistance Decrease adverse events associated with inappropriate antibiotic use Decrease costs associated with antibiotic use Public Health s Role in Antibiotic Stewardship Driver Diagram PRIMARY DRIVERS Appropriate Use of Antibiotics Data Monitoring, Transparency, and Stewardship Infrastructure Knowledge, Awareness, and Perception of the Importance of Appropriate Antibiotic Use SECONDARY DRIVERS Partnerships, Communication, Reimbursement, & Stewardship Provide information on which antibiotics are most effective within your community at a certain point in time Provide information on which diseases are prevalent within a community at a point in time Develop policies that create incentives for appropriate antibiotic use Policy, Communication, Education, Incentives, Partnerships, and Facilitation Develop appropriate policies for daycare, work, and school on appropriate attendance during illness (staying away and going back) Surveillance, Analysis, Feedback, Triage, & Leveraging Resources Leverage existing infrastructure to promote better antibiotic use Use local resistance data to inform antibiotic choice Explore ways to gather use and prescribing data Share Evidence Broadly, Provide Education, Create Urgency, & Empower Alternative Action Develop intervention plans for segmented target audiences (consumers, providers, insurers, policy makers, etc.) Change attitudes and perceptions about what constitutes appropriate antibiotic use Educate health departments and public health professionals Incorporate antibiotic usage into community assessment and improvement plans This model was developed collaboratively by public health professionals with expertise in antimicrobial resistance and quality improvement. This work was funded through a collaborative agreement between the Public Health Foundation and the U.S. Centers for Disease Control and Prevention. March 2013 Version 1.1

11 Healthy Practices. Healthy People. Healthy Places. Story From the Field Local Anbioc Stewardship Program: At the Nexus of Public Health and Healthcare In 2012, the Independence Health Department (Independence, Missouri) idenfied an increase in anbioc resistant infecons in the community that warranted improved policies addressing anbioc use in schools and childcare facilies. The department began parcipang in an Anbioc Stewardship Program organized by the Public Health Foundaon (PHF). Promong opmal anbioc use through both the public health and healthcare systems, the Public Health Anbioc Stewardship Driver Diagram provided the backbone for this pilot iniave. Because of their excellent working relaonship with Centerpoint Medical Center, the health department collaborated with the hospital to address anbioc resistant infecons; it was a natural next step in their growing partnership. The public health team in Independence kept the driver diagram nearby to guide inial brainstorming as they created a series of logic models to pinpoint opportunies for intervenon. Independence devised a mul pronged approach which focused on two points of intervenon: healthcare providers and childcare providers. PHF s technical assistance enabled the use of quality improvement in selecng intervenons to promote opmal anbioc use as outlined in the driver diagram. Collaborang with Healthcare Providers The Independence team designed resources that can be easily integrated into praconers work with the goals of increasing muldisciplinary communicaon, cooperaon, and awareness with minimal effort by the providers themselves. These efforts include: An interdisciplinary reporng system for alerts and advisories related to anbioc resistant disease incidence and news. Quick reference pocket cards to guide physicians about the safest and most effecve treatment for common diagnoses at the moment they write an anbioc prescripon, if indicated. An educaonal 3x5 card developed and distributed as part of the Centers for Disease Control and Prevenon (CDC) Get Smart campaign for pharmacists to give paents who receive anbiocs; the headline You ve just had a prescripon filled, here s what you need to know signals the importance of safe anbioc use. An educaonal prescripon pad developed and distributed as part of the CDC Get Smart iniave for providers to give paents who do not receive anbiocs; this prescripon pad provides informaon on diagnosis, general instrucons, and medicaons that may ease symptoms. Connuing Medical Educaon programs for professionals in both healthcare and public health provided in coordinaon with Centerpoint Medical Center. A grant applicaon to the Healthcare Foundaon of Kansas City to secure funding for coordinaon and expansion of various elements of the Anbioc Stewardship Program.

12 Story From the Field Collaborang with Childcare Providers The Independence team created clear standards that childcare providers can implement when working with families in the community. Using public recognion as an incenve and thoughully incorporang accessible language for instrucons and explanaons, they are iniang the following efforts: The Missouri Department of Health and Senior Services created the Prevenon and Control of Communicable Diseases: Guide for School Administrators, Nurses, Teachers, Child Care Providers, and Parents or Guardians which includes resources about everything from a cover your cough campaign to hand washing reminders, to lessons about the misuse of anbiocs and anbioc resistant disease. Locally, the Communicable Disease staff in the Independence Health Department promotes and shares this excellent resource with schools and childcare providers. A new Start Right Rang System to publicly recognize childcare centers that cooperate with standards as well as those taking extra steps to ensure that safe anbioc use pracces and policies are followed. Basic educaon for childcare providers and parents about the risk of anbioc resistant infecons with the goal of reducing inappropriate anbioc use and overall reducon in the need for anbiocs. Using the Public Health Anbioc Stewardship Driver Diagram as a guide, the Independence Health Department is off to a strong start in raising awareness of anbioc resistant infecons and how to keep them at bay in the community. In the coming months, they plan to further develop these programs and expand the collaboraon between public health and healthcare systems so that they are sharing more informaon about diagnoses of anbioc resistant infecons and the rate of anbioc prescripon use. In 2014, they will survey physicians and child care centers to measure the impact of these iniaves, and work with pharmacies to assess whether there has been a decrease in prescripons for anbiocs. Success Factors Prior relaonship between healthcare organizaon and public health department Idenfy recepve points of intervenon for implementaon Related Resources Public Health Anbioc Stewardship Driver Diagram The driver diagram used by the Independence Health Department to guide their strategies for this program. PHF provides customized training, facilitaon, and workforce development services to public health agencies and other groups that protect the public s health. To inquire about technical assistance, please visit PHF at or call Acknowledgements Special thanks to Deresa Hampton and Shawnna Jackson from the Independence Health Department for providing content for this story. Funding for this story was provided by the Centers for Disease Control and Prevenon under Cooperave Agreement Number 5U38HM The contents of this document are solely the responsibility of PHF and do not represent the official views of CDC. October 2013

13 Healthy Practices. Healthy People. Healthy Places. Story From the Field Tackling Healthcare Associated Infecons through QI When the staff in the Conneccut Department of Public Health (CDPH) recognized an opportunity to address the significant challenges posed by Clostridium difficile infecon (CDI), they decided to address the problem using a collaborave approach at regional long term care (LTC) facilies. Because residents at LTC facilies oen have compromised immune systems due to chronic health issues, they have increased vulnerability to healthcare associated infecons (HAI), such as CDI. In response to growing CDI prevalence and using the Public Health Anbioc Stewardship Driver Diagram as a reference, CDPH proposed the creaon of an interdisciplinary CDI Prevenon Collaborave in LTC facilies to reduce HAI among nursing home residents. Figure 1. Causes of Increased CDI in LTC Facilies CDPH s push to incorporate quality improvement (QI) into its work led them to pursue opportunies to support QI acvies, including those related to CDI prevenon. In 2012, CDPH received the Public Health Foundaon s (PHF) Future of Public Health Award in recognion of its promise to generate measurable outcomes benefing the future of public health through applied QI. PHF trained CDPH staff to incorporate QI methods into CDI Prevenon Collaborave efforts, and CDPH became part of PHF s Anbioc Stewardship Program. Nurses from 25 LTC facilies in Conneccut received training in QI and best pracces in reducing CDI during the project kickoff session. Following training, CDPH used monthly tracking and reporng calls among parcipang LTCs to monitor the effecveness of integrang best pracces into CDI prevenon protocols at the facilies. In addion to these calls, CDPH asked Qualidigm, a local quality improvement partner, to preform site visits at parcipang facilies. Interdisciplinary Integraon To improve interdisciplinary CDI prevenon protocols, CDPH used QI tools and models such as Plan Do Check Act (PDCA) cycle, flow charts, and cause and effect diagrams. The team also developed a best pracces checklist to simplify implementaon of best pracce protocols in the future and connued use of QI methods. LTC facilies worked with state surveyors to develop new signage to nofy staff and visitors of CDI cases and proper prevenon pracces. As implementaon proceeded, staff reported improved communicaon and morale at the LTC facilies.

14 Story From the Field Interdisciplinary Integraon (connued) LTC facilies adopted process measures to track implementaon success, including: Observaons of staff compliance with new precauon signs about contact with CDI paents. Tracking the rate and consistency with which residents with infecons and their family members receive documentaon and educaonal materials about CDI. Tracking alignment of provider prescribing pracces with best pracces in CDI prevenon and anbioc stewardship. CDPH is also tracking incidence of CDI to determine the impact of these efforts on infecon rates in the state s LTC facilies and will start a campaign to encourage facilies to enroll in the Naonal Healthcare Systems Network. Keys to Success The LTC Prevenon Collaborave benefited from the support and endorsement of CDPH senior leadership and external partners, including two LTC Associaons, the Conneccut Hospital Associaon, LTC Nursing Associaon, and the Center for Medicare and Medicaid Services Quality Improvement Organizaon. These partners facilitated LTC recruitment for the program, emphasizing that it was a well organized, collaborave iniave. CDPH has expanded the LTC Prevenon Collaborave statewide and plans on increasing the number of facilies parcipang in the collaborave. QI Tools Used An AIM statement restricts the problem statement to discrete issue on which the improvement team will focus. CDPH used an AIM statement to guide their efforts to analyze exisng processes and implement process improvement using QI tools. A flowchart visually depicts all the steps and decision points in a process from start to finish. Program parcipants used flowcharts to document processes which helped in analyzing both current and future problems. A cause and effect diagram displays mulple potenal causes for a problem. CDPH used a cause and effect diagram to categorize ideas into themes for analysis and to show current successes and strengths, which helped to empower parcipants (see Figure 1). Related Resources CDI Resources for Health Departments hp:// Future of Public Health Awards hp:// Centers for Disease Control and Prevenon (CDC) Report, Anbioc Resistance Threats, 2013 hp:// report 2013/ About the Future of Public Health Awards PHF s 2012 Future of Public Health Award recognized promising proposed iniaves in public health that ulize QI to influence posive outcomes in CDC s Winnable Bales. Award winners received onsite technical assistance to build capacity in QI and advance programs to improve outcomes. To learn more about the program and other PHF services, visit hp:// Acknowledgements Special thanks to Alessandra Litro, Health Program Assistant II and Richard Melchreit, HAI Program Coordinator at CDPH for providing content for this story. Funding for this story was provided by CDC under Cooperave Agreement Number 5U38HM The contents of this document are solely the responsibility of PHF and do not represent the official views of CDC. October 2013

15 New Strategies to Tackle Anbioc Resistant Disease Healthy Practices. Healthy People. Healthy Places. Story From the Field Maine CDC: Working with Healthcare to Address Anbioc Resistant Disease In 2010, Maine Center for Disease Control and Prevenon (Maine CDC) began an anbioc stewardship effort in order to reduce the rising rates of mulple drug resistant organisms in hospitals. Maine CDC held a two day cerficaon program for anbioc stewardship that was aended by a pharmacist and champion physician from every acute care hospital. Maine CDC also collaborated with the University of New England to study regional differences in anbiograms. During this me, Maine CDC began statewide educaon of nursing facilies regarding infecon prevenon and control pracces. In 2011 to 2012, four nursing homes in the Augusta Waterville area reported outbreaks of Clostridium difficile infecon (CDI) an infecon that is largely the result of taking anbiocs. Maine CDC then joined the Public Health Foundaon s (PHF) Anbioc Stewardship Program, which fosters collaboraon between public health and healthcare partners to opmize anbioc use and reduce anbioc resistant disease. Based on Maine s surveillance data, Maine CDC concentrated its intervenons on long term care facilies (LTCs) and hot spots within LTCs with the highest rates of CDI. Maine CDC idenfied the Augusta Waterville area and worked collaboravely with the Northeast Healthcare Quality Foundaon (a Quality Improvement Organizaon) to reduce CDI rates in this region. I am thoroughly convinced that if we do not address anbioc stewardship and the appropriate use of anbiocs, we will connue to see increasing resistance and the problems of resistant infecons will grow dramacally over the ensuing years. Stephen D. Sears, MD, MPH State Epidemiologist, Maine CDC New Strategies to Tackle Anbioc Resistant Disease Using PHF s Public Health Anbioc Stewardship Driver Diagram, Maine CDC idenfied drivers for prevenng and treang CDI at Augusta LTCs, which had many of the state s highest CDI rates. Maine CDC then developed intervenons to strengthen these drivers within each facility, including: Establishing standardized protocols for containing CDI outbreaks Establishing a universal protocol for nursing facilies regarding prevenon of C. difficile transmission Training employees at LTCs to use tracer kits to improve environmental cleaning Training employees on hand hygiene compliance and observaon Holding monthly educaonal meengs to discuss CDI prevenon and treatment protocols Collecng facility specific data to track CDI trends within and across LTCs Educang physicians on best pracces for anbioc use for outpaents, both children and adults With guidance from PHF s Senior Quality Advisor Jack Moran, Maine CDC created a Fishbone (or Cause and Effect) Diagram to idenfy barriers to prevenng transmission and acquision of anbioc resistant disease within LTCs. Then Maine CDC worked with each LTC to pinpoint and correct specific barriers. The LTC infecon prevenonists found working closely with Maine CDC and the Northeast Healthcare Quality Improvement Organizaon (QIO) was essenal to successfully adopng the new protocols. Maine CDC was dedicated to building collaborave relaonships with the LTCs to achieve their common goals. Throughout this process, the LTCs viewed Maine CDC as a facilitator and guide in infecon prevenon not merely a regulatory enforcer.

16 Story From the Field Collaborang with Healthcare Partners Because this challenge exists at the crossroads of public health and healthcare, Maine CDC engages healthcare partners to opmize the effecveness efforts to reduce CDI at LTCs. In order to reduce anbioc resistant infecons at LTCs, the health department has formed partnerships with the following organizaons: The Northeast Health Care Quality Foundaon, a regional QIO experienced at addressing anbioc resistant infecons in healthcare facilies The University of New England School of Pharmacy (UNESP), which analyzed Maine CDC s data about rates of anbioc resistance by organism and by region The Maine Medical Associaon/Maine Independent Clinical Informaon Service (MICIS), which distributed United States Centers for Disease Control and Prevenon (CDC) Get Smart materials and a Maine CDC physician pocket reference for prescribing anbiocs and provided onsite educaon to LTC medical directors and other physicians to improve prescribing pracces LTCs in the cies of Augusta and Waterville, which effecvely adopted new strategies and intervenons to reduce CDI Expanding the Reach of Collaboraon Maine CDC is monitoring CDI trends in LTCs, and will release a report on infecon rates in July To expand the reach of its pilot acvies, Maine CDC will partner with the Maine Medical Associaon to educate 400 addional outpaent physicians and LTC directors about pracces to reduce the spread of CDI. Maine CDC also hopes to bring this collaborave approach to addressing anbioc resistant infecons to many more LTCs in Maine. To do this, Maine CDC is partnering with the Maine Healthcare Associaon, a provider organizaon serving nursing facilies. The Maine Healthcare Associaon will host two webinars in which Maine CDC and the QIO will share four tools developed during the pilot with other LTC facilies throughout Maine. Related Links and Resources Public Health Anbioc Stewardship Driver Diagram The driver diagram referenced by Maine CDC used to idenfy drivers for prevenng CDI. PHF provides customized training, facilitaon, and workforce development services to public health agencies and other organizaons that protect the public s health. To inquire about technical assistance, please visit PHF at TechnicalAssistance or call PHF s Anbioc Stewardship Program Informaon about PHF s Anbioc Stewardship Program, which helped support efforts by Maine CDC to prevent CDI. Acknowledgements Special thanks to Peggy Shore and Stephen Sears at Maine Center for Disease Control and Prevenon for providing content for this story. Funding for this story was provided by the Centers for Disease Control and Prevenon under Cooperave Agreement Number 5U38HM The contents of this document are solely the responsibility of PHF and do not represent the official views of CDC. February 2014

17 Using the Population Health Driver Diagram to Increase Use of Oral Health Care To create opportunities for public health and health care collaboration to improve community health, the Public Health Foundation (PHF) has created a population health driver diagram framework. Grounded in the belief that public health and health care are more effective when their efforts are aligned than when they work separately, this approach can be used to tackle challenges at the crossroads of these two sectors. A population health driver diagram can be used to help focus and align a community s efforts to make progress on a defined community health challenge. The driver diagram consists of a general AIM statement, goals of the AIM statement, and primary and secondary drivers that specify actions that can be taken to help achieve the desired goals for improved population health. Population health driver diagrams serve as a starting point and framework for discussion, and offer flexibility for identifying and addressing unique community characteristics and needs. They also help to create an atmosphere of collaboration and cooperation by enabling each participant in these discussions to identify roles already being played by their organization and others in the community, and determine additional action that can be taken individually and collectively to positively impact the particular community health challenge. The Population Health Driver Diagram to Increase Use of Oral Health Care includes an AIM statement, goals, and primary and secondary drivers. When this driver diagram is being used by a community, changes may be desirable to any component of the driver diagram. For example, there may be other drivers that the community identifies and decides to address that are not specified in the driver diagram, or the AIM statement and goals may need to be refined so that they better relate to the community. It also is important to note that while the driver diagram articulates many drivers, choosing a subset of drivers to address may help focus community efforts and achieve desired results. Depending on the progress a community is making, additional drivers may be addressed over time, existing drivers may be refined, and other drivers may be added. This population health driver diagram was developed by PHF with funding from the Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services. We encourage you to use this driver diagram to increase use of oral health care in your community. We also encourage you to and provide us with your feedback. Please contact Micaela Kirshy, mkirshy@phf.org, (202) , with questions and feedback. 6/2014

18 Population Health Driver Diagram to Increase Use of Oral Health Care AIM Increase the proportion of children, adolescents, and adults who use oral health care, education, prevention, and treatment Goals Increase affordability of oral health care for consumers Increase availability and use of oral health care based on evidence and disease management Prevent diseases of the mouth Achieve oral health equity PRIMARY DRIVERS Education about Importance and Urgency Broad Access to Preventive Care and Treatment Infrastructure and Capacity Data Monitoring and Risk Assessment SECONDARY DRIVERS Patient, Population, Provider Knowledge Increase knowledge of comorbidities Outreach to high-risk and underserved groups Educate about available insurance coverage for oral health care Educate dental and non-dental health professionals about oral health as a population health issue Engage families and caregivers regarding importance of oral health Diverse Care Settings, Affordability Provide oral health care in non-traditional settings Expand use of and insurance coverage for services provided by dental hygienists and other non-dds/dmd providers, especially for schoolbased dental sealants Increase diversity of professionals providing oral health care Increase and strengthen publicly funded dental coverage Increase proportion of primary care and public health settings that include an integrated oral health program Professional Education, Partnerships, Planning Align provider incentives to use the prevention and disease management model Educate dental students in clinic settings with allied-health professionals Educate primary care providers and team members to provide basic oral health risk assessments, prevention, and education Increase stakeholder engagement and skill building to ensure capacity and improve oral health outcomes Require all dental professional education programs to include community service and social responsibility curricula Surveillance, Analysis, Feedback Identify high-risk populations with comorbidities Identify risk and protective factors at the individual, family, school, and community levels Identify policies that affect oral health Track community oral health status 6/2014 This work was funded by the Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services