Transforming Public Health: The Quality Enterprise

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1 Transforming Public Health: The Quality Enterprise Quality & Performance Improvement In Public Health American College of Medical Quality Crystal City, Virginia February 18, 2010 Georges C. Benjamin, MD, FACP, FACEP(E), FNAPA, Hon FRSPH Executive Director American Public Health Association Protect, Prevent, Live Well

Crossing The Quality Chasm Institute of Medicine - 2001 The committee has focused on the personal health care delivery system, specifically, the provision of preventive, acute, chronic, and

2 Crossing The Quality Chasm Institute of Medicine The committee has focused on the personal health care delivery system, specifically, the provision of preventive, acute, chronic, and end-oflife health care for individuals. Although the committee recognizes the critical role of the public health system in protecting and improving the health of our communities, this issue lies beyond the purview of the present study.

3 IOM Public Health Quality The Future of Public Health Addressed quality in the context of a well structured public health agency The Future of The Public s Health in the 21 st Century Quality addressed in the context of accountability

4 Individual Versus Population Health Health care system Public health system

Consensus Statement On Quality In The Public Health System Quality in public health is the degree to which policies, programs, services, and research

5 Consensus Statement On Quality In The Public Health System Quality in public health is the degree to which policies, programs, services, and research for the population increase desired health outcomes and conditions in which the population can be healthy Public Health Quality Forum, HHS August 2008

2009 Statement on Quality in the Public Health System A fundamental function of the public health system is to safeguard and improve the quality of health in America.

6 2009 Statement on Quality in the Public Health System A fundamental function of the public health system is to safeguard and improve the quality of health in America. Compared to the medical care system which focuses primarily on delivery of care to individuals, public health focuses more on population-based activities. There must be synergy between the two sectors in order to improve the health and quality of care for all Americans. Consensus statement on quality Howard Koh, MD, MPH, Assistant Secretary for Health, HHS

7 Quality & Ten Essential Public Health Services Public health research Using tools like NPHPS, MAPP Disease registries Professional Boards, skills development Track infectious outbreaks Health fairs School children on teen pregnancy Antismoking regulations Faith, EMS & medical providers to address the flu

8 Undergraduate Education: Engaging The Public Gives basic skills to a broader public Increases understanding of public health Articulates to graduate education for progression Educated Citizen & Public Health Initiative

9 Graduate Public Health Competencies Biostatistics Epidemiology Environmental health sciences Health systems administration Social & behavioral health Informatics & Communications Community based participatory research Global health Ethics Genomics Culture competency Policy & law

meet standards essential for the conduct of such educational programs Encourage - through periodic review, consultation, research,

10 Promote quality in public health education through a continuing process of self-evaluation by the schools and programs that seek accreditation Assure the public that institutions offering graduate instruction in public health have been evaluated and judged to meet standards essential for the conduct of such educational programs Encourage - through periodic review, consultation, research, publications, and other means - improvements in the quality of education for public health Graduate training in public health is a high growth area

school or program Ensure graduates of CEPH schools and programs have

11 We no longer give anyone a badge Voluntary certification exam completed in 2008 & 2009 Requires graduate degree from CEPH accredited school or program Ensure graduates of CEPH schools and programs have mastered the knowledge & skills relevant to contemporary public health practice

12 Lifelong Skills Development: Remains An Essential Need For All Less than 20% of Leadership have formal training in public health* Only 44% of all workers have any formal academic training and less had graduate degrees** Many need training to refocus from clinical to public health *Gerzoff 1997 ** HRSA 1989

Other Tools For Improving Individual Competency Annual meetings Continuing education Certificate courses Journals & other publications APHA provides some and expanding Short courses Lifelong

13 Other Tools For Improving Individual Competency Annual meetings Continuing education Certificate courses Journals & other publications APHA provides some and expanding Short courses Lifelong learning Practice based academic tenure pathways Other discipline certifications Health education Preventive medicine Community health nursing Environmental health Emergency medical services

Public Health Accreditation Board Voluntary accreditation system in development: Several workgroups Standards & measures Research & Evaluation

14 Public Health Accreditation Board Voluntary accreditation system in development: Several workgroups Standards & measures Research & Evaluation Equivalency Goal is to improve the functioning of governmental public health departments Too many health departments w/o full capacity

15 Public Health Systems Also Use Traditional Clinical Quality Improvement Joint Commission CLIA NCQA measures Professional Certification Provider credentialing

16 Quality Public Health Systems Bring Individual & Community Value Based on science May reduce costs to government/community May reduce costs to individual Benefit may have a cost Reduce morbidity or mortality Improve quality of life Right a wrong

17 Public Health National Quality Initiative Objectives Develop an overarching quality model Integrate existing efforts in health care & public health Demonstrate the synergies that can be obtained Prepare educational and promotional material to educate practitioners and decision makers Coordinate promotional efforts of various federal & nonfederal activities to increase awareness Advance an integrated and coordinated quality movement between public health and clinical health services

18 Quality Framework Public Health

19 Ensuring Healthy People In Healthy Communities Public Health System CQI Health Care Delivery System CQI State & local health department Public health program Environmental health Public health clinic Public health worker Quality Intersection Hospital Clinic Clinical care provider Clinical program Clinical Laboratory

20 Georges C. Benjamin, MD, FACP, FACEP(E), FNAPA, Hon FRSPH Executive Director American Public Health Association Protect, Prevent, Live Well

The Healthier America Project: A Blueprint for A Healthier America

The Healthier America Project: A Blueprint for A Healthier America Jeffrey Levi, PhD Executive Director, Trust for America s Health Presented at APHA Annual Meeting November 5, 2007 Trust for America s