title: Piloting a Statewide Home Visiting Quality Improvement Learning Collaborative.
abstract: Objective To pilot test a statewide quality improvement (QI) collaborative learning network of home visiting agencies. Methods Project timeline was June 2014-May 2015. Overall objectives of this 8-month initiative were to assess the use of collaborative QI to engage local home visiting agencies and to test the use of statewide home visiting data for QI. Outcome measures were mean time from referral to first home visit, percentage of families with at least three home visits per month, mean duration of participation, and exit rate among infants <6 months. Of 110 agencies, eight sites were selected based on volume, geography, and agency leadership. Our adapted Breakthrough Series model included monthly calls with performance feedback and cross-agency learning. A statewide data system was used to generate monthly run charts. Results Mean time from referral to first home visit was 16.7 days, and 9.4% of families received ≥3 visits per month. Mean participation was 11.7 months, and the exit rate among infants <6 months old was 6.1%. Agencies tested several strategies, including parent commitment agreements, expedited contact after referral, and Facebook forums. No shift in outcome measures was observed, but agencies tracked intermediate process changes using internal site-specific data. Agencies reported positive experiences from participation including more frequent and structured staff meetings. Conclusions for Practice Within a pilot QI learning network, agencies tested and measured changes using statewide and internal data. Potential next steps are to develop and test new metrics with current pilot sites and a larger collaborative.
authors.affiliation: Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. neera.goyal@cchmc.org.|Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. neera.goyal@cchmc.org.|Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML# 7009, Cincinnati, OH, 45229, USA. neera.goyal@cchmc.org.
authors.forename: Neera K
authors.initials: NK
authors.lastname: Goyal
authors.affiliation: Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Martha G
authors.initials: MG
authors.lastname: Rome
authors.affiliation: Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Massie
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Mangeot
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML# 7009, Cincinnati, OH, 45229, USA.|Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Ammerman
authors.affiliation: The Ohio Department of Health, Ohio Help Me Grow, Columbus, OH, USA.
authors.forename: Jye
authors.initials: J
authors.lastname: Breckenridge
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML# 7009, Cincinnati, OH, 45229, USA.|Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Carole M
authors.initials: CM
authors.lastname: Lannon
mesh_terms: D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards; D006792:House Calls / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007858:Learning; D009820:Ohio; D058991:Patient Protection and Affordable Care Act / Q000458:organization & administration / Q000639:trends; D010865:Pilot Projects; D058996:Quality Improvement / Q000639:trends*; D013997:Time Factors
keywords: Breakthrough series; Engagement; Home visiting; Learning network; Quality improvement; Retention