A Mixed Methods Evaluation of a Quality Improvement Model to Optimize Perinatal and Primary Care in the Community Health Setting
© 2024 Annals of Family Medicine, Inc..
PURPOSE: Many maternal deaths occur beyond the acute birth encounter. There are opportunities for improving maternal health outcomes through facilitated quality improvement efforts in community settings, particularly in the postpartum period. We used a mixed methods approach to evaluate a collaborative quality improvement (QI) model in 6 Chicago Federally Qualified Health Centers (FQHCs) that implemented workflows optimizing care continuity in the extended postpartum period for high-risk prenatal patients.
METHODS: The Quality Improvement Learning Collaborative focused on the implementation of a registry of high-risk prenatal patients to link them to primary care and was implemented in 2021; study data were collected in 2021-2022. We conducted a quantitative evaluation of FQHC-reported aggregate structure, process, and outcomes data at baseline (2020) and monthly (2021). Qualitative analysis of semistructured interviews of participating FQHC staff focused on the experience of participating in the collaborative.
RESULTS: At baseline, none of the 6 participating FQHCs had integrated workflows connecting high-risk prenatal patients to primary care; by the end of implementation of the QI intervention, such workflows had been implemented at 19 sites across all 6 FQHCs, and 54 staff were trained in using these workflows. The share of high-risk patients transitioned to primary care within 6 months of delivery significantly increased from 25% at baseline to 72% by the end of implementation. Qualitative analysis of interviews with 11 key informants revealed buy-in, intervention flexibility, and collaboration as facilitators of successful engagement, and staffing and data infrastructure as participation barriers.
CONCLUSIONS: Our findings show that a flexible and collaborative QI approach in the FQHC setting can help optimize care delivery. Future evaluations should incorporate the patient experience and patient-level data for comprehensive analysis.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
|---|---|
| Enthalten in: |
Annals of family medicine - 22(2024), 1 vom: 22. Jan., Seite 37-44 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Gemkow, Jena Wallander [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Continuity of patient care |
|---|
| Anmerkungen: |
Date Completed 24.01.2024 Date Revised 24.01.2024 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1370/afm.3059 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM367439891 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM367439891 | ||
| 003 | DE-627 | ||
| 005 | 20240124232111.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240123s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1370/afm.3059 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1269.xml |
| 035 | |a (DE-627)NLM367439891 | ||
| 035 | |a (NLM)38253508 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Gemkow, Jena Wallander |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A Mixed Methods Evaluation of a Quality Improvement Model to Optimize Perinatal and Primary Care in the Community Health Setting |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 24.01.2024 | ||
| 500 | |a Date Revised 24.01.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024 Annals of Family Medicine, Inc. | ||
| 520 | |a PURPOSE: Many maternal deaths occur beyond the acute birth encounter. There are opportunities for improving maternal health outcomes through facilitated quality improvement efforts in community settings, particularly in the postpartum period. We used a mixed methods approach to evaluate a collaborative quality improvement (QI) model in 6 Chicago Federally Qualified Health Centers (FQHCs) that implemented workflows optimizing care continuity in the extended postpartum period for high-risk prenatal patients | ||
| 520 | |a METHODS: The Quality Improvement Learning Collaborative focused on the implementation of a registry of high-risk prenatal patients to link them to primary care and was implemented in 2021; study data were collected in 2021-2022. We conducted a quantitative evaluation of FQHC-reported aggregate structure, process, and outcomes data at baseline (2020) and monthly (2021). Qualitative analysis of semistructured interviews of participating FQHC staff focused on the experience of participating in the collaborative | ||
| 520 | |a RESULTS: At baseline, none of the 6 participating FQHCs had integrated workflows connecting high-risk prenatal patients to primary care; by the end of implementation of the QI intervention, such workflows had been implemented at 19 sites across all 6 FQHCs, and 54 staff were trained in using these workflows. The share of high-risk patients transitioned to primary care within 6 months of delivery significantly increased from 25% at baseline to 72% by the end of implementation. Qualitative analysis of interviews with 11 key informants revealed buy-in, intervention flexibility, and collaboration as facilitators of successful engagement, and staffing and data infrastructure as participation barriers | ||
| 520 | |a CONCLUSIONS: Our findings show that a flexible and collaborative QI approach in the FQHC setting can help optimize care delivery. Future evaluations should incorporate the patient experience and patient-level data for comprehensive analysis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a continuity of patient care | |
| 650 | 4 | |a maternal health | |
| 650 | 4 | |a medical record linkage | |
| 650 | 4 | |a postpartum period | |
| 650 | 4 | |a pregnancy, high risk | |
| 650 | 4 | |a preventive medicine | |
| 650 | 4 | |a primary health care | |
| 650 | 4 | |a quality improvement | |
| 650 | 4 | |a registries | |
| 700 | 1 | |a Van Schyndel, Ashlee |e verfasserin |4 aut | |
| 700 | 1 | |a Odom, Renee M |e verfasserin |4 aut | |
| 700 | 1 | |a Stoller, Ananya |e verfasserin |4 aut | |
| 700 | 1 | |a Masinter, Lisa |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Ta-Yun |e verfasserin |4 aut | |
| 700 | 1 | |a Lee King, Patricia A |e verfasserin |4 aut | |
| 700 | 1 | |a Holicky, Abigail C |e verfasserin |4 aut | |
| 700 | 1 | |a Handler, Arden |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of family medicine |d 2003 |g 22(2024), 1 vom: 22. Jan., Seite 37-44 |w (DE-627)NLM147385709 |x 1544-1717 |7 nnns |
| 773 | 1 | 8 | |g volume:22 |g year:2024 |g number:1 |g day:22 |g month:01 |g pages:37-44 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1370/afm.3059 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 22 |j 2024 |e 1 |b 22 |c 01 |h 37-44 | ||