Matthew Fifolt

Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

OBJECTIVE The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one states Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. DESIGN Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. RESULTS There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. CONCLUSIONS The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

Bringing Community and Academic Scholars Together to Facilitate and Conduct Authentic Community Based Participatory Research: Project UNITED

Cultural competency, trust, and research literacy can affect the planning and implementation of sustainable community-based participatory research (CBPR). The purpose of this manuscript is to highlight: (1) the development of a CBPR pilot grant request for application; and (2) a comprehensive program supporting CBPR obesity-related grant proposals facilitated by activities designed to promote scholarly collaborations between academic researchers and the community. After a competitive application process, academic researchers and non-academic community leaders were selected to participate in activities where the final culminating project was the submission of a collaborative obesity-related CBPR grant application. Teams were comprised of a mix of academic researchers and non-academic community leaders, and each team submitted an application addressing obesity-disparities among rural predominantly African American communities in the US Deep South. Among four collaborative teams, three (75%) successfully submitted a grant application to fund an intervention addressing rural and minority obesity disparities. Among the three submitted grant applications, one was successfully funded by an internal CBPR grant, and another was funded by an institutional seed funding grant. Preliminary findings suggest that the collaborative activities were successful in developing productive scholarly relationships between researchers and community leaders. Future research will seek to understand the full-context of our findings.

Impact of elective versus required medical school research experiences on career outcomes

Many US medical schools have added a scholarly or research requirement as a potential intervention to increase the number of medical students choosing to become academic physicians and physician scientists. We designed a retrospective qualitative survey study to evaluate the impact of medical school research at the University of Alabama at Birmingham (UAB) on career choices. A survey tool was developed consisting of 74 possible questions with built-in skip patterns to customize the survey to each participant. The survey was administered using the web-based program Qualtrics to UAB School of Medicine alumni graduating between 2000 and 2014. Alumni were contacted 3 times at 2-week intervals during the year 2015, resulting in 168 completed surveys (11.5% response rate). MD/PhD graduates were excluded from the study. Most respondents completed elective research, typically for reasons relating to career advancement. 24 per cent said medical school research increased their desire for research involvement in the future, a response that positively correlated with mentorship level and publication success. Although completion of medical school research was positively correlated with current research involvement, the strongest predictor for a physician scientist career was pre-existing passion for research (p=0.008). In contrast, students motivated primarily by curricular requirement were less likely to pursue additional research opportunities. Positive medical school research experiences were associated with increased postgraduate research in our study. However, we also identified a strong relationship between current research activity and passion for research, which may predate medical school.

A Geospatial Mixed Methods Approach to Assessing Campus Safety

Background: While there is no panacea for alleviating campus safety concerns, safety experts agree that one of the key components to an effective campus security plan is monitoring the environment. Despite previous attempts to measure campus safety, quantifying perceptions of fear, safety, and risk remains a challenging issue. Since perceptions of safety and incidents of crime do not necessarily mirror one another, both were utilized in this investigation. Purpose: The purpose of this article is to describe an innovative, mixed methods approach for assessing campus safety at a large, urban campus in the southeast region of the United States. Method: A concurrent triangulation design was implemented to allow investigators the opportunity to collect qualitative and quantitative data simultaneously and integrate results in the interpretation phase. Data were collected from four distinct sources of information. Results: Student focus groups yielded data regarding perceptions of risk, and kernel density analysis was used to identify “hot spots” of campus crime incidents. Conclusion: While in many cases perceived risk and actual crime incidents were associated, incidents of hot spots of each type occurred independently with such frequency that an overall correlation of the two was not significant. Accordingly, while no significant correlation between perceived risk and crime incidents was confirmed statistically, the geospatial integration of these data suggested three types of safety conditions. Further, the combination of focus group data and spatial analyses provided a more comprehensive and, therefore, more complete understanding of the multifaceted issues related to campus safety.

Retention and attrition in a home visiting programme: looking back and moving forward

ABSTRACT Objective: The purpose of this study was to investigate retention and attrition in First Teacher, Alabama’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. Methods: Secondary data analysis was used to identify families that were most likely to leave through attrition; focus groups were conducted to discuss potential reasons for choosing to leave or stay in the programme. Results: Participants who were pregnant and under the age of 21 years were nearly eight times more likely to leave the programme than their peers. Focus group participants confirmed that it was frequently the relationship with their home visitor that influenced their decision to stay in the programme rather than leave. Conclusion: Based on social exchange theory, investigators observed that home visitors who seemed most successful at building and maintaining relationships with their clientele were women who expanded participant networks through an exchange of information and access to community resources.

Assessing Needs and Resources for the Home Visiting System in Alabama: A Mixed Methods Approach

AbstractThe purpose of this article is to describe the initial assessment for the development of a home visiting (HV) system in a state with no existing system. We outline a mixed methods process where the quantitative component was used to identify the communities that possess “at-risk” profiles, and the qualitative component explored the resources and gaps in existing HV services. We employed a mixed methods approach, using six categories of indicators from quantitative secondary data sources to identify “at-risk” profiles for Alabama’s 67 counties. A weighted score for each indicator was calculated and counties were ranked. Surveys and focus groups were conducted to further define resources and gaps of existing HV programs. The composite indicator scores identified 13 counties as having the highest level of risk. Five of these 13 communities had no HV home visitation services. Areas of focus for future HV system development include trust, communication, availability, cost, and timeliness. In this assessment related to the Alabama HV system, we used quantitative data to apply criteria to the indicators being measured and qualitative data to supplement the quantitative findings. We examined resources, gaps, program quality, and capacity of the existing HV programs in order to assist in the future development of the HV system and early childhood system. The methods presented in this paper have potential applications beyond HV programs and systems, including broader examinations of complex systems for service provision to the maternal and child health populations.

Exploring employee perceptions of Six Sigma as a change management program in higher education

ABSTRACT Change initiatives in higher education are frequently guided by an institutional change management program which provides employees with a framework and set of skills to better understand problems and facilitate change at the organisational level. In this paper, we explore employee perceptions of Six Sigma as a tool for facilitating change at one public institution of higher education in the southeast United States. Unlike previous research studies that focused on specific results of change initiatives using Six Sigma, our research team considered how individuals, trained in the implementation of Six Sigma techniques and strategies, viewed the potential of the Six Sigma model to enact and sustain change initiatives in a higher education setting. In this case study, we describe Six Sigma as a change management program in higher education based on Lewin’s Three-Phase Model of Change.

Man Versus Machine: Comparing Double Data Entry and Optical Mark Recognition for Processing CAHPS Survey Data

Objective:Historically, double data entry (DDE) has been considered the criterion standard for minimizing data entry errors. However, previous studies considered data entry alternatives through the limited lens of data accuracy. This study supplies information regarding data accuracy, operational efficiency, and cost for DDE and Optical Mark Recognition (OMR) for processing the Consumer Assessment of Healthcare Providers and Systems 5.0 survey. Methods:To assess data accuracy, we compared error rates for DDE and OMR by dividing the number of surveys that were arbitrated by the total number of surveys processed for each method. To assess operational efficiency, we tallied the cost of data entry for DDE and OMR after survey receipt. Costs were calculated on the basis of personnel, depreciation for capital equipment, and costs of noncapital equipment. Results:The cost savings attributed to this method were negated by the operational efficiency of OMR. There was a statistical significance between rates of arbitration between DDE and OMR; however, this statistical significance did not create a practical significance. Conclusions:The potential benefits of DDE in terms of data accuracy did not outweigh the operational efficiency and thereby financial savings of OMR.

Promoting Continuous Quality Improvement in the Alabama Child Health Improvement Alliance Through Q-Sort Methodology and Learning Collaboratives.

Objective: Q-sort methodology is an underutilized tool for differentiating among multiple priority measures. The authors describe steps to identify, delimit, and sort potential health measures and use selected priority measures to establish an overall agenda for continuous quality improvement (CQI) activities within learning collaboratives. Methods: Through an iterative process, the authors vetted a list of potential child and adolescent health measures. Multiple stakeholders, including payers, direct care providers, and organizational representatives sorted and prioritized measures, using Q-methodology. Results: Q-methodology provided the Alabama Child Health Improvement Alliance (ACHIA) an objective and rigorous approach to system improvement. Selected priority measures were used to design learning collaboratives. An open dialogue among stakeholders about state health priorities spurred greater organizational buy-in for ACHIA and increased its credibility as a statewide provider of learning collaboratives. Conclusions: The integrated processes of Q-sort methodology, learning collaboratives, and CQI offer a practical yet innovative way to identify and prioritize state measures for child and adolescent health and establish a learning agenda for targeted quality improvement activities.

Mississippi Medical Reserve Corps: Moving Mississippi From Emergency Planning to Response Ready.

Objective: The purpose of this study was to identify factors that might impact a Medical Reserve Corps (MRC) volunteers decision to respond to an emergency event. The 2 primary goals of this survey were to (1) establish realistic planning assumptions regarding the use of volunteers in health care emergency responses, and (2) determine whether barriers to volunteer participation could be addressed by MRC units to improve volunteer response rates. Design: An anonymous online survey instrument was made available via Qualtrics through a customized URL. For the purpose of distribution, the Mississippi State Department of Health sent an electronic message that included the survey link to all MRC volunteers who were registered with the Mississippi Responder Management System (MRMS) as of September 2014. Results: Approximately 15% of those surveyed indicated they would be available and able to deploy within 24 hours. The most common factors reported in terms of respondent decisions to deploy included risk to personal health (61.2%), length of deployment (58.8%), and the security of the deployment area (55.3%). In addition, 67% of respondents indicated that extended periods of deployment would have a negative financial impact on their lives. Respondents who have had training or previous deployment experience reported having greater knowledge of potential response roles, increased comfort in their ability to respond with the MRC, and increased confidence in responding to differing public health emergencies. Conclusions: Barriers to MRC volunteers being able to deploy should be addressed by each MRC unit. Issues such as risk to personal safety while on deployment, site security, and length of deployment should be considered by planners and those solutions communicated to MRC members during trainings. Emergency plans utilizing MRC volunteers will require significant evaluation to assess the risk of relying on an expected resource that could be severely limited during an actual emergency.