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Story of Measurable Improvement in Public Health

Name of Health Department/Agency: Spokane Regional Health District
State: WA
Contact Name: Alexandra Hayes
Contact Information: ahayes@spokanecounty.org
Date Added: 3/28/2012
Program/Topic Area: Communicable disease reporting
QI techniques/tools:  PDCA, Unstructured Brainstorming
Description of the process and intervention: Chlamydia, gonorrhea, syphilis and initial cases of genital herpes are required by Washington Administrative Code (246-101) to be reported by medical providers within three working days of a positive diagnosis. Investigating reported cases can interrupt disease transmission, theoretically reducing incidence and prevalence over time. Delayed reporting impedes timely case investigation, encouraging sustained transmission in a community. Using a statewide disease database, a 6 month baseline reporting average of 7 days was calculated from January to June 2010 for all reporting clinics. 27 clinics reporting greater than 7 days were visited from August to December 2010 in order to improve their timeliness of STD reporting from their baseline of 14 days to at least 10 days by June 30, 2011. During in-office meetings or telephone communication, a local health jurisdiction staff member provided each clinic with their reporting statistics, reviewed the current case report form, and facilitated unstructured brainstorming sessions to identify areas of improvement related to reporting. Most clinics were unaware of their reporting trends, utilized outdated case report forms, and had difficulties locating patients for notification and/or treatment arrangements.
Result/outcome: Post intervention results indicate improvements as the overall reporting average of targeted clinics decreased to 9.5 days: 13 of 27 clinics were reporting within the county average, 10 clinics did not meet the 10 day reporting goal and 4 clinics had no reportable cases in the measurement period. Additionally, this effort achieved a 64% increase in the number of clinics reporting within the county average (42% (2010) vs. 69% (2011)). Targeted interventions with clinics can improve reporting timeliness.
Next Steps: The methodology for this quality improvement intervention has been modified to include Pareto charts as a QI tool. This tool will identify the individual clinics that comprise the bulk of substandard reporting versus conducting interventions with all clinics reporting outside the county average.

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