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APHA Scientific Session and Event Listing

Recorded presentation

Joslyn Levy, BSN, MPH¹, Rachel Sacks, MPH¹, Jeff Harris¹, Ellen Cohen, PhD¹, Chao Wu, MBA¹, Lynn D. Silver, MD, MPH², and Mary T. Bassett, MD, MPH³. (1) Clinical Systems Improvement, Chronic Disease Prevention and Control, NYC Department of Health and Mental Hygiene, 2 Lafayette St, New York, NY 10007, 212-496-2292, ecohen1@health.nyc.gov, (2) Chronic Disease Prevention and Control, NYC Department of Health and Mental Hygiene, 2 Lafayette St, New York, NY 10007, (3) Health Promotion Disease Prevention, NYC Department of Health and Mental Hygiene, 125 Worth St., New York, NY 10013

BACKGROUND: The Preventive Services Advisor (PSA) program is a pilot project of the New York City Dept. of Health and Mental Hygiene (NYC DOHMH)'s Clinical Systems Improvement program. Advisors function as improvement consultants to ambulatory care practices in three underserved areas of New York City, coaching teams in quality improvement and assisting them to achieve systemic, sustainable improvement in diabetes care and preventive services.

METHODS: Two Preventive Services Advisors (PSAs) were deployed to East/Central Harlem and South Bronx. Following site recruitment, first year activities included registry installation, training in data analysis, and production of baseline data reports to assist planned care. PSAs also trained teams in self-management support, facilitated clinical training for providers, and assisted practices to more effectively allocate limited resources. PSAs used quantitative and qualitative methods to assess program impact and success. Quantitative measurement strategy included seven (5) diabetes-related outcome measures and four (6) process measures. Qualitative methods included weekly diaries and monthly report submission.

RESULTS: In Year One, seven (7) ambulatory care practices were recruited for participation (3 Bronx, 3 Harlem, 1 Brooklyn). Qualitative data highlight the importance of senior leadership support, and chronicle the process of engaging the team, offering important lessons for expansion of program to new sites. Quantitative results will be discussed, and differences in movement among process and outcome measures will be explored.

CONCLUSIONS: Successful integration of improvement strategies requires 1) senior leadership support and 2) simple tools to guide change. Limited access to technology and technological support is a significant barrier to improvement work. Year Two of the PSA Program will include an expansion of activities, with the addition of a third PSA and a re-design of the implementation strategy that includes a greater focus on early registry installation and training. A step-by-step guide to the program will also be produced, combining tools, “how-to” guidelines, and case studies, to direct program activities in Year Two.

Learning Objectives: