Model to improve the delivery of clinical preventive services (CPS) among New Jersey health plans

2.50
Hdl Handle:
http://hdl.handle.net/10755/163581
Category:
Abstract
Type:
Presentation
Title:
Model to improve the delivery of clinical preventive services (CPS) among New Jersey health plans
Author(s):
Ayres, Cynthia; Griffith, Hurdis M.
Author Details:
Cynthia Ayres, Rutgers University, College of Nursing, Plainsboro, New Jersey, USA, email: ayres@nightingale.rutgers.edu; Hurdis M. Griffith
Abstract:
Purpose: The delivery rates of specific Clinical Preventive Services (CPS) in NJ's Health Plans (HP) are below state and national goals. Lack of a consistent approach to the delivery of clinical preventive practices could prove to be a barrier to the implementation of these services. Clinicians contract with a number of HPs and are confronted with many sets of conflicting guidelines for preventive care. This situation exists despite two underutilized resources. These include the evidence-based guidelines by the US Preventive Services Task Force (USPSTF) which provide a scientific basis for consistency in the delivery of CPS and, the Put Prevention Into Practice (PPIP) program developed by the US Public Health Services to facilitate implementation of these guidelines by clinicians. Therefore, the purpose of this project is to improve the delivery of CPS through the use of a consistent set of CPS guidelines to be used by contracted health plan clinicians across the State. Specific Aims: The specific aim of this study was the development of consensus among the Medical Directors regarding CPS guidelines to be used by their contracted HP clinicians. Framework: The concept of consensus was used as the framework in guiding this study. Consensus is necessary when people seek to associate together, act in concert and make decisions. It is the point of maximum agreement so that action can follow. Consensus represents a win-win solution for both group members and the organizations they serve (Rees, 1998). The Medical Directors of the NJ Health Plans are in a highly competitive situation in which they are vying for plan members. Therefore, the process of consensus would be beneficial to all parties involved. Methods: The sample consisted of nine Medical Directors of the largest HPs in NJ; HPs that cover 2,293,491 of the 2,358,474 NJ residents enrolled in HMOs. The Delphi Method was used to reach consensus by the Medical Directors on the CPS guidelines. The first survey collected baseline information on each HP's level of agreement or disagreement with the CPS guidelines. A scientific expert discussed these guidelines and a second survey, providing group's ratings to the listed CPS guidelines, was given. Delphi Rounds addressing the priority level of each positive recommendation was then facilitated. Results: Data from the first Delphi Round demonstrated 14 areas of disagreement (< 85% agreement among HPs); seven areas of disagreement (< 85% agreement) in the second Delphi Round. Consensus on these seven areas of disagreement was reached among HPs at a Coalition Meeting that followed. Positively stated recommendations that the HP Medical Directors agreed on were then rank ordered to identify priority for implementation. The eighteen CPS receiving the highest rankings were selected for inclusion on a laminated sheet for easy clinician reference. These included: Cervical Cancer, Breast Cancer, Childhood Immunizations, Adult Immunizations, Hypertension, Depression, Tobacco Use, Postmenopausal Hormone Prophylaxis, Chlamydial Infection, Diabetes Mellitus, High Cholesterol/Other Lipid Abnormalities, Colorectal Cancer, Elevated Lead Levels in Childhood and Pregnancy, Neural Tube Defects, Physical Activity/Healthy Diet, Motor Vehicle Injuries, Substance Abuse, and Unintended Pregnancy. Conclusions: These activities provided the groundwork necessary to work with clinicians directly responsible for implementing preventive services. Focus groups were conducted to inform clinicians about the decisions made by the Medical Directors, determine their level of agreement with these decisions, identify facilitators and barriers to clinician implementation of the agreed upon guidelines, and identify a consistent set of guideline implementation tools. Knowledge gained from these activities will be disseminated to clinicians through statewide conferences and publications. Conferences will be developed based on the data from activities with the HP Medical Directors and the focus groups with contracted HP clinicians. The purpose of these conferences will be to develop and disseminate a statewide model for collaboration of Health Plans to improve the delivery of clinical preventive services among their participating clinician practice. Implications for Nursing Practice: Conflicting and confusing guidelines are detrimental to the delivery of preventive care and create a major system barrier against the improvement of these services. This study uses a systematic approach to reach consensus among HP Medical Directors on CPS guidelines and implementation tools. This approach will provide a template for HPs nationwide to come to consensus on guidelines and implementation tools that support clinicians in the delivery of CPS. The momentum is increasing in support of evidence based practice that will improve the quality of patient care and decrease the morbidity and mortality of preventable diseases. Due to the nature of the nurse-client relationship, opportunity exists for nurses to provide these preventive care practices. However, nurses need time and organizational support to access and synthesize the best evidence for making changes in practice. Great opportunity exists for nurses to work collaboratively with HPs in promoting the delivery of these preventive services.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleModel to improve the delivery of clinical preventive services (CPS) among New Jersey health plansen_GB
dc.contributor.authorAyres, Cynthiaen_US
dc.contributor.authorGriffith, Hurdis M.en_US
dc.author.detailsCynthia Ayres, Rutgers University, College of Nursing, Plainsboro, New Jersey, USA, email: ayres@nightingale.rutgers.edu; Hurdis M. Griffithen_US
dc.identifier.urihttp://hdl.handle.net/10755/163581-
dc.description.abstractPurpose: The delivery rates of specific Clinical Preventive Services (CPS) in NJ's Health Plans (HP) are below state and national goals. Lack of a consistent approach to the delivery of clinical preventive practices could prove to be a barrier to the implementation of these services. Clinicians contract with a number of HPs and are confronted with many sets of conflicting guidelines for preventive care. This situation exists despite two underutilized resources. These include the evidence-based guidelines by the US Preventive Services Task Force (USPSTF) which provide a scientific basis for consistency in the delivery of CPS and, the Put Prevention Into Practice (PPIP) program developed by the US Public Health Services to facilitate implementation of these guidelines by clinicians. Therefore, the purpose of this project is to improve the delivery of CPS through the use of a consistent set of CPS guidelines to be used by contracted health plan clinicians across the State. Specific Aims: The specific aim of this study was the development of consensus among the Medical Directors regarding CPS guidelines to be used by their contracted HP clinicians. Framework: The concept of consensus was used as the framework in guiding this study. Consensus is necessary when people seek to associate together, act in concert and make decisions. It is the point of maximum agreement so that action can follow. Consensus represents a win-win solution for both group members and the organizations they serve (Rees, 1998). The Medical Directors of the NJ Health Plans are in a highly competitive situation in which they are vying for plan members. Therefore, the process of consensus would be beneficial to all parties involved. Methods: The sample consisted of nine Medical Directors of the largest HPs in NJ; HPs that cover 2,293,491 of the 2,358,474 NJ residents enrolled in HMOs. The Delphi Method was used to reach consensus by the Medical Directors on the CPS guidelines. The first survey collected baseline information on each HP's level of agreement or disagreement with the CPS guidelines. A scientific expert discussed these guidelines and a second survey, providing group's ratings to the listed CPS guidelines, was given. Delphi Rounds addressing the priority level of each positive recommendation was then facilitated. Results: Data from the first Delphi Round demonstrated 14 areas of disagreement (< 85% agreement among HPs); seven areas of disagreement (< 85% agreement) in the second Delphi Round. Consensus on these seven areas of disagreement was reached among HPs at a Coalition Meeting that followed. Positively stated recommendations that the HP Medical Directors agreed on were then rank ordered to identify priority for implementation. The eighteen CPS receiving the highest rankings were selected for inclusion on a laminated sheet for easy clinician reference. These included: Cervical Cancer, Breast Cancer, Childhood Immunizations, Adult Immunizations, Hypertension, Depression, Tobacco Use, Postmenopausal Hormone Prophylaxis, Chlamydial Infection, Diabetes Mellitus, High Cholesterol/Other Lipid Abnormalities, Colorectal Cancer, Elevated Lead Levels in Childhood and Pregnancy, Neural Tube Defects, Physical Activity/Healthy Diet, Motor Vehicle Injuries, Substance Abuse, and Unintended Pregnancy. Conclusions: These activities provided the groundwork necessary to work with clinicians directly responsible for implementing preventive services. Focus groups were conducted to inform clinicians about the decisions made by the Medical Directors, determine their level of agreement with these decisions, identify facilitators and barriers to clinician implementation of the agreed upon guidelines, and identify a consistent set of guideline implementation tools. Knowledge gained from these activities will be disseminated to clinicians through statewide conferences and publications. Conferences will be developed based on the data from activities with the HP Medical Directors and the focus groups with contracted HP clinicians. The purpose of these conferences will be to develop and disseminate a statewide model for collaboration of Health Plans to improve the delivery of clinical preventive services among their participating clinician practice. Implications for Nursing Practice: Conflicting and confusing guidelines are detrimental to the delivery of preventive care and create a major system barrier against the improvement of these services. This study uses a systematic approach to reach consensus among HP Medical Directors on CPS guidelines and implementation tools. This approach will provide a template for HPs nationwide to come to consensus on guidelines and implementation tools that support clinicians in the delivery of CPS. The momentum is increasing in support of evidence based practice that will improve the quality of patient care and decrease the morbidity and mortality of preventable diseases. Due to the nature of the nurse-client relationship, opportunity exists for nurses to provide these preventive care practices. However, nurses need time and organizational support to access and synthesize the best evidence for making changes in practice. Great opportunity exists for nurses to work collaboratively with HPs in promoting the delivery of these preventive services.en_GB
dc.date.available2011-10-27T11:10:04Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:10:04Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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