Assessing the Public Health System in Delaware

Assessment Results

Essential Public Health Service # 9:
Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services

On December 20, 2006, an Assessment Team including representatives from the Division of Public Health (DPH), Henrietta Johnson Medical Center, Delaware Healthcare Commission, Division of Medicaid, and Medical Assistance (DMMA), Department of Health and Social Services (DHSS), Department of Natural Resources and Environmental Control (DNREC), and DE HIV Consortium listened to public testimony about how well Essential Public Health Service # 9 is performed in Delaware based on the model National Public Health Performance Standards (NPHPS). Those providing public testimony included representatives from DPH, DNREC, Christiana Care Health Services, Connections, and Christina Care Health Systems (CCHS).

Following the testimony, the Assessment Team completed the NPHPS instrument on Essential Service # 9: Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services. This essential service model standard includes a state public health system that:

1. Assures that the state’s communities are served by appropriate and timely personal and population-based health services;
2. Shares results of performance evaluations with partners for use in improvement and strategic planning processes;
3. Improves the quality and outcome of health services in Delaware.

The Assessment Team examined four indicator categories for the essential service:

1. planning and implementation;
2. technical assistance and support;
3. evaluation and quality improvement; and
4. resources.

The team identified strengths and gaps in Delaware’s public health system performance of these indicator areas.

The Assessment Team rated the Delaware public health system as having partially met the model standard in the area of planning/implementation, evaluation and quality improvement and resources. Within planning/implementation, Delaware does an excellent job evaluating home health care and long-term care services. The Public Health System workforce is diverse with a high level of expertise and the health care professionals’ credentials and licenses are monitored.

The Team identified noticeable gaps in technical assistance and resources. Gaps included:

1. little technical assistance in reviewing of population-based and personal health services;
2. there is no consultation service and guidance to conduct consumer satisfaction studies with respect to broad health services;
3. there is no existing shared system-wide resources to effectively conduct evaluation activities; and
4. no analytical tools to measure and monitor compliance with performance standards for population-based and personal health services.

Evaluation of the Assessment Process:

The overall evaluation results indicated that participants felt that it was beneficial to assess this essential service. The public testimony provided was not as helpful as it has been for some previous essential service assessments. Although majority ruled on instrument questions/answers, voting on some of the instrument questions varied. This essential appeared to be more difficult in comparison to some of the other essentials. Representations from some sectors were missing such as hospitals which led to difficulty with interpreting some of the language used in the assessment tool.

Sharing of “Take Away” Thoughts

The sharing of “take away” thoughts by the assessment team always provides good feedback. One team member shared that we have a lot to do but felt we have the seeds for getting this done. A member shared that integrating all the information gathered will be a major challenge and will require a lot of effort to collaborate but it can be done. Several agreed that it was a difficult essential service to rate since it is a very sensitive and complex area but it needs to be addressed.

Priority List

Each member of the assessment team was asked to vote on a scale of 1 - 10 on the importance and priority of each of the four indicator categories with 10 being the highest priority. Below are the indicator areas with the priority scores and a summary of strengths (in italic) and gaps (in bold ) that were identified in the Delaware public health system. There was a lot of information that was shared and hopefully we captured the critical points.

9.1 Planning and Implementation (priority rank: 8)

• There is a strong collaboration of partners throughout DE.
• DE tobacco program has done an excellent job with planning and involving the communities.
• Hospitals and home care agencies are monitored by DPH Office of Health Facilities Licensing and Certification (OHFLC) for health care regulation.
• Division of Medicaid, and Medical Assistance (DMMA) has a Quality Improvement Task Force which supports ongoing quality oversight, tracking, monitoring of Medicaid funded programs and waivers.
• DPH programs currently focus on compliance, vs. quality assurance and quality improvement.
• Quality plans and activities need to be developed.
• Delaware tends to be reactionary rather than proactive when it comes to evaluating our programs.
• Programs have mostly paper records making it difficult to monitor and assess data.
• There is a lack of periodic, pre-determined scheduling for evaluation.
• The regulations are antiquated and in need of revision.
• Enforcement authority is lacking in the statute.

9.2 Technical Assistance/Support (priority rank: 9)

• There is a long standing collaboration with other state agencies which use DPH as technical experts.
• DPH and other state entities provide technical assistance to the community such as task forces with hospice and home health care.
• Regulations are outdated and do not reflect the 21^st century.
• DE doesn’t do a good job with consumer satisfaction studies.
• Enforcement of regulations is difficult because the enforcement varies with every regulation.

9.3 Evaluation/Quality Improvement (priority rank: 10)

• Delawareans going through the NPHPS assessment to determine areas of improvements in the public health system.
• The Office of Health Facilities Licensing and Certification (OHFLC) review existing regulations to ensure that they reflect current knowledge and practice.
• All systems and processes within OHFLC have been revised, refined, prioritized, and organized.
• Personnel receive extensive on-the-job training to be able to complete their duties.
• A number of initiatives including Healthy Delaware 2010, Infant Mortality Task Force, and Cancer Coalition have focused on quality improvement in areas of public health.
• Federal and Foundation grants require evaluation as part of the funding criteria.
• The public health system has a tendency to be reactive rather than proactive; the system is weak and inconsistent in evaluating activities.
• Programs and services such as Smart Start, Kids Kare and EPSDT paid for by Medicaid and provided by DPH are without statewide administrative direction and lack a period, pre-determined schedule for evaluation.
• Data for evaluation and quality improvement is missing, inconsistent and/or difficult to access due to lack of integrated data systems.

9.4 Resources (priority rank: 9)

• SPHS partners seek and apply for new sources of funding.
• Data warehouses are currently being explored within the state systems.
• There is a strong collaboration of partners throughout DE.
• Due to of lack of resources staff are not able to be proactive in survey activities.
• There is a lack of integrated data systems throughout the state.
• Resources and staffing are not available to plan, develop, and conduct educational programs focused on evaluation and quality improvements techniques.
• There is a lack of resources including personnel, time, and funds.
• Partners operate in silos.

Next Steps:

Participants mentioned several steps that should be taken:

• Disseminate results/information to as many public sectors as possible.
• Continue to work with the various interest groups to improve the public health system in Delaware.

The Division of Public Health has a meeting scheduled for January 11, 2007 with all of the participants in each of the essential service assessments. Participants will be asked to prioritize the services and gaps, develop an implementation plan, and draft action steps with assigned responsibilities.

• Go back to 2006 Assessment Meetings and Summaries

Last Updated: Wednesday January 10 2007