School Health Through the Lens of Data: State and National Quality Initiatives for School Health Centers

For two years – 2015-2016 and 2016-2017 — our district participated in the National Quality Initiative (NQI) for school health centers. Last year, we were part of the local initiative for the Connecticut sites.

What are these initiatives about? Why do we need them? What good do they do for us?

The NQI was launched in 2014. It is a joint project of the School-Based Health Alliance and the Center for School Mental Health at the University of Maryland. According to the Alliance’s mission statement for the NQI, in the modern world, school health centers are challenged to operate as businesses—with clinical efficiency, coding and billing savviness, and financial practicality. The NQI is an opportunity to explore strategies that increase SHC sustainability and expansion while continuing to provide important, high-quality services that tackle the root causes of poor health and education outcomes among children and adolescents.

The NQI pursues two main goals:

  1. Develop a set of standardized national performance measures for SHCs and encourage the field to voluntarily adopt and report on these measures.
  2. Expand the number and improve the sustainability of SHCs.

The performance measures were identified by a group of health care experts during their research of the “key performance indicators” in the school health center setting. They are:

  1. Well-child visit
  2. Annual risk assessment
  3. BMI screening
  4. Depression screening
  5. Chlamydia screening

These measures can be tracked in a database (in our case, HealthX) through associated ICD-10 and CPT codes.

Along with the number of visits, the number of students who received these services at least once (unduplicated users) are counted. The NQI is also looking at specific age groups (3-11 and 12-17 years old).

Data on visits and users are entered to the NQI data portal on the SHC Alliance website monthly. At the end of each reporting period, charts showing progress are generated automatically from the provided data.

Participating SHC teams meet periodically to discuss how to collect the required data using a PDSA (Plan-Do-Study-Act) tool. They also communicate their findings and challenges to their peers from all over the country during period conference calls led by the NQI experts.

In New Haven, two schools were selected for the NQI – Davis and Barnard. They conducted work with the help of the Board of Education administrative group.

At the very beginning, there was a lot of frustration about the project, because it was not easy to make time in the already busy schedules to meet and to discuss, to comprehend the quality measures, and the process of working with them.  However, the more we discussed, the more focused we stayed, the better we got. By the end of the first year, there was almost no need to meet anymore and to fill the PDSA sheets. Data collection was fully streamlined.

The same two schools participated in the Connecticut Quality Initiative (CT QI) this past school year. The goals were slightly different: based on their experience with the NQI, the sites were encouraged to concentrate on one problem in their clinical practice.

The work was led by a group of consultants from JSI Research and Training Institute. They were hired by the CT Association of School Based Health Centers (CASBHC).

Most of the participants in CT chose a data collection problem to work on, but the New Haven team’s project was different: the clinicians were interested in exploring health education possibilities. Specifically, they decided to conduct obesity prevention classes and to monitor outcomes. They developed a curriculum, identified students, and set up a counseling schedule. They also developed a pre and post questionnaire to track progress. The project lasted about 6 months, starting at the beginning of the school year. It was challenging to squeeze these classes into the existing school schedules, to reach parents with follow-up calls, to adjust the classes to match the students’ individual level of knowledge, but in the long run, the study proved to be a success. The district CT QI team created a storyboard on the project and presented it at the final meeting with all CT sites (on the photos: Jane Milberg, APRN, Davis school and Ranbir Bains, APRN, PhD, Barnard school; CT QI cohort).

If you are interested in learning more about this work, please contact Liliya Garipova at 475-220-1239.

Please click here to view and/or download the NHPS CT QI storyboard.