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The Magnolia Place Initiative is a collaboration of faith-based and community groups within a 500-block portion of Los Angeles that crosses Pico Union, West Adams and the North Figueroa Corridor, west of downtown. This project used smartphones to help a group of Magnolia Place residents record images and information from their neighborhoods in ways that may contribute to meaningful change while building community capacity for research. We developed a "Holiday Campaign" around Halloween, which involved taking snapshots and mapping the observations, and created a rating scale for measuring holiday spirit. We also wrote a Spanish-language guide for the project.
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Vision: All 35,000 children in the Magnolia catchment area will break all records of success in their education, health, and the quality of nurturing care and economic stability they receive from their families and community.
Magnolia Community Initiative
About the Magnolia Community Initiative
• Voluntary network of 70 organizations
• Involves government and regional organizations – including Los Angeles County Chief Executive Office – to influence infrastructure that affects many residents, and to facilitate spread of what works beyond the catchment geography
• Emphasizes sustainable, scalable, evidence-based strategies: (1) increase access, use and quality of family-desired services, activities,
resources and support;
(2) strengthen social ties among residents; and
(3) improve economic opportunities and development.
• Connects diverse programs and providers (including physicians, child care and preschools, and mental health) to shared accountability and a common change process
Achieving Population Outcomes
1. Work as a system to achieve population outcomes
2. Use design ideas that increase synergy/alignment of all sectors,
at all levels (policy, practice, families)
3. Increase expectations of, and accountability for, impact for a
population
4. Combine expertise on “what to try” with expertise on “how to
change”
5. Use tests and prototypes to implement
promising ideas that customize to work
consistently, across settings, and under all
conditions
6. Use networks to produce and accelerate
innovation, learning and spread
MagnoliaCommunityDashboardJune2012
ParentExperiencesinMagnoliaPartner
Settings,andintheCommunityOverall
Current&PotentialReachtoChildren
%ParentsofChildren0-5WithProtectiveFactors %ParentsAchievingFamilyGoals
DevelopmentalProgressofChildrenEnteringKindergarten
27%
WhoAreProficientin
%of3rdGradeChildren
Reading
0% 100%
Health 7 31 9 35 24 15 15 22 19 31 9 5
Child care 20 - - - 33 39 40 40 - 40 - -
Family support 51 50 57 68 70 44 60 59 33 25 48 38
Linkage orgs - - - - - - - - - - - -
Community 127 - 106 - - - 96 - 97 - - 86
J A S O N D J F M A M J J
2011 2012
Number of questionnaires per month
0%
20%
40%
60%
80%
100%
JulAugSeptOctNovDecJanFebMarAprMayJun Jul
2011 2012
%ParentsReadingWithTheirChildDaily
Jul AugSeptOctNovDec Jan FebMarAprMayJun Jul
2011 2012
%ParentsRepor ngTiestoNeighbors
0%
20%
40%
60%
80%
100%
JulAugSeptOctNovDecJanFebMarAprMayJun Jul
2011 2012
%ParentsRepor ngPosi veRela onshipwithChild
Jul AugSeptOctNovDecJan FebMarAprMayJun Jul
2011 2012
%ParentsAskedAboutChildDevelopmentConcerns
Jul AugSeptOctNovDec Jan FebMarAprMayJun Jul
2011 2012
%ParentsAskedAboutFamilyStressors
0%
20%
40%
60%
80%
100%
JulAugSeptOctNovDecJanFebMarAprMayJun Jul
2011 2012
%ParentsDiscussingResourcesforFamilies
Jul AugSeptOctNovDec Jan FebMarAprMayJun Jul
2011 2012
%ParentsReceivingEmpathicCare
Jul AugSeptOctNovDecJan FebMarAprMayJun Jul
2011 2012
%ParentsHelpedwithFamilyIncome/Finances
0%
20%
40%
60%
80%
100%
JulAugSeptOctNovDecJanFebMarAprMayJun Jul
2011 2012
%ParentsDiscussingResourcesforSocialSupport
Jul AugSeptOctNovDec Jan FebMarAprMayJun Jul
2011 2012
%ParentsAskedAboutDepression
% receiving care in this system
% reached by network child care
% reached by network doctor
18%13% 13% 15% 13%
20%
9%
23%32% 29%
18%23%
Communica on Physical Language&cogni ve
Socialcompetence
Emo onalmaturity
Hasatleast2areasofvulnerability
HasIEP
Vulnerable Veryready
SocialConnec ons(%with2of2)
ConcreteSupports(%with
6of6)
Resilience(%with5of5)
0%
20%
40%
60%
80%
100%
At l
east
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0%
20%
40%
60%
80%
100%
SocialCondi ons
ParentHealth
EconomicStability
Paren ng
!"#$%&'
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In doctor offices
In child care
In the community overall
In family support programs
Goal
In linkage organizations
Developmental progress, by kindergarten
Protective factors for families
Family and community conditions
Reading proficiency, third grade
Potential and actual reach to children in the community
Parent activities and behaviors
Measures of real-time improvement in services and supports
Measuring Progress for the Population
Network Reach to Residents
Magnolia Community Survey, October 2011 (790 residents; all ages)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
50
100
150
200
250
300
350W
IC
St T
ho
mas
CB
SC
Ho
ove
r R
ec
Tob
erm
an
Mag
no
lia E
l
No
rman
die
Red
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ield
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LA C
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ino
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irs
Pat
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ays
Pan
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an
An
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blic
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sel
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e B
aby
CFR
C
SAJE
17
36
cen
ter
89% of survey respondents had contact with at least one partner in the past year
75% had contact with at least one of 5 most common network partners
Cu
mu
lati
ve %
Co
un
ts o
f re
sid
ents
in c
on
tact
wit
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artn
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Health Care Providers Seen by Children Ages 0-5 in Past 12 Months
PRELIMINARY DATA. Parents surveyed in WIC centers within Magnolia catchment, 2010-12. N=682 (of parent surveys completed on 632 children); cumulative percentages include some duplicate counts
Counts of children seeing the provider
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
50
100
150
200
250
300
Eisner
StJohns
ClinicaSanJudas
ClinicaMacArthurPark
ClinicaSanMiguel
PicoClinica
KaiserPermanente
TeresaMedical
MsrOscarRomero
CaliforniaFamilyCare
SanMiguel
Children'sHospital
WomenandChildren'sW
ellness
CentroMedicaArthurPark
Queenscare
Altamed
ClinicadelaM
ujer
Dr.Ghalili
HoracioLopez
TeresaMedical
CenturyW
omen'sClinic
CasadeSalud
ClinicadeLosAngeles
Others
About 19% of children saw a health care provider in the network
Known
Ideas
New
Ideas Little is known or published
Best science History of success Evidence based
Peter Margolis, EDSI Pacoima Collaborative Design Meeting, 3 November 2009
How to Generate Ideas That Will Achieve System Level Results
Test Prototype
Pilot Reliability (consistency)
Scale and spread
A Recipe for Population Impact
Change Concepts
Evidence-Based Programs and Content
Model for Improvement
Network for Continual Learning
Select
Topic
Expert
Group
Change
Concepts
Participants
LS 1 LS 2 LS 3
P
S
A D
P
S
A D
Prework GLOBAL CQN AIM
We will build a sustainable quality
improvement infrastructure within our practice
to achieve measurable improvements in
asthma outcomes
Specific Aim
From fall 2009 to fall 2010, we will achieve
measurable improvements in asthma
outcomes by implementing the NHLBI
guidelines and making CQN’s key practice
changes
Measures/Goals
Outcome Measures:
>90% of patients well controlled
Process Measures
>90% of patients have “optimal” asthma care (all
of the following)
assessment of asthma control using a
validated instrument
stepwise approach to identify treatment
options and adjust therapy
written asthma action plan
patients >6 mos. Of age with flu shot
(or flu shot recommendation)
>90% of practice’s asthma patients have at least
an annual assessment using a structured encounter
form
Engaging Your QI Team and
Your Practice*The QI team and practice is active and
engaged in improving practice processes
and patient outcomes
Using a Registry to Manage
Your Asthma Population *Identify each asthma patient at every visit
*Identify needed services for each patient
*Recall patients for follow-up
Using a Planned Care
Approach to Ensure Reliable
Asthma Care in the Office * CQN Encounter Form
* Care team is aware of patient needs and
work together to ensure all needed
services are completed
Developing an Approach to
Employing Protocols * Standardize Care Processes
* Practice wide asthma guidelines
implemented
Providing Self management
Support * Realized patient and care team
relationship
Key Drivers
Interventions
Form a 3-5 person interdisciplinary QI Team
Formally communicate to entire practice the importance and goal of this
project
Meet regularly to work on improvement
All physicians and team members complete QI Basics on EQIPP
Collect and enter baseline data
Generate performance data monthly
Communicate with the state chapter and leaders within the organization
Turn in all necessary data and forms
Attend all necessary meetings and phone conferences
Select and install a registry tool
Determine staff workflow to support registry use
Populate registry with patient data
Routinely maintain registry data
Use registry to manage patient care & support population management
Select template tool from registry or create a flow sheet
Determine workflow to support use of encounter form at time of visit
Use encounter form with all asthma patients
Ensure registry updated each time encounter form used
Monitor use of encounter form
Select & customize evidence-based protocols for your office
Determine staff workflow to support protocol, including standing orders
Use protocols with all patients
Monitor use of protocols
Obtain patient education materials
Determine staff workflow to support SMS
Provide training to staff in SMS
Assess and set patient goals and degree of control collaboratively
Document & Monitor patient progress toward goals
Link with community resources
CQN Asthma Project Practice Key Driver Diagram Version 2.0
Peter Margolis, CCHMC; Ed Wagner, MD, MPH: MacColl Institute; Associates in Process Improvement; Institute for Healthcare Improvement
Whatarewetryingtoaccomplish?
Howwillweknowthatachangeisanimprovement?
Whatchangecanwemakethatwillresultinimprovement?
Act Plan
Study Do
PDSA Example – Texting for Daily Reading
Can we increase the frequency of daily book-sharing by introducing texting, to prompt reading and to enable parents to share their successes with each other, in real time?
Drivers
Current outcomes:
Parent practice:
System practice:
% Reading daily
% Discussing importance of reading
Support parents to manage their child’s needs & promote development
% of third grade children proficient in reading: 27% % of children entering kindergarten with communication vulnerability: 18%
0%
20%
40%
60%
80%
100%
JulAugSeptOctNovDecJanFebMarAprMayJun Jul
2011 2012
0%
20%
40%
60%
80%
100%
JulAugSeptOctNovDecJanFebMarAprMayJunJul
2011 2012
Collaboration with the CTSI – Year 2
Aim 1: Test the impact of several key functions of partnered infrastructure for translational research, to increase the volume and breadth of partnered research activities and funding, and to accelerate the timing of population impact
• Using MCI Research and Evaluation group to identify common priority topics, and link researchers and network partners
• CERP staff support of data visualization for community residents
• Biostatistics consulting to facilitate impact evaluation
Collaboration with the CTSI – Year 2
Aim 2: Identify effective, scalable applications of mobile health technology that improve population health
•Feasibility pilot with Center for Embedded Networked Sensing (CENS) to identify effective uses of smartphones for helping residents describe their neighborhoods and daily lives in ways that contribute to meaningful action for neighborhood change
– Offer residents access to Ohmage, which is an open-source, mobile to web platform that records, analyzes, and visualizes data from prompted experience samples entered by residents
– “Holiday survey” to develop positive neighborhood asset measures
– Storytelling narratives about “a day in the life”
HolidayMicro-CommunityParticipationSurveyChecklist TeamLeader________________________________Date:_12/________/2011 Start-Time:_____:_____ End-Time:_____:_____ TeamMembers:_____________________________
Howtonumberunitsifnumbernotlistedorvisible Page___of______
AddressesSINGLEORMULTIPLE
UNIT
IFMULTIPLE,HOWMANY
UNITS?
UNITNUMBER
HOLIDAYDÉCORRATING
WRITETYPEOFDECORATION&LOCATION
PHOTOTAKEN?
PHOTO#
Example:123414thStreet
Example2:123414thStreet
M
M
4
4
A
B
4
1
STRINGOFLIGHTAROUNDROOFLINE
WREATH
YES
YES
1
2
1. SORM
2.
3.
4.
5.
Key:Decorations-0=None,1=oneholidayitem,2=twoitems,3=3items,4=fourormoreitems
Neighborhood Observation