text:
A collection of some of our most popular pages. Click on a category
to see related links. To jump to a page, just click on the image.
More NICHQ
Newsletter Archive
NICHQ Defined [Video]
2015 Impact Report
Other NICHQ Sites
Quality improvement in public health means working through every sector and influence that affects how people live. At the highest level, this includes the rules and laws where people live. Missouri working to creating better care for individuals with sickle cell disease by working with the state government to make impactful change.
The NICHQ-led Best Fed Beginnings initiative has made it possible for 218,000 more babies to be born in Baby-Friendly hospitals every year.
When a 2014 report showed one child almost every three days in Virginia died related to a preventable unsafe sleep environment, leaders at the Virginia Department of Health knew it was time to take action.
To create innovative change in healthcare, quality improvement teams and learning collaboratives must be rigorous in every step of their efforts. Factors like meticulous testing and robust data collection are essential for successful change; It is also important to match that rigor with a certain flexibility.
Parents of children with special health needs become experts on their children's condition in a way that doctors and administrators cannot. Their countless hours on the front line, navigating the healthcare system and other community resources, gives them invaluable insight into how these systems work (and do not work) for them. That is why NICHQ emphasizes the value of utilizing the parent/family perspectives in change efforts.
New maps show state Medicaid quality metrics and performance-based incentives for women's health services to improve birth outcomes.
In all types of quality improvement efforts, sustainability is a vital consideration that often goes overlooked until the project's final stages. With the right balance of foresight and strategy, however, team leaders can plan for sustainability as a project gets underway.
Minnesota's Department of Health began working towards increasing the number of full term births in 2015 by focusing efforts to increase awareness and the use of 17-alpha hydroxyprogesterone caproate (17P) in women who have had previous spontaneous singleton preterm births.
Pediatrics journal article features NICHQ initiative were 80% of hospitals achieved Baby-Friendly status.
Because safe sleep is such a complex issue that requires continuous communication and education for families, the New York State Department of Health uses a multifaceted approach with its Safe Sleep Project.
After nearly 20 years of guiding teams in constructing PDSA cycles we've identified three common pitfalls. The good news is you can easily avoid them.
While the baby box can be seen as an innovative product and a promising practice, it does not meet the requirements of an evidence-based initiative.
Effective family engagement begins with finding parents who are engaged in improving health outcomes for everyone.
Efforts to improve immunizations show how health disparities can be closed.
NASHP and NICHQ release case studies on Delaware and Georgia's uses of Medicaid policy to help reduce costly unplanned births.
Quality is interpreted differently by healthcare and public health.
Gwen Webber-McLeod shares some tips on identifying with and approaching strategic partners.
Collaboration between WIC and a hospital has had a big impact on breastfeeding support for many new moms.
A thorough onboarding process can empower new team members to be strong contributors.
A well-rounded team makes a word of difference for QI.
Mothers aren't just benefiting from improved practices and policies, they're helping hospitals identify strategies to better serve their patients.
Data on epilepsy care systems may lead to the type of improvements necessary to create stronger support for patients.
Better alignment between systems that support early childhood development can lead to improved outcomes for all children.
Data is a key part of quality improvement, and collecting it can make a huge difference in the results of an initiative.
A Texas hospital and WIC agency have teamed up to ensure that breastfeeding support and education start before delivery and well after birth.
Engaging in-person and remote audiences requires nuanced techniques when bolstering collaboration.
New technology and intervention strategies look to make a real difference in children's health.
Two articles spotlight NICHQ-led projects that are helping improve breastfeeding practices.
Planning is the first step for running successful PDSA cycles, making important to get right.
QI is a necessary tool for closing gap in pediatric vision care.
Boston is working to eliminate smoke from its housing to improve everyone's health.
The infant mortality toolkit supports teams looking to improve infant health in their communities.
Inequities in oral healthcare are leaving children in underserved communities at risk for worsening health conditions.
Innovative programming is being used to further improve children's health.
Promising results have led to two NICHQ projects being featured in the Maternal and Child Health Journal.
When proposing a new quality improvement initiative to leaders to gain their support, you'll need different kinds of evidence and data to support your case.
Sickle cell disease care is being improved for Indiana's children, and new strategies are helping support better transitions of care.
This new issue brief delves into how perinatal regionalization improves the delivery of risk-appropriate care, and how Medicaid can help support regionalization efforts.
Advertisements don't often show babies sleeping in safe position, and that affects what caregivers learn about putting children to bed.
Pregnancy planning and women's health, regardless pregnancy intentions, can help reduce the risk of birth defects and improve health outcomes for moms and babies.
While there are statewide initiatives to improve breastfeeding support for new moms, community support is also key to their comfort and success. Hospitals and groups like Women, Infant and Children (WIC) foster that kind of support, and other organizations are starting to fill in gaps to ensure that moms have the resources they need to breastfeed or pump in public spaces.
To improve breastfeeding support and education, an El Paso hospital and a local WIC clinic began working together, and found that a continuous approach helps engage families.
Racial disparities in health and healthcare access have a profound affect on infant health, especially when it comes to preterm births.
Learn all about Quality Improvement 101, a digital course that teaches the fundamentals of change.
A new action kit aims to support early hearing detection and intervention (EHDI) programs reduce loss to follow-up through quality improvement and innovative strategies.
TaLana Hughes, MPH, Executive Director of the Sickle Cell Disease Association of Illinois, shares why she participates in the Sickle Cell Disease Treatment Demonstration Program.
Part of the NICHQ and Maternal and Child Health Bureau-led Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) involves state teams determining where there are opportunities to improve systems so they can better reach underserved women and infants. In our special Underserved Population Series, we've highlighted IM CoIIN teams that have made strides in reaching underserved populations across different strategic focus areas for addressing infant mortality. These inspiring stories show that change is possible, and that there are ways to reach every mother and every child. Although the healthcare system is far from perfect, new strategies can be implemented to extended it to people who can't access the help they need.
Across the United States, organizations and government agencies are creating new approaches to improve children's health. Because we support innovation for helping children lead healthier lives, we've highlighted some of the most exciting initiatives we've seen in the last few weeks. Read on to learn how some groups are addressing critical health needs.
Sudden Infant Death Syndrome (SIDS) is the fourth leading cause of infant mortality in the United States, according to the Centers for Disease Control and Prevention. During SIDS Awareness Month in October, healthcare systems, government agencies and public health organizations are reaching out to providers and parents to educate them on what they can do to better protect infants.
In 2014, the obesity rate for children and teenagers between ages 2 and 19 in the United States increased to 17.2 percent, up from 13.9 percent in 1999. While various organizations and agencies are working to help children lead healthy lifestyles, there has been another trend in recent years that has come into play: gamification.
For women who have recently given birth, waiting at least 18 months before becoming pregnant again is essential as it allows the body much-needed time to recover and heal. Longer intervals between pregnancies also mean better birth outcomes and healthier babies. While there is no consensus on optimal interpregnancy interval, research shows that short intervals of less than 18 months and intervals longer than 60 months are associated with poor health outcomes.
Unplanned and complex births carry potentially avoidable health complications and costs to families and states. Broad healthcare payment and delivery reform is underway across the country to improve outcomes, enhance patient experience and reduce costs. Some states are capitalizing on these reforms to promote planned and healthy births by driving improvement in effective contraceptive use and postpartum follow up care. Their efforts create potential opportunities for cross-agency collaboration and integrate well with other initiatives, such as the Centers for Medicare and Medicaid Services' Maternal and Infant Health Initiative and the Health Resources and Services Administration's Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN).
Early childhood trauma – whether from unexpected acts of violence or entrenched, continuous influences such as chaotic home life or family violence – is pervasive and can have cumulative, life-altering impacts. The stress of childhood trauma releases hormones that physically damage a child's developing brain. Children with toxic stress live most of their lives in flight or fight mode, making it difficult to learn in school and build healthy relationships.
For 25 years, the National Healthy Start Association (NHSA) has served as a leading voice in support of government policies and programs that serve pregnant women, babies, and families in vulnerable communities. NHSA works diligently to ensure optimal birth outcomes and elimination of disparities advocating for community-based services, such as outreach, home visitation, care coordination, health education, health and depression screening, and paternal engagement programs.
Learning leaders' styles is a great first step towards engaging them in quality improvement (QI) efforts. The next two steps -- establishing a vision and aligning aims with the organization -- are important both to securing leadership buy-in and to the work's ultimate success. Undertaking these actions early on allows for more substantive conversations about QI plans and opportunities that can foster interest at every level of the organization.
The Wisconsin Providers and Teens Communicating for Health (PATCH) program is helping to reduce teen pregnancy rates in Wisconsin by enhancing communication between teenagers and their healthcare providers. The PATCH program trains and employs Teen Educators who then educate medical professionals on how to communicate with younger patients, with a particular focus on sensitive subjects, including sexual and reproductive health.
Missouri aims to move the state's hospitals away from self-designation for levels of risk appropriate care to better support perinatal regionalization—the idea that a system exists to designate where babies are born or transferred according to the level of care they need at birth—and improve health outcomes for moms and babies.
Increasing the number of patients with sickle cell disease (SCD) who receive regular care from knowledgeable providers is one of the three main goals of the Sickle Cell Disease Treatment Demonstration Program (SCDTDP), for which NICHQ is the national coordinating center. But what happens to patients with SCD who have trouble initiating or remaining in treatment? Through the SCDTDP, community health workers (CHWs) are a critical layer of support for these at-risk patients.
A healthy pregnancy starts before conception, but almost half of pregnancies in the U.S. are unplanned. This increases the risk of poor outcomes for both moms and babies. Planning can help women better prepare themselves for pregnancy, and it all starts with a single question from their doctors: Would you like to become pregnant in the next year? The One Key Question® (OKQ) initiative from the Oregon Foundation for Reproductive Health (OFRH) encourages healthcare providers to ask every woman this specific question because it changes the context of other health factors.
Although great strides have been made in recent years, infant mortality remains a problem in the United States. The infant mortality rate has declined – dropping 13 percent between 2005 and 2013 – while still leaving the U.S. far behind many industrialized nations.
At the outset of every project, we determine how it will relate to our three areas of focus—bridging health and healthcare, improving systems of care, and increasing support for healthy beginnings. Recently, three new projects have touched on these foundations, progressing towards improvements in systems for children's health and outcomes for families.
While the country's rate of sudden infant death syndrome (SIDS) has dropped by more than 50 percent over the past two decades, SIDS continues to claim the lives of about 1,500 U.S. infants each year. SIDS is the leading cause of death for infants and is highly correlated with unsafe sleep practices, which is why the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) has made safe sleep practices one of its six focus areas. By helping to eliminate persistent but avoidable disparities in SIDS rates, addressing unsafe sleep practice with underserved populations can reduce infant mortality for all.
MCH Practice Fellow Avery Desrosiers has been part of the IM CoIIN team during her time at NICHQ. Over the course of her work, she's learned about how quality improvement can affect maternal and child health, how encourages innovative changes within specific communities to improve health outcomes for vulnerable populations.
The National Healthy Start Association's (NHSA) Where Dads Matter initiative helps engage men and dads in maternal and child health to help support health outcomes. NHSA President Kenn Harris recently spoke with us about Where Dads Matter, its impact and the role male caregivers play in MCH programs.
Quality improvement means making long-term changes that can be adapted and sustained in different environments. Testing is one of the essential steps in optimizing a change idea so that it can improve a specific element within public health.
Data sharing is one of the most significant barriers between city and state health departments when it comes to reducing infant mortality. States and cities accumulate a great deal of data at various levels on birth outcomes and maternal care, but they don't always make it readily available to each other.
Programs from healthcare providers, government agencies and other organizations help improve children's health by addressing new needs and closing gaps in care. This month, we've found innovative and inspirational examples touch on subjects like children's sleep during hospital stays and efforts to improve in-school care.
Two articles related to NICHQ's portfolio of sickle cell projects are featured in a special sickle cell supplement of the American Journal of Preventive Medicine out today, in advance of World Sickle Cell Day June 19.
Fostering the creation of healthy families by choice, not chance, is not a new idea. Organizations and agencies are working to improve pregnancy planning, spacing and preventing unintended pregnancies. Given the high rates of unintended pregnancy in the U.S., action is needed from all stakeholders–consumers, health providers, policy makers–in proactively supporting this critical conversation.
"Follow the Leader" isn't always a game that should be played during quality improvement (QI) work. In fact, often, QI teams need to be proactive about engaging their leaders, creating a partnership to support change initiatives. To do that, leaders might have to be pushed out of their comfort zones.
A new video series is showcasing how healthcare providers in Texas are successfully implementing the Ten Steps to Successful Breastfeeding, a set of evidence-based practices hospitals can follow to increase breastfeeding initiation and duration by new moms. Created by the Texas Department of State Health Services, this 10-video series features healthcare providers sharing their strategies for success on the pathway to improvement.
With the projection that more than half of the nation's children will be part of a minority race or ethnic group by 2020, the need to address health equity has never been stronger.Equity in healthcare is the idea that everyone has the same access to quality care, regardless of social, economic, demographic or geographical differences. This ideal is not a current reality in the U.S. healthcare system. There are many barriers hampering health equity and the overall health of America's children.
More mothers in New York will soon experience better improvements in hospital maternity care, as 21 more hospitals join the state's Breastfeeding Quality Improvement in Hospitals Collaborative (BQIH). Cohort A saw 12 New York hospitals work together and use quality improvement (QI) methods to change their systems and practices to better support a mothers choice to breastfeedings. Cohort B will see 20 new hospitals participate in the collaborative, building off the momentum and learnings from their predecessors.
Unplanned pregnancies can present a tremendous challenge for many women, healthcare payers and the community, and are associated with a number of negative health outcomes, such as delayed prenatal care and premature births. Efforts like the Centers for Medicare and Medicaid Services' (CMS) recent guidance and the Collaborative Improvement & Innovation Network to Reduce Infant Mortality (IM CoIIN) have improved maternal and infant health outcomes, while also highlighting the $10 billion cost burden Medicaid expends on unplanned births.
The Best Babies Zone (BBZ) Initiative has been working on the social determinants of health for four years. In 2012, BBZ was launched to address the social, economic and environmental factors that contribute to poor birth outcomes. With funding from the W.K. Kellogg Foundation, three small pilot "zones" were launched in Cincinnati, OH, New Orleans, LA, and Oakland, CA. In these cities, a lead organization connects and convenes partners from across sectors, creating possibilities for innovative projects that address the root causes of infant mortality in that community.
In the 1930s, Finland's infant mortality rate reached 65 deaths per 1,000 live births, leading to the 1938 introduction of baby boxes—kits that include a mattress, bedding, diapers, a box that serves as a crib and other necessities. By 2015, that rate had dwindled to an estimated 2.52 deaths per 1,000 live births. In 2014, there were 3,500 sudden unexpected infant deaths in the United States, 25 percent of which were caused by accidental suffocation or strangulation in bed. Learning from Finland's success, organizations in the U.S. are beginning to offer their own baby boxes to new families.
While a higher percentage of Rhode Islanders have health insurance compared to the U.S. average, achieving health equity has been a challenge for the state—especially for its infant mortality rate. Now, the Rhode Island Department of Health is targeting key social factors that impact infant mortality in minority groups, including education, income and stress. The Rhode Island Commission for Health Advocacy and Equity was created in 2011 to address the inequity, by bringing together state agencies to focus on the social determinants of health—typically defined as the wider set of forces and systems shaping the conditions of daily life. Aligning the efforts of those inside and outside the state is also key.
Reducing the rate of pre-term birth is a major priority for state health agencies and a growing concern for state Medicaid programs. Medicaid agencies provide coverage for over half of the nation's births each year and pay for a higher rate of premature or low-birth weight babies than the private insurance market (10.4 percent versus 9.1 percent). Pre-term birth, a birth that occurs prior to 37 weeks of gestation, is the leading cause of infant mortality in the United States. Early delivery is associated with a host of long-term health issues for the infant, including sight and hearing loss, cerebral palsy and developmental and intellectual disabilities.
Mercédez Cahue shares her breastfeeding experience and why she joined the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative as a parent partner.
Wyoming is improving its birth outcomes one downloader at a time. An interactive mobile app—Due Date Plus—that the state Medicaid office developed for pregnant women is redefining prenatal education and transforming how Medicaid meets the needs of its pregnant population.
It is becoming increasingly clear that efforts to improve risk-appropriate site of delivery may benefit from close collaboration among perinatal care providers, payers and public health organizations. State health departments and state hospital associations often manage repositories of population-level perinatal data while perinatal quality collaboratives can engage front-line providers. Collaborative partnerships among these entities can facilitate improved outcomes at the population level.
Through a Healthy Weight Initiative at the Greater New Bedford Community Health Center, well over 200 kids have learned about monitoring sleep routines, fruit and veggie intake, screen time, physical activity and sweetened beverages. It's a focus on healthier lifestyles and better choices, not weight loss, which is helping kids and families to see results.
Engaging pilot sites to test out change ideas and collect data is one of the best ways to learn how to make change at a local level. Pilot sites can test ideas and assist with planning and implementing a project "on the ground" with individuals in a project's target audience. If pilot sites are challenged around collecting data to drive their improvement efforts, here are six tips to support them.
Children greatly benefit from having active paternal figures in their lives. According to the State of the World's Fathers report, it leads to improved mental health in children, higher immunization rates and support for women who are breastfeeding. The creation and availability of educational resources that encourage male involvement are crucial to achieving that. Knowing this, the California WIC Association (CWA) created "Engaging Men & Dads at WIC: A Toolkit" to help the local WIC (Women, Infants and Children Supplemental Nutrition Program) organizations better connect with dads.
An ongoing effort from the Illinois team involved in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) is to get 90 percent of very preterm infants in Illinois delivered in Level 3 perinatal facilities. These facilities feature neonatal intensive care units (NICUs), where a combination of leading-edge technology and specially trained staff can vastly improve health outcomes for high-risk babies.
With both large urban and rural areas in Texas, sharing consistent and accurate information about the benefits of breastfeeding with mothers and healthcare workers is an enormous undertaking. One statewide initiative, the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative, is harnessing the power of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) staff, using them as conduits for communicating evidence-based practices and offering guidance to both mothers and healthcare providers.
Forget the old marketing tactic of shouting loud and often. Mario Drummonds, MS, LCSW, MBA, the CEO of Strategy Interactions, and a participant in the NICHQ-led Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN), shares four strategies for building a public health social movement to increase state and national attention on your healthcare issue.
In South Carolina, half of all pregnancies in 2010 were unintended, primarily due to either lack of or failed contraceptives. Within the South Carolina Medicaid population, almost 79 percent of women defined their pregnancy as unintended. This is particularly troubling because births resulting from unintended pregnancies are linked to adverse maternal and child health outcomes and myriad social and economic challenges. To reduce this percentage, South Carolina Medicaid began a policy change in 2012 aimed at increasing the use of immediate postpartum inpatient insertions of long-acting, reversible contraceptives (LARCs).
As more primary care practices work towards identifying themselves as a medical home, patients and family caregivers can play a vital role in shaping how healthcare is delivered.
From my recent experience at the Infant Mortality Summits, a meeting of the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, it seems that the time is ripe for the widespread growth of quality improvement (QI) strategies in the public health arena.
Learning often begins when facts contradict our assumptions. While attending the kickoff summits of the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality in July, I became aware of at least two facts that contradicted my previous assumptions: (1) that infant mortality rates for non-Hispanic blacks are higher in the upper Midwestern states than they are in the deep South and (2) that the declines in infant mortality in several southern states over the past decade have been steeper than anywhere else in the country.
In previous blog posts, I've often featured a children's story as the jumping off point for my message. This time, "story" is the message.
As NICHQ's faculty chair for Best Fed Beginnings, a national initiative that supports hospitals seeking Baby-Friendly designation, I am frequently exposed to pushback regarding the improvements required for a hospital to achieve this designation. Recently, an article published in the Washington Post portrayed Baby-Friendly practices as a problematic set of policies that "force" a new mother to breastfeed against her wishes. Nothing could be farther from the truth.
In support of National Sickle Cell Awareness Month, NICHQ invited Fatima Oyeku, a woman living with sickle cell disease, to share her perspective. "Maybe I'm just being overly optimistic, but I honestly think SCD could be eradicated if more people knew their trait status and have the opportunity to make an informed decision about having children," she says.
Compared to other Western countries, infant mortality in the US is shockingly high. High infant mortality is a social problem that can only be solved through massive collaboration and out-of-the-box innovation.
The concept of collective impact is in NICHQ's DNA. All of our work is in some way about bring together participants from difference sectors committed to a common agenda to solve complex social problems. Until recently, we didn't have the benefit of the language or framework.
To more accurately reflect our purpose, we are making a change in our name, from "healthcare" to "health." NICHQ's purpose has always been to improve children's health. That is our passion and now our name is aligned.
Policies for using NICHQ's website and any content contained within.
A listing of all the main pages and sections on this website.


text:
June 2011
"Having relied on my beefy 15'6" GLX's for fishing the fast-running waters of Russia's Kola Penninsular in previous years I have to say that I had some concerns using the much lighter 15' NRX for what I consider the toughest test in my Salmon Fishing calendar. I needn't have worried.The NRX handled the heavy Shooting Heads really well casting the 35 metres needed with minimum effort, although I had to alter my impatient style somewhat ! The rod really came into its own casting my 750 grain Skaggit, the progressive action is ideally suited for this type of line, and with wind often a problem on the Kola I wouldn't be without the Skag.
NRX tested by Rae Borras
Test NRX Salmon rods by Rae Borras
Above all, the "feel" of the NRX when playing a fish is fantastic.The fishing was hard on the Kola this Spring due to unusual weather and seven fish to 22lb for my week was disappointing, but every one was a joy to play on the rod. I played a very big fish on the Eastern Litza for a while and never thought I was running out of "poke".Eventually the hook did exactly that and straightened!
Meanwhile my fishing buddie Mark Bird was putting his NRX through its paces whilst landing a superb 34lb fish on the Eastern Litza.Thinking he wasn't fishing deep enough in a gulley on the "Dream" pool he had a rare brainwave and decided to double-up his "German Snaelda" fly and use two in tandem! It was this set-up that the big fish took!. Great fishing or just luck? I will pay Mark the respect of congratulating him on a great piece of fishing.
I will have to wait until next year to trump his fish, but one thing is certain: the 15'NRX will be in my rod-case as the ideal tool for the job.
Rae Borras,
Fishing Presenter OnlineFishing TV
Rae Borras,
Fishing Presenter OnlineFishing TV
22lb salmon
17lb salmon
22lb salmon

subset: commoncrawl