CCDPH serves the North, West and Southern suburbs surrounding the City of Chicago. The primary goal of CCDPH is to optimize and achieve health equity for all living within our jurisdiction. Population: 2.5 million living within 125 municipalities over a 700-mile square area.
As a part of the COVID-19 pandemic strategic plan, over 200 Contact Tracers were hired to interview patients, provide information regarding proper isolation/quarantine processes and identify resources needed to isolate safely. CCDPH CTI maximized existing Care Coordination Teams to provide resources to patients in need. With the huge rise in the number of cases, it soon became apparent that the existing processes could not meet the needs of the patients. CCDPH pivoted and created an independent Contact Tracing Initiative (CTI) Care Resource Coordination (CRC) Team.
The CTI CRC Team was created to serve all patients within the CCDPH demographic area who truly identified a need to safely isolate/quarantine. As the pandemic progressed, it was quickly identified that issues such as food insecurity and Mental/Emotional Health needs were exacerbated. The goal was to identify and address immediate needs, but to also connect patients with ongoing resources and support. An additional, unplanned, but much needed benefit to the program was to further build trust in the Public Health System by meeting the needs of the patients and one on one communication.
The new CTI CRC Team, consisting of 8 members, were chosen from the existing pool of Contact Tracers. They were identified based on their communication skills, ability to critically think and a willingness to serve patients throughout the CCDPH area. Several members were also Bilingual (Arabic, Polish and Spanish-speaking). Trainings were held to educate the new CRC Team members, but to also share the new process with the entire CTI Team of over 200 Contact Tracers and Supervisors. The process was implemented within a month of inception. The “new” CTI CRC has been consistently able to rapidly address patient resource requests. Because of the team’s hard work, positive outcomes have been identified:
- Needs of the patients have been met and met quickly, developing a greater degree of trust within the CCDPH community.
- Contact Tracers, who had lost faith in the CRC process, were more willing to offer resources to those truly in need, as they knew that the request would be responded to in a timely manner.
Initial Results: From June to December 2021: The CTI CRC addressed all 5249 requests in less than 42 hours and was able to close 99% of the requests, significantly surpassing the State of Illinois goal to address requests within 48 hours.
The CTI CRC Team was created to addressing the basic isolation/quarantine needs of the COVID-19 positive patient population within the CCDPH jurisdiction and leveraged technology, analytics and community partnerships for implementation.
The following tools were created and executed rapidly to meet the growing needs of the community:
- A “Home-Grown” database identifying local Community Based Organization to support needs at a hyper-local level.
- Development of close, working relationships with Community Based Organizations (CBOs). The CRC leaders held brainstorming meetings with the CBOs to identify needs at the local level, identifying best-practices to meet the needs of their specific community.
- Use of “Now Pow”: A tool identifying additional resources within a short distance of the client’s home allowing the client to develop a relationship with a local support system.
- Partnering with the State of Illinois team responsible for the CTI documentation program, “Sales Force”.
- Development of a CTI CRC focused Tableau data base to allow the team to address analytics. The team leaders have the ability to drill down to the slightest detail (age, Zip Code, demographic, type of need) to make adjustments and prioritize resources as needed.
- The two leaders of the CTI CRC adopted the “Plan-Do-Study-Act” (PDSA) process of continuous improvement by meeting with CTI leadership on a weekly basis. Because of the analytic tools and feedback loops created with the CBOs action plans could be quickly developed. Through the use of Tableau, the team could quickly identify outcomes of actions taken.
- An example of CTI CRC Tableau analytics is attached to this application.
The CTI CRC quickly identified the need to create partnerships at multiple levels in order to be successful. In addition to working with the Sales Force Team and local CBOs, the Team built relationships with the affiliated Cook County Hospital system. A few examples:
- Supply Chain/Logistics: The Team partnered to mobilize excess stock of PPE and deliver to the smaller CBOs who could not stockpile larger amounts of product. This partnership allowed for a more equitable distribution of product.
- Hospital relationships: The Team developed relationships with hospital-based leaders in respite housing, Social Work and Nursing for opportunities to enhance the care provided to the Covid Positive patients.
From the onset, the CTI CRC recognized the need for continuous quality improvement. In addition to the processes listed above, the following practices have been implemented:
- Daily CTI CRC Huddle: The Team meets daily for 30 minutes to discuss the issues of the day, challenging cases and to bounce ideas off of one another.
- TEAMs “CHAT”: Via Microsoft TEAMS, the CTI CRC asks for help from Team members, shares new CBO/local resource connections and identifies needs.
- Mental/Emotional Health partnerships: Development of a link between the CTI CRC and local mental health agencies for individual and group support for patients. Additionally, support for local school districts have been established due to our collaboration.
- School District Support: The CTI CRC has established a strong working relationship with schools within the CCDPH jurisdiction. Through the use of public email address, local school nurses and administrators are free to reach out to the CT CRC Team for resource consultation.
Lessons learned:
- Flexibility: The Team needed to be nimble enough to address frequent changes. With the sudden arrival of omicron and the Fall surge of Delta, the team was willing to adapt quickly and identify processes to reach out to the greatest number of clients with limited resources.
- Communication: Setting the standard of open communication with no idea being too small or too “Innovative”. Big thoughts can generate new processes, either within the team or with our constituents.
- Data: Tracking data and being able to act quickly in response to changes has been a key to the Team’s success.
Epidemiology
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