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Using Continuous Quality Improvement Tools to Promote Tobacco Cessation Among Primary Caregivers in a Home Visiting Program in Alabama

Fifolt, Matthew PhD; Preskitt, Julie PhD, MSOT, MPH; Johnson, Heather H. MPH; Johns, Elisabeth MPH, OTR/L; Zeribi, Karen Askov MHS; Arbour, MaryCatherine MD, MPH

Journal of Public Health Management and Practice: November/December 2019 - Volume 25 - Issue 6 - p 543–546
doi: 10.1097/PHH.0000000000000833
Research Reports: Research Brief Report

Alabama's Maternal, Infant, and Early Childhood Home Visiting–funded program was one of 10 state teams accepted to participate in the first wave of the Federal Home Visiting Program State and Territory Continuous Quality Improvement Practicum. This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners. The Alabama team tracked CQI data weekly for the duration of the practicum using an annotated run chart. Participants included 20 identified tobacco users in 2 participating LIAs. This article highlights specific CQI tools to achieve the project aim. On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim; these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.

Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama (Drs Fifolt and Preskitt and Mss Johnson and Johns); Shift-Results, Seattle, Washington (Ms Zeribi); and Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Arbour).

Correspondence: Matthew Fifolt, PhD, Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 330N Ryals School of Public Health, 1665 University Blvd, Birmingham, AL 35294 (

The authors thank the members of the Alabama Department of Early Childhood Education for their participation in the CQI Practicum as the state grantee, specifically Dianna Tullier, Tami Sellers, and Lee Johnson III. In addition, the authors are grateful for the significant contributions made by Alicia Thurmond and Tina Barnes, the two lead parent educators who worked with their HV sites to test ideas throughout this practicum. The authors also express their appreciation to the families, home visitors, and home visiting supervisors who served as partners in this project. Dr Arbour acknowledges contributions of Susan Zaid, Julie Leis, and Matthew Poes at James Bell Associates and Mary Mackrain and Kelley O'Carroll at Education Development Center, Inc.

The CQI Practicum is part of the Design Options for Home Visiting Evaluation (DOHVE) Contract which is led by the United States Department of Health and Human Services' (“HHS”) Administration for Children and Families (ACF) in collaboration with the Health Resources and Services Administration (“HRSA”). DOHVE was awarded to James Bell Associates in partnership with Educational Development Center, Inc. This publication lists nonfederal resources to provide additional information to consumers.

The views and content in these resources have not been formally approved by HHS, ACF, or HRSA. Listing these resources is not an endorsement by HHS, ACF, or HRSA.

The authors have no conflicts of interest to report.

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