At Zufall Health Center, Quality Improvement Leads to Patient Empowerment

September 16, 2014
By Kristen Holmstrand

Sam Wakim and Rina Ramirez
Rina Ramirez, MD, FACP, Chief Medical Officer, and Sam Wakim, DMD, MPH, Chief Dental Officer, of Zufall Health Center

At Zufall Health Center, a medical and dental home based in northwestern New Jersey that provides health services to more than 21,000 vulnerable and underserved local residents, quality improvement work has become central to ensuring that the center delivers the best care to its community. Through several learning collaborative projects, including the NICHQ-led Collaborate for Healthy Weight and Early Childhood Caries Collaborative, Zufall Health Center has found that small tests of change led to an improved process for providing patient education and patient empowerment.

Focus on the community
In early 2012, Zufall set out to address obesity in the community with their participation in the Healthy Weight Collaborative. At that time, there were few programs aimed at promoting healthy eating and active living in Zufall’s home community of Dover, NJ, where 60 percent of adults and 20 percent of children were obese or overweight. The health center sought to develop an assessment tool for incorporating discussions of healthy eating and active living into every well-child and routine adult physical visit. Through numerous Plan-Do-Study-Act (PDSA) cycles—small tests of change to rapidly test and implement improvements—the team was able to develop an assessment tool customized to its staff’s and patient’s needs.

“Through PDSA cycles, we developed risk assessment tools that were reviewed and approved by patients, and also met the objectives of identifying risks, providing education and counseling, and developing self-management goals,” says Zufall’s Chief Medical Officer and team leader Rina Ramirez, MD, FACP. “The process was incorporated into the workflow and different members of the health care team were assigned to conduct the assessment, review the plan and document the intervention in the medical record. The process is now a routine part of medical visits at all of our sites.”

Ramirez quickly realized that there was a natural fit between her medical team’s obesity prevention work and Zufall’s dental team goals. For example, the teams found mutual benefits in encouraging children and adults to cut down on sugar and soda consumption. This relatively small step towards healthy eating would affect obesity rates and help prevent cavities.

A year later when Zufall Health Center joined the Early Childhood Caries Collaborative, Chief Dental Officer Sam Wakim, DMD, MPH led the new team and used the healthy weight assessment tools as the base for a new patient-friendly dental assessment tool. The team also tested providing cultural competency and motivational interviewing training to staff to make conversations about using the assessment tools easier.

Empowering patients

Through both collaboratives, Zufall Health Center found that the most exciting result of their work was improved patient education and empowerment. In using the assessment tools, clinicians and dentists were now having regular conversations with patients about risk factors, healthy eating and active living—tailored to each individual’s needs.

Father and Son at the dentist's office

Zufall Health Center’s Davia D. Strachan, DDS, reviews the dental assessment form with patient Anthony Gomez and his father, Ramiro Gomez.

“We used to just make notes in a patient’s file; now those notes are the start of a conversation so patients can understand what is going on and why,” explains Wakim. “We target our prevention plans to the patient based on their needs and what they’re capable of doing. Now, the patients realize how much control they have over their own health.”

Zufall’s providers make sure that patients and their families can articulate their self-care goals before the visit ends. And, the new assessment tools are designed so that families can take the form home and hang it on their refrigerator as a reminder of their ongoing self-care goals.

“Both collaboratives helped us to communicate the message of prevention, to empower patients to take control of what they do have control over, and to discuss self-management goals more effectively,” shares Ramirez. “We have become better providers, a better health center and a healthier community.”

Patients couldn’t agree more. Ramiro Gomez, father of four, is grateful to Zufall Health Center for the reminders about good dental health. “Zufall gave me a wake-up call about my little ones’ teeth. I was in shock that they got cavities. The center opened my eyes and reminded me of all the things my wife and I need to be on top of, like brushing and cutting down on sweets,” he explains.

After bringing the assessment tool home and working with his family (including the children’s babysitter), Gomez has seen great improvement. “Things are going really well. We check the calendar [tool] for brushing, and now my kids give me a lecture about what is healthy,” says Gomez. “I’m very thankful for everyone at Zufall, and I’m really happy about the service we receive.”