Mainstreaming Chronic Disease Surveillance
Missouri’s Common Ground Project
The Missouri Department of Health and Senior Services (MDHSS) is committed to improving its chronic disease program planning and operations and integrating public health data and information systems into them. A grant from the Robert Wood Johnson Foundation, called Common Ground, taught program staff within the Bureau of Cancer and Chronic Disease Control to use a specialized methodology for defining and analyzing the shared business processes of its chronic disease programs.
The “business” of chronic disease programs is implementing programs directed toward individuals to help prevent the onset or to help slow the progression of chronic diseases and maintain a decent quality of life while living with the affliction. The Common Ground grant funded, in part, the program managers to develop a business process matrix plus associated context and task flow diagrams that visually depict program operations and then to redesign and integrate their processes for greater efficiency.
The Business Process Matrix depicts the components that characterize a business process—the goals, objectives, triggers, inputs/outputs, business rules, and outcomes (horizontal axis) —and also the key set of identified chronic disease program processes (vertical axis). Using the matrix to define the components, a workgroup of the chronic disease program managers were able to
- determine if a given activity had the appropriate structure to be classified as a business process,
- eliminate tasks that were mistakenly identified on the master list as business processes,
- recognize when two or more processes shared enough characteristics to be collapsed into one process.
The Context Diagrams—created using the Business Process Matrix—reflect relationships and boundaries that exist between participants, i.e. individuals and groups, within a work environment. These diagrams also illustrate the flow (lines) of transactions and health data information between participants (circles). Arrows indicate the direction of transaction or information exchange.
The activities that take place in a business process are referred to collectively as the task set for that process and are represented graphically by one or more Task Flow Diagrams. Task flow diagrams proceed from, and are more detailed than, context diagrams. Mapping of key tasks sheds more light on how resources are used within a business process.
Through analyzing and capturing their business processes in visual forms, the chronic disease workgroup realized the common elements across their program’s processes, task flows and contexts. The chronic disease program managers gained a better understanding of where and how to incorporate process efficiencies and health data information systems into their programs.
The Business Process Analysis and Redesign methodology can be used by any group, within MDHSS or outside (e.g. the Local Public Health Agencies), involved in efficiency improvement efforts or in fielding an integrated set of community programs. Also, the Information Technology Services Division’s requirements development strategies for information systems may benefit from field program staff awareness of the potential for the health information integration efficiencies inherent from using this methodology.
As another part of the Common Ground grant, MDHSS built and published a redesigned Chronic Disease Pathways web portal and a set of chronic disease specific Community Profiles and data query tools. These are available through the Chronic Disease Pathways page.
The main categories in the Pathways page, under which are listed chronic disease topics and links, evolved from the participants identified in the context diagrams of the business process analysis: programs to address specific diseases and risk factors, health data systems, the public, community partners and providers of health care services.
The data query tools, Community Profiles and interactive data tables, are based—as data was available—on the Indicators for Chronic Disease Surveillance found in the September 10, 2004/Vol. 53/No. RR-11 of the “Morbidity and Mortality Weekly Report.” These indicators include measures of physical activity and nutrition, tobacco and alcohol use, cancer, cardiovascular disease, over-arching conditions and other chronic diseases and risk factors. Chronic disease program managers, Local Public Health Agency administrators, and department epidemiologists added other useful indicators.
Eight distinct business processes were identified as common across MDHSS’ chronic disease programs: 1) Data Management; 2) Disease Status and Burden Assessment; 3) Policy, Standards and Regulations; 4) Program Administration; 5) Partner Mobilization; 6) Prevention, Control and Self-Management Education; 7) Screening and/or Risk Identification; 8) Program Evaluation. The Context and Task Flow Diagrams for each process are listed below.
Context Diagrams [return to text]
Context Diagram 1: Data Management
Context Diagram 2: Disease Status and Burden Assessment
Context Diagram 3: Policy, Standards and Regulations
Context Diagram 4: Program Administration
Context Diagram 5: Partner Mobilization
Context Diagram 6: Prevention, Control and Self-Management Education
Context Diagram 7: Screening and/or Risk Identification
Context Diagram 8: Program Evaluation
Task Flow Diagrams [return to text]
Task Flow Diagram 1: Data Management
Task Flow Diagram 2: Disease Status and Burden Assessment
Task Flow Diagram 3: Policy, Standards and Regulations
Task Flow Diagram 4: Program Administration
Task Flow Diagram 5: Partner Mobilization
Task Flow Diagram 6: Prevention, Control and Self-Management Education
Task Flow Diagram 7: Screening and/or Risk Identification
Task Flow Diagram 8: Program Evaluation