enhancing the medical home for children with special health care needs: a quantitative approach the...
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Enhancing the Medical Home for Children with Special Health Care Needs: A Quantitative Approach
The Quality ColloquiumAugust 20, 2008
Angelo P. Giardino, MD, PhD, MPHRenee M. Turchi, MD, MPH
Overview Definitions
Medical Home Children and youth with special heath care needs (CYSHCN)
The Center for Children w/ Special Health Care Needs
Medical Home Index Definitions Center specific data
Educating Practices in the Community – Integrated Care Program (EPIC-IC)
Joint Statement Medical HomeCore Principles
Personal physician Physician directed medical practice Whole person orientation Care coordination across multiple systems Quality and safety Enhanced access Appropriate payment for services
Who are children and youth with special health care needs (CYSHCN)?
Children who have or are at increased risk for chronic physical, developmental, behavioral,
or emotional conditions
and
who also require health and related services of a type or amount beyond that required by
children generally.
How many children and youth have special health care needs?
Approximately 13-18% (9-12.5 million) of children in the U.S.
Approximately 15.4% of children in PA have special health care needs (430,640 total)
Functional and Clinical Outcomes
family-centered,timely,efficient
coordinated & equitable
evidence-based & safe
informed,activated
patient/family
supportive, integrated community
prepared,proactive
practice team
Health System
Health Care Organization (Medical Home)DeliverySystemDesign
Decision Support
ClinicalInformation
Systems
Care Partnership
Support
Community Resources & Policies
Care Model for Child Health in a Medical Home
The Center for Children with Special Health Care Needs
What is our mission?
To work together with families of children and youth with special health care needs to provide ongoing,
comprehensive, family-centered medical care and to improve access to services, community resources and advocacy to assure that children obtain optimal support through life stages as well as promote their independence
with dignity and respect.
The Center for Children with Special Health Care Needs
Located at St. Christopher’s Hospital for Children
Inception: 2003
Staff 3 pediatricians 2 nurse care coordinators Social Worker Office Manager Patient Service Rep
Patient Population at The Center
The number of CYSHCN identified at The Center has increased 50% since 2003.
2007
2006
2005
2003-04
+
The Center also treats siblings of CYSHCN.
Data and Tracking our Progress…..
Description of our Services
Well-child and acute illness management
Develop care plans Collaborate with schools Coordinate care across
multiple systems (i.e. community resources)
Special Programs
Medical Home Index (MHI) Nationally validated measurement tool
Measures 25 indicators across six domains Organizational capacity Chronic condition management Care coordination Community outreach Data management Quality management
Each domain scored 1-8 Overall MHI score transformed 1-100
Center for Medical Home Improvement, www.medicalhomeimprovement.org
Medical Home Index Scores
Domain
2.6 2.73.0
2.53.0
2.5
4.33.8
4.2
3.03.5
5.56.4
6.77.5
4.54.0
6.0
0
2
4
6
8
OrganizationalCapacity
ChronicCondition
Mgmt.
CareCoordination
CommunityOutreach
Data Mgmt.
QualityImprovement
Item
score
Year 1
Year 2
Year 3
p<0.05
Complexity Scores of CYSHCN
0
10
20
30
40
50
1 2 3 4
St. Chris
PA
Types of Insurance- The Center for CSHCN
Public82%
Private13%
Public+ Private
5%
Time Spent on Care Coordination
PCP<1%
(87)
Office Staff15%(3118)Other
4%756
Care Coordinators76%
(15,496)
Social Worker5%(951)
Center Activities Over Time2004 2005 2006 2007
Referrals to specialists 2255 3213 3178 2907
Studies 1000 1509 1516 1407
Care Plans 243 120 244 261Medical
Summaries 157 175 245 285
Community resource referrals
739 570 370 715
Mental Health
referrals169 80 64 76
Health Care Utilization
0
100
200
300
400
500
600
700
800
Admissions Ed Visits Total Patients
2004-05
2006
2007
Programs at The Center at SCHC
Participate in EPIC IC Care Coordination Home Evaluations Joint Pulmonary Program FASD Initiative Transition Program Down Syndrome Program
How did the Center for CYSHCN evolve?
What is the EPIC IC program?
Quality improvement initiative
Works with pediatric practices to implement Medical Home principles within the practice
Data Collection and Management
Site visits/Technical Assistance/Conferences
Summary of EPIC IC Participation
62 practices trained in medical home principles
Over 33 practices received funding for care coordination
Practices represent: 6 regions & 30 counties in PA urban, suburban, and rural communities Hospital systems
EPIC IC Medical Home Sites
Medical Home Adopter (currently active in EPIC IC)
Medical Home Adopter (Achieved implementation)
Medical Home Adopter (First year of implementation)
Medical Home Trainee (Received Training)
In recruitment
Satellite office
Average Practice MHI Scores By Domain
3.4
5.2
5.9
4.3
5.4
6
4
5.5
6.3
3.8
4.7
5.5
3.7
4.4
5.3
3.2
4.85.0
3.7
5.0
5.7
0
1
2
3
4
5
6
7
8
Org. Cap. CCM Care Coor. Comm. Out. Data Mgt. QI Total Score
Year 1 Year 2
Year 3
All p values <0.05
Where are we going?Policy, research, practice
Funding
AAP and Chapter involvement
Cost effectiveness
Co-management models
Adult Medical Home (IPIP)
NCQA Advanced Medical Home
ABP Certification
Contact Information
Angelo P. Giardino, MD, PhD, MPH
832-828-1216
Renee M. Turchi, MD, MPH
215-427-5331
References
Joint Principles of the Patient Centered Medical Home. American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA). March, 2007. http://www.medicalhomeinfo.org/Joint%20Statement.pdf
McPherson M, Arango P, Fox H, et al. A new definition of children with special health care needs. Pediatrics. 1998; 102: 137-140
vanDyck PC, Kogan MD, McPherson MG et al. Prevalence & Characteristics of Children w/ Special Health Care Needs.Arch Pediatr Adolesc Med 2004;158: 884-890
www.cshcndata.org Center for Medical Home Improvement, www.medicalhomeimprovement.org Newacheck PW., Strickland B, Shonkoff JP, et al. An epidemiologic profile of children
with special health care needs. Pediatrics. 1998;102:117–122. Strickalnd BB, McPherson M, Weissman G, et al. Access to the medical home:
Results of the National Survey of Children with Special Health Care needs. Pediatrics. 2004; 113(5):1485-1492.
www.pamedicalhome.org