Incorporation of the Bright Futures Program in Rural, KS

Dr. Ellen SquireDr. Michelle PopeLisa Gagnon RN

Preventive Services Improvement Project

Learning Session 2

November 11-12, 2011

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Disclosures

We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. We do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation.

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About HaysMed Pediatric Center

Ave. number of visits per year: 15,600 Number of well checks per year: 7,200

We have added providers! 4 full-time and 1 part-time pediatricians 1 part-time physician assistant

Only pediatricians for a large referral area

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Where we started

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Where we started

Paper based system, old paper forms

Limited anticipatory guidance No standardized developmental screening No standardized autism screening No maternal depression screening No dental screening

Great variability between physicians Inconsistent BMI, Wt/Lgth, vision, hearing

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Initial Barriers and Concerns

Physician resistance Nursing/Staff concerns Parental cooperation Paper obligations Insurance/payment concerns Referral agent/agency availability Time!!

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Our 1st Approach

Gradual Progression 2 month and 18 month WCC Concurrent office systems/referral tracking 1-2 forms/month throughout the year with

gradual incorporation of Dental, ASQ, MCHAT, etc.

Forms Only Previsit Questionairre WCC form

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Gradual Progression???

February: forms - 2 mo. & 18 mo.• Previsit Questionnaire• Referral Tracking/CYSHCN tracking• Preventative Services Prompting Sheet

March: 2 more forms - 9 mo. & 2 yr.• Community Resources Update• Supplemental Quentionnaires

April: 2 more forms - 4 mo. & 6 mo.• ASQ

May: 2 more forms - 1,2 week & 1 yr.• Dental Screening/Fluoride

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Gradual Progression???

June: All visit forms• MCHAT

July: All visit forms• Maternal Depression

August: All visit forms• Parental Strengths

September/October:• Review

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Our Biggest Barriers

Nursing/Staff resistence• Perceived “extra work”

Referral Tracking

Plethora of Paper!

Maternal depression/Dental

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Our Biggest Barriers

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What Surprised Us

It was relatively easy Physicians were a minor barrier Feel like WCC are more complete

Little time for supplemental forms

Time was the same

Brought us together

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Any changes?

Less paper?

Strength based approach - • cue on form

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Conclusions

We had a great time

Learned a lot about our office: physicians, staff, and ancillary agencies

Went from doing a good job on WCCs to “pride” in our WCCs

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are needed to see this picture.