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Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative, Portland, OR, Kasey McCracken, MPH Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative, Portland, OR, Colleen Reuland, MS, Pediatrics, OHSU, Oregon Pediatric Improveme Partnership, Portland, OR

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Page 1: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Putting Bright Futures into Practice by Engaging Parents

Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative, Portland, OR,

Kasey McCracken, MPH Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative, Portland, OR,

Colleen Reuland, MS, Pediatrics, OHSU, Oregon Pediatric Improvement Partnership, Portland, OR

Page 2: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Agenda for Call

• Brief overview of CAHMI

• Engaging Patients – Why is it needed?

• Operationalizing Bright Futures – Harnessing the Power in Patient Engagement • Overview of patient engagement tools current in use

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Page 3: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

About the CAHMI

Who We Are: The Child and Adolescent Health Measurement Initiative

(CAHMI) is a national, not-for-profit initiative based out of Oregon Health and Science University in the Department of Pediatrics in Portland, OR. Originally housed at FACCT - Foundation for Accountability, the CAHMI was established in 1997.

Our Evolving Mission:“To ensure that children, youth and families are at the center of quality measurement and improvement efforts in order to advance high quality consumer-centered health care.”

“Providing data and inspiring partnerships to improve health care promote lifelong health for children, youth and families.”

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Page 4: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Key Topics Addressed by CAHMI Tools

Coverage and Access• Insurance coverage, gaps in coverage and impact of uninsurance and

type of coverage• Adequacy of insurance• Timely access to covered/needed care

Quality & Equity• Medical home for all children and children and youth with special

health care needs• Mental, emotional and behavioral health• Health disparities for vulnerable populations (minorities, low income,

by health status/CSHCN)Prevention and Healthy Development

• Childhood obesity (BMI, Activities, TV watching, etc)• Early childhood development• Transition to adulthood

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Page 5: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Application of Measures

NQF Ratified/Endorsed:1. CAHMI Promoting Healthy Development Survey (PHDS) 2. CAHMI Young Adult Health Care Survey (YAHCS)3. Developmental Screening –CAHMI Steward with NCQA4. CAHPS-CCC (CAHMI led initial development of prior to NCQA

endorsement)5. 21 Measures from the National Survey of Children’s Health (NSCH) and

National Survey of CSHCN, including• Medical Home• Insurance Adequacy• Gaps in Insurance (Duration)• Care Coordination• Developmental Screening• Transition to Adulthood for CSHCN• School and Community Measures• Health Risks (BMI; Smoking in Home; Dental Carries/Decay) and Behaviors (Physical

Activity)

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CAHMI Measures Endorsed by the National Quality Forum

Page 6: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Data In Action Focus

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Page 7: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

The Good News!

• Patient-centered care, engagement and choice are included as strategic pillars of prominent policy and improvement efforts

• We have moved beyond the “feel good” interpretation of patient-centered care and “us vs. them” interpretation of engagement and choice.

• Growing consensus that good quality care and health outcomes is substantially related to whether consumers and patients are able to play a significant role in selecting, managing and evaluating their own care.

Patient-Centered Quality Measurement & Improvement:

Why is it needed?

Page 8: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Why are Patient-Centered Measurement Tools Needed To Improve in Well-Child Care ?

Efforts are needed to improve well-child care Assessments of quality for well visits show 9 out of 10 children receiving

well visits miss one or more of basic aspects of recommended care. Parents report they wish they had received this care.

Sig. variation in quality of care by : Child and family characteristics; Provider; Office System

• Within provider variation is as large as across providers

Well-child care is primarily about educating and empowering the parent/family to promote child’s development Parent-based data needed about whether informational needs are met and status of child and family health

Yet, the parent/patient voice is often missing in efforts to assess and improve quality--despite the fact that

patients are often the most valid source for quality measurement and

are essential partners in improvement

Page 9: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Operationalizing Bright Futures

The New Challenge of the Revised Guidelines

• The revised guidelines call for the provider to “attend to the concerns of the parents” as a first priority for the visit.

How can pre-visit tools support providers to address parents’ priorities?

Page 10: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Overview of HRSA/MCHB R40 Funded CAHMI/OHSU Patient-Centered Quality

Measurement and Improvement Project (2/08-2/12)

Page 11: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Using the CAHMI Promoting Healthy Development Survey (PHDS)

Using the CAHMI Parent PlanYourChildsWellVisit (PCW) Online Tool and Parent Information Integrated into the EHR

“Enhanced Encounter” Well Child Care Model

Using the Provider and Clinic Specific “Provider Feedback Reports” from the Promoting Healthy Development Survey (PHDS)

Page 12: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Baseline Quality MeasurementHomepage for Online PHDS

(www.childrensclinicsurvey.com)

Page 13: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of Pediatrics2011 National Conference and Exhibition

Provider Feedback Report on the PHDS

Page 14: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober, 2011 PreSIP Discussion

Parent-Centered Quality Improvement Tool:Plan My Child’s Well Visit Tool (Paper-based Tool)

Page 15: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Bright Futures Recommendation:Where it is in the Online PCW Tool

Part 1: Open-ended questions

1. Share with me one thing that your child is able to do that you're excited about:

2. Are there any specific concerns you would want to discuss at your child’s upcoming well-visit?

3. Have there been any MAJOR changes in your family lately? Check all that apply.

4. Do you have concerns about your child’s learning, development or behavior?

• Part of developmental surveillance

Page 16: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Shared Encounter Form: ExampleRelated Bright Futures Recommendation

Anticipatory Guidance & Parental Education

Page 17: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

3.Child & Family Health Screening

Page 1: SHARED ENCOUNTER FORM (SEF)Related Bright Futures Recommendation

Page 18: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

4. Developmental Surveillance

Page 1: SHARED ENCOUNTER FORM (SEF)Related Bright Futures Recommendation

Page 19: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

SEF FRAMEWORK FOR FORMATTING:DESIGNED FOR EASY USE/SCORING

Developmental Surveillance• Bold are milestones 90% children do (rec. screening)• Non-bold – give ASQ Learning Activity

Page 20: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

3.Child & Family Health Screening

Page 1: SHARED ENCOUNTER FORM (SEF)Related Bright Futures Recommendation

Page 21: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

SHARED ENCOUNTER FORM (SEF):PAGE 2 (Copy Goes to Parent)

Page 22: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Parent-Centered Quality Improvement Tool:Plan My Child’s Well Visit Tool: Demonstration

http://www.youtube.com/watch?v=KQMtCoFcWlA

Page 23: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Online PCW Tool – Content

Part 1: Child & Family Health Screeners 1A : Open-ended questions about strengths, questions or concerns, changes in the home

1B. General Child Health Screening Questions • Included The Children’s Clinic’s Lead and TB Screeners

1C: Developmental Surveillance, and, where applicable, a PDF of the ASQ.

1D: Screeners Assessing for Issues in the Family that Impact the Child

Part 2: Anticipatory Guidance & Parental Education

2A. Parent picks their top three priorities

2B. Education about recommended topics:-- Can be assessed before OR after the visit. -- So it can be referenced by provider during visit.

Page 24: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Additional PCW Features: Developmental Screening 9, 18, & 24 Month Visits

Page 25: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Extending the Well Child Care Visit: Online Educational Materials Via the PCW

Page 26: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Extending the Well Child Care Visit: Parent Visit Guide

Page 27: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Getting the Parent’s Voice into the EHR: Mapping to the Existing EHR Forms

EHR Forms Updated to Align to Bright Futures through this processPCW Section Related EHR Forms

1A: Open-ended questions Nurse Intake FormDevelopmental Screen FormAssessment of the Family (New Form)

1B: General Child Screening/TCC Lead & TB Screeners

Nurse Intake,Assessment & PlanTB/Lead

1C: Developmental Surveillance & Screening

Developmental Screen(ASQ not imported)

1D: Screeners Assessing for Issues in the Family/Home

Nurse Intake FormAssessment of the Family (New Form)

2: Anticipatory Guidance/Parent Education

Anticipatory Guidance

Page 28: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Examples of the EHR Feed: Open Ended items

[Parent report: She can say so much lately. It is fun to hear the new ]

[Parent report: Should she be interested in toilet training?]

Page 29: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Examples of the EHR Feed: General Child Screeners

Page 30: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of Pediatrics2011 National Conference and Exhibition

Findings Sneak Peak!PCW Usage Summary: June, 2010-Sept, 2011

• 2076 Completed tools (2139 started tool)• 43.2% response rate as of September, 2011

– varies by age of child, up to 52.2% for 6 month old visits

• Median Completion Time: 9 min

Page 31: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

What Parents Think: Some Early Findings

Interim Results from Follow-up Survey (N=154)

Overall Value• 91.7% of parents reported that they would recommend the

PCW to other parents• 85.2% of parents reported that the tool helps to prioritize

topics to discuss with the health care providerAcceptability• 91.2% of parents reported that they were comfortable with

the amount of time that it took to complete the tool

Page 32: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

PCW Usage Summary: June, 2010-Sept, 2011

Top 5 Priorities Picked (Across all Ages)Visit Priorities Number of Selections

Behaviors to expect in the next few months 887

Ways to guide and discipline your child 482

Your child’s moods and emotions 231

How much and what kinds of food your child eats 197

How much food your child needs, weight gain 174

Page 33: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of Pediatrics2011 National Conference and Exhibition

What Parents Think: Some Early FindingsUsefulness of PCW Features: Percentage of Parents Reporting Feature as “Extremely” or “Very Useful”

Ability to complete questions at home 98.70%

Ability to complete the tool before every visit, with age-specific questions 96.70%

Delivery of report to provider before the visit 90.50%

Availability of customized Visit Guide to take to the visit 66.90%(12.8% A Little/Not at all)

Availability of a report to keep as a record for the family 57.80%(17% A little/Not at all)

Access to online educational materials 83.20% (4% A little/not at all)

Page 34: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

What Parents Think: Some Early Findings

Parent Report of Whether the PCW Section Helped them to Identify Topics to Discuss with Their Child’s Doctor or

Healthcare Provider

Yes Somewhat Not Really

Child Health Screener. Topics about your child’s health 58.4% 20.8% 20.8%

Assessment of the Family. Topics about you and your family 46.3% 23.1% 30.6%

Developmental Surveillance. Topics about your child’s development and what he or she is able to do

80.8% 13.5% 5.8%

Page 35: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

What we hear!

Parents:

“I didn’t get my email!”

Providers:

“I can’t live without my CAHMI visits”

Page 36: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

American Academy of PediatricsOctober 2011 PreSIP Discussion

Next Steps

• Analyzing Evaluative Data• Parent report – using the PHDS• Provider surveys and focus groups

• Exploring funding and partners for next step• Beta test of existing tool focused on well-child care for

young children• Development of tools for other populations/needs

• Example: Children with special health care needs

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Page 37: Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative,

Thank You

Christina Bethell, PhD, MBA, MPHDirector, The Child and Adolescent Health Measurement Initiative

[email protected]

Kasey McCracken, [email protected]

For additional information about the PCW, contact [email protected]

Colleen Reuland, MSExecutive Director: Oregon Pediatric Improvement Partnership

[email protected]