putting bright futures into practice by engaging parents christina bethell, phd, mba, mph,...
TRANSCRIPT
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
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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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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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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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
American Academy of PediatricsOctober 2011 PreSIP Discussion
Data In Action Focus
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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?
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
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?
Overview of HRSA/MCHB R40 Funded CAHMI/OHSU Patient-Centered Quality
Measurement and Improvement Project (2/08-2/12)
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)
Baseline Quality MeasurementHomepage for Online PHDS
(www.childrensclinicsurvey.com)
American Academy of Pediatrics2011 National Conference and Exhibition
Provider Feedback Report on the PHDS
American Academy of PediatricsOctober, 2011 PreSIP Discussion
Parent-Centered Quality Improvement Tool:Plan My Child’s Well Visit Tool (Paper-based Tool)
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
Shared Encounter Form: ExampleRelated Bright Futures Recommendation
Anticipatory Guidance & Parental Education
3.Child & Family Health Screening
Page 1: SHARED ENCOUNTER FORM (SEF)Related Bright Futures Recommendation
4. Developmental Surveillance
Page 1: SHARED ENCOUNTER FORM (SEF)Related Bright Futures Recommendation
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
3.Child & Family Health Screening
Page 1: SHARED ENCOUNTER FORM (SEF)Related Bright Futures Recommendation
SHARED ENCOUNTER FORM (SEF):PAGE 2 (Copy Goes to Parent)
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
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.
American Academy of PediatricsOctober 2011 PreSIP Discussion
Additional PCW Features: Developmental Screening 9, 18, & 24 Month Visits
American Academy of PediatricsOctober 2011 PreSIP Discussion
Extending the Well Child Care Visit: Online Educational Materials Via the PCW
American Academy of PediatricsOctober 2011 PreSIP Discussion
Extending the Well Child Care Visit: Parent Visit Guide
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
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?]
American Academy of PediatricsOctober 2011 PreSIP Discussion
Examples of the EHR Feed: General Child Screeners
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
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
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
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)
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%
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”
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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Thank You
Christina Bethell, PhD, MBA, MPHDirector, The Child and Adolescent Health Measurement Initiative
Kasey McCracken, [email protected]
For additional information about the PCW, contact [email protected]
Colleen Reuland, MSExecutive Director: Oregon Pediatric Improvement Partnership