the medical home and quality improvement a. chris olson, md, mhpa president washington chapter of...
TRANSCRIPT
The Medical Home and Quality Improvement
A. Chris Olson, MD, MHPAPresident Washington Chapter of PediatricsMedical DirectorSacred Heart Children’s HospitalClinical ProfessorUniversity of Washington
November 2, 2006
The Medical Home and Quality Improvement The Medical Home Quality Improvement Families and Quality improvement
What is a Medical Home?NOT just a building or place but a way of providing
health care services that are:
• Accessible • Family-centered• Coordinated• Comprehensive• Continuous• Compassionate • & Culturally Sensitive
Children with Special Health Care Needs
“Children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”
Adopted by the AAP (October 1998). McPherson M, Arango P, Fox HB, A new definition of children with special health care needs. Pediatrics 1998; 102:137-140
Crossing the Quality Chasm – A new health care system for the 21st century
“The current care systems cannot do the job. Trying harder will not work. Changing systems of care will”
“Improved performance will depend on new system designs.”
American Academy of Pediatrics Quality Improvement Medical Home and quality improvement part
of the strategic plan for the Academy Maintenance of certification requires quality
improvement activities for pediatricians that board certified.
American Academy of Pediatrics
May 2005 Board of Directors affirm commitment to quality and approve significant funding for quality initiative Increase QI staff infrasturcture and resources Develop and support primary care innovation
network Identification, testing and refinement of tools, strategies,
and measures to translate guidelines into practice
Measures: how will they be used
AAP Draft policy statement on measures We believe that the primary purpose of
performance measurement should be to identify opportunities to improve patient care. We support the use of performance measures that are utilized in the spirit of continuous quality improvement. We affirm the importance of partnership with children and families in these improvement efforts.
State efforts for quality improvement and medical home Immunization registries/immunization rates of
the practice Oral Health/Fluoride Varnish Obesity prevention/BMI’s Well visits/Bright futures Collaboratives Medical Home Leadership Network/Website
Medical Home Index
Office/Family Organizational capacity Community outreach Chronic condition management Data management Care coordination Quality improvement
Medical Home IndexQuality Improvement/Change
Level 1
Quality standards for children with special health care needs are imposed upon the practice by internal or external organizations.
Medical Home IndexQuality Improvement/Change Level 2
In addition to Level 1, an individual staff member participates on a committee for improving process of care at the practice for CSHCN. This person communicates and promotes improvement goals to the whole practice.
Medical Home IndexQuality Improvement/Change
Level 3
The practice has it own systematic quality improvement mechanism for CSHCN; regular provider and staff meetings are used for input and discussions on how to improve care and treatment for this population.
Medical Home IndexQuality Improvement/Change
Level 4
In addition to Level 3, the practice actively utilizes quality improvement (QI) processes; staff and parents of CSHCN are supported to participate in these QI activities; resulting quality standards are integrated into the operations of the practice.
Data Collection
Data person FACCT survey criteria Excel spreadsheet/Access Disease specific data collection Insurance plans
Care Coordination
Office coordinator Inservice presentations Care Plans Specialty follow up Chronic Care visits
Reminder system Care Coordination costs
Cost of Care Coordination
774 encounters/not reimbursed services Most complex consumed 25% of the time 11% of the patients 51% of the encounters not medical Cost of time spent coordinating
$22,809 to $33,048 Efforts to finance unreimbursable care
coordination
Future efforts
Increase reimbursement to pediatricians/family physicians who care for children leading to increased access
Reimbursement for services directly related to care coordination or preventive services
Task force on quality Release of policy this fall Pay for Performance
Family centered care
Family is the constant in the care of the patient
Connecting families Newsletter Bulletin board
Family advisory council Asking families and surveys
A medical home should be able to…
Form active partnerships with families Identify and monitor CSHCNs Coordinate care in a systematic manner Communicate with other community
resources and pediatric specialty services
This requires redesign of existing services