Transcript The Medical Home and Quality Improvement

The Medical Home and
Quality Improvement
A. Chris Olson, MD, MHPA
President
Washington Chapter of Pediatrics
Medical Director
Sacred Heart Children’s Hospital
Clinical Professor
University of Washington
November 2, 2006
The Medical Home and Quality
Improvement
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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:
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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
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“The current care systems cannot do the job.
Trying harder will not work. Changing
systems of care will”
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“Improved performance will depend on new
system designs.”
American Academy of Pediatrics Quality
Improvement
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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
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May 2005 Board of Directors affirm
commitment to quality and approve
significant funding for quality initiative
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Increase QI staff infrasturcture and resources
Develop and support primary care innovation
network
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Identification, testing and refinement of tools, strategies,
and measures to translate guidelines into practice
Measures: how will they be used
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AAP Draft policy statement on measures
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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
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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
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Office/Family
Organizational capacity
Community outreach
Chronic condition management
Data management
Care coordination
Quality improvement
Medical Home Index
Quality 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 Index
Quality 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 Index
Quality 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 Index
Quality 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
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Data person
FACCT survey criteria
Excel spreadsheet/Access
Disease specific data collection
Insurance plans
Care Coordination
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Office coordinator
Inservice presentations
Care Plans
Specialty follow up
Chronic Care visits
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Reminder system
Care Coordination costs
Cost of Care Coordination
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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
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$22,809 to $33,048
Efforts to finance unreimbursable care
coordination
Future efforts
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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
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Family is the constant in the care of the
patient
Connecting families
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Newsletter
Bulletin board
Family advisory council
Asking families and surveys
A medical home should be able to…
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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
References
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www.medicalhomeinfo.org
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www.medicalhome.org
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Source for CME on quality improvement
www.medicalhomeimprovement.org
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State of Washington medical home site
www.nichq.org
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AAP site for medical home information
Medical Home Index site
www.ihi.org
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CME on quality improvement
Children and adults