Transcript CHIPRA - Maine Quality Counts

Amy Belisle’s Disclosure
I have no relevant financial relationships
with the manufacturers(s) of any
commercial products(s) and/or provider of
commercial services discussed in this CME
activity.
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Objectives for First STEPS, LS 1
Setting the Stage: Why we are focusing
on Immunizations, the PCMH, and Bright
Futures
 Reviewing the Model for Improvement
 Teamwork: Conducting a Gap Analysis,
Crafting an Aim Statement, and
Developing PDSA cycles
 Next Steps: Moving Forward over the Next
8 months
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Learning Session Ground Rules
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Be respectful - always
Limit side conversations
Keep phone conversations out of meeting room
Respect confidentiality of conversations
Encourage everyone to contribute
Respect all opinions
Keep patient records confidential (breakout room
available in the Carriage House for confidential
computer work or taking calls)
Welcome to our Special Guests
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VCHIP
IHOC/Muskie
MaineCare
Office of Information Technology
Maine CDC, Maine Immunization Program
Maine AAP, AAFP, MOA
Maine Vaccine Board
Maine Immunization Task Force
Maine Immunization Coalition
Maine Child Health Improvement Partnership (ME
CHIP)
We have lots of experts
in the room!
First STEPS
MAINE
Lewiston
CMMC Pediatrics,
CMMC Family
Medicine
CMMC Pediatric
Hospitlaistss
Waterville
Pediatrics
Winthrop
Pediatrics
Kennebec
Pediatrics
Norway Western
Maine Pediatrics
Bridgton
Pediatrics
Bangor
Penobscot
Pediatrcs
Husson Pediatrics
EMMC Family
Medicine
Inpatient Pediatric
Hospitalists
MMP Westbrook
PediatricsWestbrook
South Portland
MMP South
Portland
Portland
MMP Portland
BBCH Pediatric
and Med-Peds
Clinic
MMC Family
Medicine Center
BBCH Pediatric
Hospitalists
Saco:
MMP Saco
EllsworthMaine Coast
Pediatrics
Rockland- PenBay
Pediatrics
FalmouthMMP Falmouth
Brunswick:
Bowdoin Medical
Group
Brunswick
Pediatrics
Practices Demographics
21 outpatient groups and 3 inpatient
hospitalists groups
 96 physicians
 30, 666 children with MaineCare covered
by practices by Aug 2010 numbers
 # practices in ImmPact 2: 16 practices
and 1 joining in October
 Chart review: 3 outpatient and 3
hospitalists groups
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Practices by the Numbers
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Practice coaches from the following
systems:
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Central Maine Medical Center
Eastern Maine Healthcare
Maine Coast Memorial Hospital
MaineGeneral
Maine Medical Center PHO/MaineHealth
Martin’s Point
Maine Primary Care Association
What is the Quality Gap?
The gap between the care we know
is best and our ability to deliver it,
every time, to every patient in the
way they need it.
Maine is 41st in the nation in immunization
rates (Commonwealth Fund, 2010)
 We need to move from thinking about
each patient we immunized in our office
last week to managing our entire
population of patients
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Why Is this Important to Your
Practice?
Meaningful Use Requirements
 Universal Childhood Immunization
Program–January 2012
 Pathways to Excellence
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Prevent Illness, Save Lives!
Immunizations
Save Lives and Money
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Immunizations are the most cost-effective health
prevention activity for children,
$1 spent= $6.30 direct medical cost savings and
$18.40 of indirect cost savings
95% decline in most vaccine-preventable
childhood diseases in 20th century
Currently only 18% of children in the United
States receive all vaccinations at the
recommended times
(Maine Primary Care Association. “LD 1408: An Act to Establish the Universal Childhood Immunization Program – a
Winning Combination for patients, providers and health plans in Maine,” 2010., Briss, P., Rodewald, L., Hinman, A.,
Shefer, A., Strikas, R., Bernier, R.,…Williams, S. “Reviews of Evidence Regarding Interventions to Improve Vaccination
Coverage in Children, Adolescents and Adults.” American Journal of Preventive Medicine, 2000, 18(IS), 97-100.
Omer, S., Salmon, D., Orenstein, W., deHart, M., Halsey, N. “Vaccine refusal, mandatory immunization, and the risks
of vaccine-preventable diseases.” NEJM, 2009, 360(19), 1981-1988., Gust, D., Strine, T., Maurice, E., Smith, P., Yusuf,
H., Wilkinson, M…Schwartz, B. “Underimmunization among children: effects of vaccine safety concerns on
immunization status.” Pediatrics, 2004, 114(1), e16-22.
Moving from Specific QI Initiatives to
Changing Systems
IHI Model for
Improvement
 Lean
 Six Sigma
 Dartmouth
Clinical
Microsystems
 PCMH
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(Making Health Care Work: A Microsystems Approach, Nelson, 2006)
“Systems are perfectly
designed to get the
results they achieve”
-Paul Batalden
Current “Systems”
Atlanta’s infamous
‘Spaghetti Junction’
What We Have Learned So Far:
Measurement is Complicated
 Data Collection is even more Complicated
 Practices have a lot of turnover in the
summer months
 Collaboration is a challenge when trying to
connect groups across health care
systems and independent sites
 When we work together, we can identify
problems and solutions much faster
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How Today’s Topics Fit Together
Immunization QI
Bright Futures
PCMH as the Foundation
4 Questions
When we meet 8 months from now to
discuss immunization rates, what needs to
happen in that time period for you to
consider this pilot a success?
 What are the barriers that you have to
face and work around to achieve
progress?
 What are the biggest opportunities that
you need to focus on and capture to
achieve success?
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4 Questions
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What strengths will you need to reinforce
and maximize and what skills and
resources will you need to develop that
you don’t currently have to capture these
opportunities?
Let’s make it fun! Games and Prizes!
Prize Categories for Today:
 Prize for 1st Person to Complete Ice
Breaker Game
 Prize for Best Theme Song
 Prize for Best Slogan for Raising
Immunization Rates/Learning
Collaborative
 Best idea to improve office flow around
immunizations
 Closest delivery date for the twins!
First Teams to Win:
Prize for 1st team to complete their
paperwork
 1st team to submit baseline data
 1st team to submit immunization survey
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