Transcript Maine Quality Counts presents… August Provider Lunch

The First STEPS Learning Initiative is part of the Maine Improving Health Outcomes for Children demonstration grant awarded
by the Centers for Medicare and Medicaid Services to MaineCare in partnership with the Maine Center for Disease Control and Prevention,
the Muskie School of Public Service at the University of Southern Maine, Vermont’s Medicaid Program, and the University of Vermont.
The Celebration Dinner is Sponsored by the MaineHealth Childhood Immunization Task Force
Game Plan for the Evening
• The First Steps Highlight Reel
• The 5th Quarter- The Work Continues
• The Awards Ceremony
• The Booster Club- How Your
Work Continues to Impact
Immunization Rates and Improve
the Lives of Children in Maine
First STEPS for the “I” TeamIdentify why it is important to work
on Immunizations? Why now?
• Decreasing vaccine-preventable disease has been named
one of the decade’s top ten greatest public health
achievements
• Maine, however, has experienced an increase in vaccine
hesitancy, refusals and delays
• Several outbreaks of Pertussis and Measles the last 2 yrs
• Immunization rates have stagnated: hovering between 6274% over the past ten years (4.3.1.3.3.1.4)
• Maine is 41st in the country; In 2011, the state with the best
immunization rate in the US was CT, at 96%
First STEPS: Need to Get Everyone
Moving Towards the Same “I” Goal
Need coordinated leadership and action to improve immunization
rates, decrease preventable diseases, hospitalizations, deaths, and
improve the quality of life of children and families.
Need to Build on Existing Payment Initiatives, Quality
Improvement Infrastructure, and Metrics:
• Improving Health Outcomes for Children (IHOC)/CHIPRA Grant
•Accountable Care
•Maine Universal Childhood Immunization Program, January 2012
• Patient Centered Medical Home
•Meaningful Use Immunization Metrics, CHIPRA 24 Metrics
• Pathways to Excellence
Need to Identify the League
Maine CDC
Maine Immunization Program
Martin’s Point Health Care
Maine Health Childhood Immunization Task Force
Maine Vaccine Board
22 Pediatric and Family Medicine Practices & 2 Inpatient Pediatric Hospitalist Groups
Need to Organize the League:
Maine Child Health Improvement
Partnership (ME CHIP)
• Mission
To optimize the health of Maine children by initiating and
supporting measurement-based efforts to enhance child health
care by fostering public/private partnerships.
• Vision
All practices providing health care to children will have the skills,
support, and opportunities for collaborative learning needed to
deliver high quality health care.
• Current Project
Overseeing the First STEPS (Strengthening Together Early Preventive
Services) Learning Initiative
Setting the “I” Goal:
• First STEPS Aim Statement: To improve preventive
services for Maine's children.
• Between Sept 2011 & Sept 2012, improve
immunization rates (2010) by > 4 percentage
points in practices that serve a high volume of MaineCare.
• For each vaccine, we set a goal of increasing by 4
percentage points if baseline >80% up to 96% and >10
percentage points if baseline less than 80%; baseline data
based on NIS data (not ImmPact 2- unavailable at the time)
• Outcome: By 7 months, we had reached 3 percentage point
improvement overall. (Muskie evaluation based on April
15, 2012 data)
Recruit the “I”
Teams
LewistonCMMC Pediatrics,
CMMC Family
Medicine
Norway –
Western Maine
Pediatrics
Waterville
Pediatrics
Winthrop
Pediatrics
Kennebec
Pediatrics
•22 Practices
•2 Hospitalist groups
•96 physicians
•30, 666 children with
MaineCare covered by
practices by Aug 2010
numbers
Bridgton
Pediatrics
BangorPenobscot
Pediatrics
Husson Pediatrics
EMMC Family
Medicine
EMMC Inpatient
Pediatric
Physicians
MMP Westbrook
Pediatrics
MMP South
Portland
Pediatrics
Portland
MMP Portland
BBCH Pediatric and
Med-Peds Clinic
MMC Family
Medicine CenterPortland
MMC Pediatric
Hospitalists
MMP Saco
Pediatrics
EllsworthMaine Coast
Pediatrics
RocklandPenBay Pediatrics
FalmouthMMP Falmouth
MMC Family
Medicine Center
Brunswick:
Martin’s Point Brunswick
Pediatrics
Brunswick Pediatrics
Run Practice Sessions
• Very important to name the team captainsoffice champions to run the project and leaders
to work at the state and community level
• Develop a learning community- 2 conferences
and monthly phone calls
• Review Monthly Data
• Recruit and Organize the Coaches to work with
the practices
• Develop education strategies to work with
children and families
Reviewing the Stats
• Fifteen out of 21 practices (70%)
reporting in IMMPACT2 demonstrated
improvement in overall immunization
rates through April 2012
• Twelve practices (57%) increased their overall
rates by 3 percentage points or more.
• These rates of improvement ranged from 0.4
to 16 percentage points from baseline
Source: Muskie School of Public Service, University of Southern Maine
10
The average percentage point change between each practice site's total
immunization rates from September 2011-April 2012
Site R
16.0%
Site T
11.6%
Site O
6.3%
Site I
4.8%
Site M
4.7%
Site S
4.5%
Site L
4.3%
Site H
3.8%
Site G
Site F
3.4%
Site J
3.2%
Site D
3.1%
Site K
1.7%
Site E
0.7%
Site A
0.4%
Site C
-0.3%
Site B
-0.7%
Site N
-1.4%
Site P
-1.5%
Site U
Site Q
Source: First STEPS
Phase I Evaluation
Report, Muskie School of
Public Service,
University of Southern
Maine
3.6%
-1.8%
-2.6%
Avg. Change +3.0%
Average percentage point change across First STEPS Phase I practices’ ImmPact2
combination and individual rates, 9/11 – 4/12.
2-Year-Olds
Up-to-date on all vaccines
6.1%
Diphtheria, Tetanus & Pertussis
2.5%
Haemophilus influenza type B
2.7%
Hepatitis A
5.8%
Hepatitis B
4.5%
Measles, Mumps, & Rubella
3.5%
Pneumococcal conjugate vaccine
2.1%
Polio
Rotavirus
3.7%
-3.0%
Varicella (chickenpox)
Source: First
STEPS Phase I
Evaluation
Report, Muskie
School of Public
Service,
University of
Southern Maine
3.6%
6-Year-Olds
Up-to-date on all vaccines
2.0%
Diphtheria, Tetanus & Pertussis
2.6%
Measles, Mumps, & Rubella
Average
Change +3.0%
1.7%
Polio
2.7%
Varicella (chickenpox)
2.4%
13-Year-Olds
Up-to-date on MCV and Tdap
7.3%
Meningococcal vaccine (MCV)
7.0%
Tetanus, Diphtheria (Tdap)
6.9%
Human Papillomavirus (girls only)
-0.3%
Document the Game Plan: Change Package
• Develop Champions throughout the Office Staff
• Reach agreement at each practice on vaccination schedule,
catch up schedule, and contraindication lists
• Develop systems to constantly update registries, standardize
recall/reminders system, and utilize MOGE document:
increased from 25 to 72% in First STEPS
• Make immunization improvement part of office work flows
and performance reviews
• Provide adequate staff training
• Review data to guide work: increased from 40 to 82%
Spread the Change
• Reward Immunization Work-Recognize all work of
the practices, coaches, and partners
• Recognize Immunization Rates with Public
Reporting- Pathways to Excellence
• Design infrastructure to support improvement
including Health information technology and
ImmPact2 that can guide practices quality
improvement
• Get the message out to families- VaxMaineKids
Facebook, Twitter, Web site
5th Quarter
Award Ceremony
Booster Club
Vaccine Board Updates-from Dr. Losey
• 1st Year is Going Well under Universal Coverage Law
• Working on assessment calculations for covered lives in a
calendar year
• Vaccine supply Issues: Pentacell shortage has hit with
variable effect. Pro-Quad will again be available for us
10/1/12.
• No word yet from ACIP on whether they will recommend
GSK's MCV/HIB combination. Vaccine Board is awaiting the
ACIP recommendation. Unfortunately without Type B
meningococcal coverage, you are missing a majority of the
infant meningococcal cases.