Transcript Maine Quality Counts presents… August Provider Lunch

First STEPS 2014: (Strengthening
Together Early Preventive Services)
Improving Developmental and Autism
Screening:
Kick Off & Orientation Call
Amy Belisle, MD
Director of Child Health Quality Improvement
Sue Butts-Dion
First STEPS Program Manager, QI Specialist
Maine Quality Counts
February 13, 2014 and Repeated March 13, 2014
Agenda
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Welcome Teams and Roll Call
Review First STEPS Year 5 Aim and Logistics
Expectations for Teams and for MOC
QI Teamspace
Q&A
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
partnership.
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.
Aim for First STEPS 2014
• Raise Screening Rates: Improve Developmental and Autism
Screening Rates
• Work Together: Work collaboratively with other primary care
practices and community partners to learn from each other
and to improve systems and to test changes (using the Model
for Improvement and Plan-Do-Study-Act Cycles as a frame)
• Welcome Parent-Partners: Enhance how we are including the
voice of the parent partners in our improvement work.
• Optimize Existing Work: Build on the work of the Patient
Centered Medical Home, Health Homes, healthcare
organizations, and community organizations.
Participating Practices
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Non-MOC
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Aroostook Pediatrics
Bethel Family Center
Blue Hill Memorial
Bridgton Pediatrics
D.F. Russell Medical Center
EMMC Family Medicine
Eleanor Widener Dixon Community
Center
Elmwood Family Practice
Foden Road Pediatrics
Healthreach Community Center
Lincoln Medical Partners
Lovejoy Health Center
Mayo Psychiatry
Mayo Regional Hospital
Mid Coast Pediatrics
MMP Family Medicine
MMP Pediatrics
Yarmouth Pediatrics
York County Community Corp
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MOC
– CMMC Family Medicine Residency,
Lewiston
– Ellsworth Family Practice, Ellsworth
– Elmwood Family Practice, Waterville
– Fore River Family Medicine, Portland
– Intermed Foden Road, South Portland
– Intermed Marginal Way, Portland
– Intermed Yarmouth, Yarmouth
– Martin’s Point Healthcare-Brunswick
Pediatrics, Brunswick
– Waterville Pediatrics, Waterville
First STEPS and
Community Partners
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MaineCare
Muskie School of Public Service, USM
Maine Developmental Disabilities Council
Maine Autism Society
Maine Parent Federation
Maine CDC
Child Development Services
Office of Child and Family Services
Maine Children’s Alliance
Maine Children’s Growth Council
Head Start
Families and Parent Partners
State Agencies Interdepartmental Early Learning and Development Team (SAIEL)
Developmental Systems Integration (DSI) Project
Why is this important?
• Developmental delays and conditions affect
10% of children
• 1/88 kids with autism*
*(March 30, 2012, MMWR, Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities
Monitoring Network, 14 Sites, United States, 2008)
Periodicity Schedule for
Developmental Screening and Metrics
• The American Academy of Pediatrics (AAP) recommends the
following:
 Developmental Surveillance: at every well-child care visit (Bright
Futures)
 Children receive general developmental screening with a standardized
tool at ages 9, 18, and 24 or 30 months.
 Children receive screening for autism at 18 and 24 or 30 months.
• Children's Health Insurance Program Reauthorization Act
(CHIPRA)/Maine Health Homes metric is a documented
developmental screening by ages 1, 2, and 3 years.
AMCHP January 25, 2014
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Our Challenge
MaineCare claims
documented rates for
developmental screening
is 1-6% for children ages 1,
2, and 3.
Source: MaineCare claims data, 2011
Source: Improving Health Outcomes for Children (IHOC) Summary of Pediatric
Quality Measures for Children Enrolled in MaineCare FFY 2009-FFY 2012, Muskie
School of Public Service, University of Southern Maine, April 2013, p. 25.
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2014 work focused on creating a circle of strength
around kids to promote healthy development.
Assess
Surveillance
Screening
Evaluation
Ev
S
Assess
Evaluation
S
Screening
Assess
Screening
Surveillance
Assess
Surveillance
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Requirements for
Provider Champions Desiring MOC
• Submit MOC sign up forms and BAA (data agreement) to QC for Kids
• The First STEPS Practice Teams will:
– lead office practice improvement by identifying goals and processes for
improvement, removing barriers and providing resources
– attend 1 Regional Training (must include provider champion)
– submit data monthly—PDSA and Process data
– meet as a team on a monthly basis for quality improvement discussion
– participate in monthly phone calls to share improvements made and to
receive coaching
• In collaboration with the practice team, the practice’s physician
champion will complete a pre and post practice profile describing the
practice structure and changes in office systems.
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First STEPS 2014 Webinars, 2nd Thurs 12-1 pm
DATE
February 13th or
March 13th, 2014
TOPIC
Intro to new practices; QI Methodology: Understanding the model for
improvement; creating aim statements, effectively designing and using
PDSA cycles, metrics for developmental screening, intro to QI Team
Space
April 10, 2014
Making the Connection with the Medical Home and Child
Development Services, Part C, and other Early Childhood Partners
doing Developmental screening in the Community- Dr. Bob Holmberg
and Cindy Brown
May 8, 2014
Brief Review of New MCHAT-R. What is Next? When a Child
Doesn’t Pass Initial Autism Screening, Review of the MCHAT 2/F
Interview- Dr. Carol Hubbard
June 12, 2014
Planned Coordinated Care in Patient and Family-Centered Medical
Home- Dr. Bob Holmberg and Nancy Cronin
July 10, 2014
Management of Behavioral Issues in Children with Autism Spectrum
Disorders- Dr. Carol Hubbard
August 15,
2014**Note the
only day that is a
Friday and not
Thursday.
Translating Developmental Science into Healthy Lives: Realizing the
Potential of Pediatrics and the Science of Early Brain and Child
Development (EBCD)- Dr. Andrew Garner, National AAP
Practice Team Preparation
Checklist
• Review the orientation packet
• Save the important dates on your calendar
(Regional Training Sessions, monthly
calls/webinars, data reporting deadlines)
• Complete and submit Office Systems Survey
by February 28, 2014
• Submit baseline data measures to the online
collection tool by March 15, 2014. (MOC)
Meet as a Team
• Complete an office system survey to help your
office identify opportunities for improvement.
– Emailed to practices following this call
• Discuss and write a rough draft of your team’s
improvement aim and targets for improving
developmental and autism screening.
Office Systems
Assessment Components
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Developmental Surveillance practices
Developmental and Autism Screening practices
Referral and Follow up practices
Informing and engaging parents and care givers
Working with community partners
Quality Improvement practices
Billing and coding practices
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Method for Change
What are we trying
to accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Deming’s
PDSA cycle
Act
Plan
Study
Do
API’s
Model
for
Improvement
Year 5: High Level
Aim & Goals
2014 First STEPS Aim Statement: To improve the rate of developmental and
autism screening for children ages 0 to 3 by 50% from March 2014 to
September 2014 using chart review data.
Goals
• 75% of children will have a documented developmental screening using a
validated tool (ASQ or PEDS) at the 9 mo, 18, and the 24/30 mo well child
visits
• 75% of children will have a documented autism screening (MCHAT R or
MCHAT F) at 18 and 24/30 mo.
• 75% of children identified with a concern of developmental delay will have
a documented follow-up plan (observation, recheck in office, or referral)
• 75% of all visits with developmental and autism screening will be billed
and coded correctly.
Your Aim Statement
• The (name of your team/practice):
• intends to accomplish (This is a general over arching statement
describing what you intend to accomplish during the time you
work on this process – it answers the first question of the Model
for Improvement. The process is identified in the statement, any
specific or segmented area is mentioned and words like improve,
reduce, and increase are often utilized)
• by (time frame, i.e. month/year in which you intend to
accomplish improvement)
• for (what group are you doing this for – who is the customer)
• because (the rational and reasons to work on this improvement
project)
• Our goals include: (your measures – it answers the second
question of the Model for Improvement. Here they are stated as
numeric goals)
“Soon is not a time, some is not a number, hope is not a plan.”
-Donald Berwick, MD, Former CEO, Institute for Healthcare Improvement
Example Aim & Goals
• By September 30, 2014, our practice will improve our autism
screening rates for children at the 18 or 24/30 month appointments
from 45% having completed to 90% having them completed.
• By September 30, 2014, 100% of Developmental and Autism
Screening results will be reviewed with family/care givers.
• By September 30, 2014, 100% of Developmental Screening results
with a referral or follow up indicated will have a documented action
plan in their charts (currently at 65%).
• The goals should be directed by your baseline data. Your practice,
for example, may be at 100% for the Autism Screening measures
and choose to focus the improvement work on Developmental
Screening. We will, however, still expect practices to report all of
the process measures for both Development Screening and Autism
Screening each month.
Optional Quality Improvement
Science Webinars with QI Coach
• April 23rd noon
• June 4th noon
• July 23rd noon
– Introduction to the Model for Improvement and
the Science of Improvement
– Assessing Processes and Establishing Aims
– Measurement for Improvement
– Holding the Gains
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Quality Improvement
Coaching
• If you currently work with your system’s or
PHO’s Quality Improvement (QI) Coach on
other initiatives, alert them to your
involvement in this collaborative. If you are an
independent practice, we will work with your
practice to identify a coaching resource.
Data Submission
• Submission Dates
– March 15 (Baseline), April 15, May 15, June 15, July 15, and August 15
• Randomly select 20 charts from ages 9 mo- 30 months for children
seen in your practice for WELL CHILD VISITS for the month that you
are doing the chart review. For sampling purposes, please select
approximately 5-7 charts per month from the 9 and 18 month
categories and 10 from the 24/30 month category.
• Enter chart data into your QI Team Space each month. (Note: You
can use the paper chart review tool if helpful.)
• Collecting data at three levels:
– Level 1: Total number of children general developmental and/or
autism screening AND results documented in chart.
– Level 2: Of those in “a)”, number with a referral or follow-up indicated.
– Level 3: Of those in “b)”, number with documented follow-up plan in
chart.
First STEPS 2014 Measures
• % documented use and results of a developmental screening tool
(PEDS or ASQ-3) at 9, 18 and 24/30 months.
• % documented that the screening results were reviewed and
discussed with the family.
• % Documented use and results of an autism-specific screening tool
at 18 and 24/30 mo of age (MCHAT R or F)
• % of children identified with a concern of developmental delay
(referred on PEDS/ASQ-3 or MCHAT R/F) that have a documented
follow-up plan (observation, recheck in office, or referral
• Total number of referrals to Child Developmental Services (CDS) and
Developmental Pediatricians each month under age 5
• % of charts where billing was done with correct modifiers for
developmental screening and autism screening
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Example
General Developmental Screening Example:
• Level 1: Of 20 charts, total of 12 had screening results documented
in chart. (Num=12 and Den=20 for 60%)
• Level 2: Of 12 with documented screen and results, 3 w/ referral or
f/u indicated. (Num=3 and Den=12 for 30%)
• Level 3: Of the 3 with referral or f/u indicated, 2 had a documented
follow-up plan in chart. (Num=2 and Den=3 for 77%)
Autism Screening Example:
• Level 1: Of 20 charts, 9 were eligible for autism screening (18 or
24/30 month visit). Of 9, total of 4 had screening results
documented in chart. (Num=4 and Den=9 for 53%)
• Level 2: Of 4 with documented screen and results, 4 w/ referral or
f/u indicated. (Num=4 and Den=4 for 100%)
• Level 3: Of the 4 with referral or f/u indicated, 2 had a documented
follow-up plan in chart. (Num=2 and Den=4 for 50%)
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Summary Notes
• Still opportunity for practices to participate for
MOC—would need to get paperwork submitted
ASAP
• If you are participating for MOC and have not
submitted your paperwork, please do so!
• Another orientation call on March 13th for any
teams member wanting to attend.
• See you at the Regional Meeting!
• Those participating for MOC (and anyone
interested in the on-line QI Team Space) please
remain on the line for additional training.
Take a deep breath…technical support
available AFTER this call and
throughout the project
QI Team Space: System Requirements
• Tested and supported web browsers:
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Mozilla Firefox 17.0 or greater
Google Chrome
Apple Safari 5.1.4 or greater
Microsoft Internet Explorer 9.0 or greater.
• Microsoft Internet Explorer 8.0 (on Windows 7 or greater) is
partially supported through June 30, 2014, but may not be
supported after this date.
• Note: Windows XP users must use the most
recent version of Google Chrome or Mozilla
Firefox. Microsoft Internet Explorer on Windows
XP is NOT supported by TeamSpace.
THIS DATA IS TEST DATA—NOT ACTUAL DATA FROM A PRACTICE. FOR
DEMONSTRATION PURPOSES ONLY!!
THIS DATA IS TEST DATA—NOT ACTUAL DATA FROM A PRACTICE. FOR
DEMONSTRATION PURPOSES ONLY!!
THIS DATA IS TEST DATA—NOT ACTUAL DATA FROM A PRACTICE. FOR
DEMONSTRATION PURPOSES ONLY!!
Tips from Practices
• Initial entry might take 2-5 minutes/chart until you get
used to it
• Sue Butts-Dion will set up individual meetings as
needed to train and work with practices
• Don’t wait until the last minute to enter all 20 charts
– You know you need 20 charts total (@5-7 each for 9 mo.
and 18 mo. and @6-10 for 24/30 mo.)
– Plan to pull 5 each week and spend 30+ minutes entering
– Then, submit on the due date of the 15th of the month
starting with baseline on March 15th
Getting Started
• Need your signed MOC paperwork and BAA
(Data Sharing Agreement) returned to Maine
Quality Counts to activate your QI Teamspace
• Set up your system requirements (See
“Getting Started” document sent out prior to
call.)
Questions & Reactions
Contact Information
• Amy Belisle, MD, Director of Child Health Quality Improvement, Maine
Quality Counts, [email protected]/ 207-847-3582
• Sue Butts-Dion, First STEPS Project Manager, 207-283-1560,
[email protected]
• Debra Gilbert, Administrative Coordinator, Maine Quality Counts
• [email protected], 207.620.8526 ext. 1017
• Nan Simpson, MSW, DSI Project Manager,
[email protected], 207-441-3722
• Sue Mackey Andrews, Consultant to QC for Kids on DSI Project,
[email protected], 207-564-8245
• Kyra Chamberlain, BS, RN, IHOC Project Manager, Maine, 207-2288085, [email protected]
• Kim Fox, MPA, Research Associate, Muskie School of Public Service,
[email protected]
• Joanie Klayman, LCSW, IHOC Project Director, Maine and Vermont,
[email protected], 207-780-4202
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