Transcript AAP Screening-Welcome Developmental Surveillance and

Welcome!
The Developmental Surveillance and
Screening Policy Implementation
Project (D-PIP)
I have no relevant financial relationships with the manufacturer(s) of any commercial product(s)
and/or provider of commercial services discussed in this CME activity.
AAP Developmental Screening Update
2001 Title:
“Developmental Surveillance and Screening of
Infants and Young Children”
 Recognition of concept of surveillance
 Use of periodic screening
 Use of reliable and valid standardized screening
instruments
 Referral for early intervention
 Determine cause
 Maintain community-based links
“Pediatricians' Reported Practices Regarding
Developmental Screening:
Do Guidelines Work? Do They Help?”

Current efforts to screen for developmental problems are inadequate
for the following reasons:
–
–
–
–
–


Inconsistent delivery
Failure to use validated screening tools
Lack of confidence in advising patients who have developmental concerns
Lack of available resources
Inadequate training
Only 20-30% of children with disabilities are identified before school
entrance
Most common developmental screening technique is clinical
assessment, which detects <30% of children with developmental
disabilities
Periodic Survey of AAP Fellows #53 (2002); N Sand, et al., Pediatrics 2005
Developmental Surveillance and
Screening Partnerships
AAP, CDC, and MCHB Collaborations
 Both
cooperative agreements housed in AAP
Division of Children with Special Needs
– Policy Revision Committee
– Policy Implementation Project
 Foster increased collaboration on
developmental screening and surveillance
AAP PRC Members and Staff

Policy Revision Committee
–
–
–
–
–
–
–
–

AAP Staff
–
–
–
–
–
–

W. Carl Cooley, MD – Medical Home Initiatives PAC
Paula Duncan, MD – Bright Futures
John Duby, MD – Council on Children with Disabilities
Joseph Hagan Jr, MD – Bright Futures
Paul Lipkin, MD – Council on Children with Disabilities
Michelle Macias, MD – Section on Developmental and Behavioral Pediatrics
Nancy Swigonski, MD, MPH – Medical Home Initiatives PAC
Lynn Wegner, MD – Section on Developmental and Behavioral Pediatrics
Stephanie Skipper, MPH- Manager, Council on Children with Disabilities
Jill Ackermann- Manager, Medical Home Surveillance and Screening
Amy Brin, MA- Manager, Screening Programs, Division of Children with Special Needs (no longer at AAP)
Mary Crane, PhD, LSW- Manager, Section on Developmental and Behavioral Pediatrics
Amy Gibson, MS, RN- Director, Division of Children with Special Needs
Darcy Steinberg, MPH- Director, Bright Futures
Liaisons and Consultant
– Paul Biondich, MD, MS – Partnership for Policy Implementation
– Donald Lollar, EdD- Center for Disease Control and Prevention
– Melissa Capers, MA, MFA
AAP D-PIP Staff

Pediatrician staff
– Paula Duncan, MD

Bright Futures; University of Vermont
– Paul Lipkin, MD



Principal Investigator
Council on Children with Disabilities
Johns Hopkins University
– Michelle Macias, MD


Section on Developmental and Behavioral Pediatrics
Medical University of South Carolina
– Nancy Swigonski, MD, MPH



Medical Home Initiatives Project Advisory Committee
Indiana University
AAP Staff
– Jill Ackermann


Project Coordinator
Manager, Medical Home Surveillance and Screening
– Ginny Chanda

Screening Assistant
– Stephanie Skipper, MPH

Manager, Council on Children with Disabilities
The 2006 AAP Policy Statement on Screening and
Surveillance Goals
 Increase
identification of children with
developmental disorders by child health
professionals
– Improve methods of surveillance and screening

Greater consideration of motor and communication
disorders
– Provide concrete guidelines (algorithm)

Age-targeted screening
– Eliminate barriers, e.g. reimbursement
 Improve
medical assessment
The 2006 AAP Policy Statement on Developmental Surveillance
and Screening:
New Recommendations to Improve Quality
 Revision
of 2001 AAP policy statement
 Innovative approach to writing policy at the academy
 Writing group (Policy Revision Committee)
included:
Council on Children With Disabilities,
 Section on Developmental and Behavioral Pediatrics,
 Bright Futures Steering Committee,
 Medical Home Initiatives for Children With Special Needs Project
Advisory Committee,
 Medical Informatician

The 2006 AAP Policy Statement on Developmental
Surveillance and Screening
 New
Title:
Identifying Infants and Young Children
with Developmental Disorders in the
Medical Home:
An Algorithm for Developmental
Surveillance and Screening
 Anticipated
Publication: July 2006
So, what’s
next?
Implementation!
Strategies for Implementation
 Utilize
the AAP policy statement algorithm to
guide decision making
 Choose a developmental screening tool with
sensitivity and specificity of 70-80%
 Utilize quality improvement approaches to bring
surveillance and screening into the process of
care – it is a whole office system endeavor, so
involve all office staff
 Change office procedures as appropriate (eg,
scheduling, administration of tool, training, etc)
Strategies for Implementation (cont.)
 Review
billing processes to ensure appropriate
CPT codes are used and proper payment is
received
 Involve parents in developing an effective office
system (eg, include parents on a
planning/advisory board)
 Establish a practice “champion” to lead efforts,
share enthusiasm, and ensure the
implementation continues
AAP Developmental Surveillance and Screening
Policy Implementation Project (D-PIP)
 Aims
to implement the new policy statement
into 17 pilot pediatric practices
 Goals of the D-PIP include:
– Determine if the policy statement is efficiently and
effectively implemented into pediatric practice
– Recognize strategies for implementation
– Examine outcomes of implementing the algorithm
 17
pilot sites will serve as best-practices
following the project
Orange = Community Health Centers
Blue = Private Practice
Pink = Residency Programs
D-PIP: 17 Practices
Residency Programs
Private Practice
Community Health Centers
Wishard Primary Care Center
Indianapolis, IN
New Ulm Medical Center
New Ulm, MN
Boys Town Pediatrics
Omaha, NE
Charter Oak Health Center
Hartford, CT
Children’s Clinic
Muskogee, OK
Kids Clinic
Lawrenceville, GA
Ypsilanti Health Center
Ypsilanti, MI
South Valley Pediatrics
Hamilton, MT
Hospital of Saint Raphael Pediatric
Primary Care Center
New Haven, CT
Children’s Hospital of Pittsburgh
Primary Care Center
Pittsburgh, PA
Alexandria-Lake Ridge Pediatrics
Alexandria, VA
Midland Community Healthcare
Services
Midland, TX
Marshall University Pediatrics
(CHC, Private Practice, and
Residency)
Ohio Pediatrics, Inc
Huber Heights, OH
The Children’s Clinic, Serving
Children and Their Families
Long Beach, CA
Children’s Clinic La Jolla
La Jolla, CA
North Arlington Pediatrics
Arlington Heights, IL
Thank You and Welcome to the
AAP D-PIP!!