Transcript Maine Quality Counts presents… August Provider Lunch

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.
Objectives for First STEPS, Phase 2
• Setting the Stage: Focusing on the PCMH, Bright Futures, and
Developmental and Autism Screening
• Working Together: Developing Successful PDSA Cycles and
Learning from Autism Implementation Group
• Welcoming Parent-Partners: Thinking about how to include
them in our Quality Improvement Work
• Raising Rates: Improving : Improving Developmental, Autism,
and Lead Screening
• Creating Next Steps
First STEPS
MAINE
CMMC Pediatrics
CMMC Family
Medicine
Waterville
Pediatrics
Winthrop
Pediatrics
Kennebec
Pediatrics
Penobscot
Pediatrics
Husson Pediatrics
EMMC Family
Medicine
EllsworthMaine Coast
Pediatrics
BBCH
Pediatric and
Med-Peds
Clinic
RocklandPenBay Pediatrics
Martin’s Point
Pediatrics Brunswick
Practices by the Numbers
• 12 outpatient groups
• 45 physicians
• 20,000 children with MaineCare covered by
practices by Aug 2010 numbers
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
Head Start
Families and Parent Partners
Why Is this Important to Your Practice?
• Developmental delays and conditions affect 10% of
children
• 1/88 kids with autism*
• 85% of children with lead poisoning in Maine have
MaineCare health insurance; Only 50% of children at
age one are currently tested and 25% of children at age
2
• CMS requirements for lead testing vs. screening for
children enrolled in MaineCare may be changing in the
next 6 months- would require changes in state law
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*(March 30, 2012, MMWR, Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring
Network, 14 Sites, United States, 2008)
Why screen for lead and
developmental delays?
• Lead is toxic to the brain
• Lead poisoning can negatively affect cognition,
social functioning and communication skills
• Pica- kids with autism and developmental delay
may be more likely to put things in their mouths,
increase risk for lead poisoning
• Early intervention and treatment can greatly
improve prognosis
• Screening at similar ages
Why is this important to me?
3 years
2 years
6 years
Why is this important for families?
• Hope to find answers and improve quality of life
for children and families
• Early intervention
• Need a more standard approach to evaluate with
screening tools- we see the kids for a few minutes
in the office, parents are with the kids all the time
and can provide critical information
• Need help with care coordination
• Need help with finding treatment services
The American Academy of Pediatrics (AAP) Policy Statement on
Identifying Infants and Young Children with Developmental
Disorders in the Medical Home
• Recommends addressing child development by
including routine developmental surveillance,
• Periodic screening using standardized tools;
• And if a developmental concern is identified, further
evaluation to identify specific developmental disorders.
• Early identification of children with developmental
delays and subsequent intervention can improve
outcomes for young children.
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’s preventive care for children including
being ranked 14th for developmental screening
(only 20% screened) by the Commonwealth
Fund in 2010.
Quality Gap- Providers are not using
screening tools
• Many physicians and primary care providers rely on
informal developmental milestones and/or observation to
monitor a child’s development.
• “Clinical judgment” alone is known to capture only about
30% of the children with delays—leaving many with
unidentified needs and missed opportunities for timely and
beneficial intervention.
• Early developmental delays are often not identified until
well beyond the period in which early intervention is most
effective.
• While detection rates increase by using a standardized
instrument, national data indicate a low percentage of
physicians use a standardized instrument.
Source: Muskie School of Public Service, University of Southern Maine
Updated Billing Codes from MaineCare
for Developmental Screening
• 96110: General Developmental Screening
Tool- PEDS/ASQ ($8.99)
• 96110HI- Autism Specific Screening Tool –
MCHAT 1 ($8.99)
• 96110HK- Autism Specific Screening ToolMCHAT 2 ($86.59)
Learning from Previous Pilot and
Current Autism Implementation Grant
• In 2009, a developmental screening pilot was done in
Maine with 5 sites
• In 2010 DHHS’ Children with Special Health Needs (CSHN)
program applied for and was awarded a three-year State
Autism Implementation Grant (AIG) of approximately
$300,000 annually, funded under the federal Combating
Autism Act Initiative.
• Maine is in the middle of a 3 year pilot with 2 sites (Bangor
and Portland) to work on an Autism Implementation Grant
with the Maine Developmental Disabilities Council.
– Improve Screening
– Promote the medical home and care coordination
– Connect to evaluation and intervention services for children
Phase 2 Aim statement
• Improve the rate of developmental, autism,
and lead screening for children according to
the Bright Futures Recommendations for
Pediatric Preventive Care by 50% from May
2012 to December 2012.
Goals
• 75% of children have a documented developmental
screening using a validated tool (ASQ or PEDS) at the 9 mo,
12- 23 mo, and the 24 -36 mo well child visits
• 75% of children have a documented autism screening
(MCHAT1 or MCHAT2) between 16 -24 months
• 75% of children identified with a concern or developmental
delay have a documented follow-up plan (observation,
recheck in office, or referral)
• 75% of all children will have a lead risk screening
questionnaire to determine a child’s level of risk at 12 mo
• 75% of all children will have a lead risk screening
questionnaire to determine a child’s level of risk at 24 mo
Office System Goals
• Incorporating screening tools in your office
flow
• Work on referral tracking for all patients
• Develop list of community and medical
resources for families and patients
• Think about care coordination and care plans
for families
• Involve families in your quality improvement
efforts
Office Systems Survey Fast Facts…
• 92% respondents have standard approach to
developmental surveillance
• When surveillance completed
– 73% at all well visits
– 18% at well and sick visits
– 9% at selected visits
• 100% use standard tool
When do you currently perform developmental screening in your practice? (check all that
apply)
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
Parental concern is
expressed
Surveillance
demonstrates risk
Every well child visit
30 mo visit
24 mo visit
18 mo visit
9 mo visit
0.0%
Which developmental screening tool(s) do you currently use? (check all that apply)
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
BINS
PDQ
Denver II
Bright Futures
PEDS
ASQ
0.0%
Please rate, on a scale of 1-5, to what degree the following items are barriers to implementing
developmental screening in your practice (5= strongly agree it is a barrier and 1=strongly disagree that it is
a barrier).
Other (please rank and specify below)
Screening interrupts the flow of patients at the practice
Overall cost to practice
No referral source in the community
Lack of training on performing screening
Lack of time
Lack of staff
Cost of tool
0.00
1.00
2.00
3.00
4.00
5.00
More OSS Fast Facts
• 100% respondents screen for autism (M-CHAT)
and 18% use lead screen questionnaire
• When children referred for diagnosis and
treatment as a result of a positive developmental
or autism screen, evaluation for majority happens
between 2-5 months.
• Only 16% respondents have care coordinator to
assist with referrals and f/u
• Only 8% of respondents involve parent partners
• 33% perform staff training for developmental
screening & surveillance
In Summary…
• There are lots of opportunity for change and
improvement!
Let’s make it fun! Games and Prizes!
Prize Categories for Today:
• Prize for Best Slogan for Learning Collaborative
• Prize for Best Theme Song
• Drawing for Completed Evaluation Form
• Draw name of practice that brought a parent
partner
First Teams to Win:
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On time data submission
On time office system survey
1st team to enroll in the Learning Session:
1st team to submit completed Office system
survey:
Tell us what you think!
• Local Evaluators- Sherrie Winton would like to
talk with volunteers about First STEPS- sign up
and enter to win a prize
• National Evaluators- may be coming this summer
• Nancy Cronin is working on adding
autism/developmental screening to the Child Link
registry
• Eric Frohmberg-building info into Lead Database
Next STEPS
Amy Belisle, MD
Next STEPS
• Proposals for Next 2 Coaching Calls:
June 14th:
July 12th:
• Data Cycles: 15th of the month- next June
• Provide Feedback to Evaluators!
• Next Learning Session- Sept 14th, Freeport
• Celebration Dinner- Sept 14th, 5-7 pm at the
Harraseeket with Phase 2 LS 2
Phase 2 Timeline in Packet
Contact Info / Questions
• Amy Belisle, MD, 207-829-8444 Director of Child Health Quality
Improvement, Maine Quality Counts,
[email protected]
• Sue Butts-Dion, 207-283-1560 First STEPS Program Manager,
Quality Specialist, Maine Quality Counts, [email protected]
• Nancy Cronin, MA, ASD Systems Change Coordinator, Maine
Developmental Disabilities Council,207-287-4214, Fax: 287-8001,
[email protected]
• Barbara Farrell 207-622-3374 ext. 218, First STEPS Administrative
Assistant, Membership & Events Coordinator, Maine Quality Counts,
FAX 207-622-3332 [email protected]
• Catherine Gunn, 207-780-5576 First STEPS Data Collector, Cutler
Institute for Health and Social Policy Muskie School of Public Service
FAX 207-228-8083 [email protected].