Transcript National Center for Medical Home Implementation

Medical Home in Pediatrics:
The HOW TO Webinar Series
brought to you by the National Center for Medical Home Implementation
How To Incorporate Best Practices in
Family-Centered Care in Your Practice
Lee Partridge (Moderator)
National Partnership for Women and Families
Rebecca Malouin, PhD, MPH
Michigan State University
Javier Aceves, MD, FAAP
Young Children’s Health Center, New Mexico
Joseph Pringle, Jr., MD, FAAP
Shannon Huffman, Family Centered Health Navigator
Debbi Kennerson-Webb, MA, LPA
North Carolina Project Launch
May 29, 2013
Disclosures
We 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.
I do not intend to discuss an unapproved/investigative
use of a commercial product/device in my presentation.
Webinar Objectives
By the end of this webinar, the participant will be able to:
 Explain the definition and importance of family-centered care
in a pediatric care setting
 Explore case studies that represent the broad spectrum of
family-centered care implementation in practice
 Highlight practical tools that practices can use to better
partner with families in their delivery of care
Rebecca Malouin, PhD, MPH
Department of Pediatrics and Human Development
College of Human Medicine
Michigan State University
Defining Family-Centered Care
 Care which assures the health and well-being of children and
their families through a respectful family-professional
partnership. It honors the strengths, cultures, traditions, and
expertise that everyone brings to this relationship. Familycentered care is the standard of practice which results in highquality service. (MCHB, 2005)
Principles of Family-Centered Care
 Families and professionals work together in the best interest





of the child and family. As children grow, they assume
partnership roles.
Everyone respects the skills and expertise brought to the
relationship
Trust is acknowledged as fundamental
Communication and information showing are open and
objective
Participants make decision together
There is a willingness to negotiate
Why is Family-Centered Care Important?
 Core principle of the AAP Desirable Characteristics of a
Medical Home (AAP, 2002)
 Associated with less delays in care and fewer unmet service
needs, for CYSHCN (Kuo et al 2011)
 Associated with reduced odds of emergency department
visits, and increased odds of medical home visits for CYSHCN
(Kuo et al 2011)
 Associated with more efficient use of services, better health
status, greater family satisfaction with care, greater access to
care, better communication, better systems of care, better
family functioning and reduced costs for families. (Kuhlthau
eta al, 2011)
Have We Achieved Family-Centered Care?
 65.5% of respondents to national survey of CYSHCN reported
receipt of family-centered care (Kuo et al, 2011)
 Disparities in reported receipt of family-centered care by
families of different racial, ethnic, and socio-economics
backgrounds as well by type of special need (Kuo et all, 200;
Guerrero eta la, 2010; Montes et al, 2011)
What are Best Practices in Family-Centered Care?
 Proposed a national study to:
identify pediatric medical homes which exemplify best
practices in family-centered care
 describe these medical homes as case studies, and
 identify common processes and structures within the
medical homes associated with provision of family-centered
care

Methods
 Convened a national advisory committee of content experts





National Center for Medical Home Implementation
Maternal and Child Health Bureau
Family Voices
Institute for Patient- and Family-Centered Care
National Partnership for Women and Families
 Solicited nominations from listserves of the MCHB and AAP
 Committee selected 17 practices based on components of
family-centered care, and including diverse types of medical
homes
 Conducted 30-60 minute interviews with key informants
 Care
Practices
 4 rural, 6 suburban and 7 urban
 Represent community clinics or health centers, private




practices, academic practices, health –system affiliated
practices and hospital-based practices
Approximately half of the practices serve predominantly
Medicaid-eligible population
Majority have recognition as a medical home
Majority have electronic medical record or other technology
to support population management
A little over half had external funding to support familycentered structure and processes within the practice
Practice name:
Practice address:
Geographic location:
Type of practice:
Organizational structure:
Size of practice:
Number of patients:
Patient insurance:
Young Children’s Health Center
306-A San Pablo SE
Albuquerque, NM
Large city/urban
General pediatrics for 30 years, but added multiple specialties in August 2011
Affiliated with the University of New Mexico; self-supported through city and state contracts and grants
6 part-time pediatricians
1 part-time child psychologist
2 part-time nurse practitioners
1 pediatric pulmonologist
1 pediatric cardiologist
1 pediatric dermatologist
1 pediatric gastroenterology physician assistant
2 licensed social workers
1 counselor
2 case managers
1 care coordinator
5,000
5%-7%
commercial/private insurance
80%-85% Medicaid
10%
uninsured/underserved
Medical home recognition:
Centers for Medicare and Medicaid Services Tier I Medical Home; currently working toward achieving Tier II
certification
Healthy Tomorrows grant recipient to support medical home initiatives
Calvin Cia Award for Medical Home
Patient/family experience questionnaire:
Press Ganey patient satisfaction survey administered monthly
Staff satisfaction survey administered annually
EMR system:
Other information technology:
Yes
Funding source(s):
The YCHC is affiliated with University of New Mexico School of Medicine; however, it is mostly
self-sufficient. It receives funding from 4-6 different sources that allow it to provide more
comprehensive services than would otherwise be available. The YCHC has received competitive
grants for a home visitation program, as well as gang prevention and gang intervention
programs. For over 20 years YCHC has received direct funding from the state legislature, and it
also receives direct funding from the city of Albuquerque.
No
Organizing Framework
 Access
 Care management
 Collaborative learning with other practices
 Collaborative learning with patients and families
 Communication with patients and families
 Cultural diversity and sensitivity
 Gathering feedback from patients and families
 Mission and culture
 Quality improvement
Examples within Gathering Feedback from
Patients and Families
 Engage parent/family partners via parent advisory board or
family partner who regularly consults with staff/providers
 Patient/family experience questionnaires/surveys
Family-Professional Partnerships
“We meet once a month for an hour to discuss incremental
improvements in care, and one thing we’ve always emphasized is
that these are actually parent partners and no parent advisors.
Parent partners are equal partners in these meetings, so their
opinions are equally as valid as the doctors’ or the care
coordinators’ opinions. So that they’re really equally partners in
making these changes in the practices.”
Family-Professional Partnerships
“We sort of assumed we knew what their needs were, and so it
was I think important to again make that shift and say, well,
we think we’re providing what the parents need, but let’s
actually ask them.”
Javier Aceves, MD, FAAP
Young Children’s Health Center
Albuquerque, New Mexico
Young Children’s Health Center
Family-Centered Model
 South East Heights of Albuquerque, New Mexico
 “International District”
 Serving primarily Spanish speaking population
 Started by UNM pediatric faculty concerned about numbers of
children coming from this neighborhood
 Took a “holistic approach” from the beginning: hired a social
worker before a nurse
 Community-based; give preference to residents of specific zip
code areas
Young Children’s Health Center
Family-Centered Model
 Because of increased numbers of CYSHCN, applied for Medical
Home grant to address specific needs including the formation
of a “Parent Advisory Team”
 Role of parents is evolving: advisory, support group, growing
advisory skills
 Some of their specific contributions include:
 expansion of evening and Saturday clinics
 brought in specialists to the clinic
 expansion of behavioral health services
Young Children’s Health Center
Family-Centered Model
 Spanish speaking staff
 Hire staff from same community and previous patients
 “Family Computer Learning Center”
 Activity Center has daily activities:




Eat & Play
literacy
art & crafts
birthday celebrations
 Home visitation program for first time parents
 Infant Mental Health program: Child Psychiatry faculty and
child psychiatry fellows
Young Children’s Health Center
Family-Centered Model
The Challenges:
 Competing values


“Learning versus service”
Increased system efficiencies versus more personalized approach
 Meeting families where they are
 The steps to a true partnership
Joseph Pringle, Jr., MD, FAAP
Shannon Huffman, Family Centered Health Navigator
Debbi Kennerson-Webb, MA, LPA
North Carolina Project LAUNCH
NC Project LAUNCH
Family-Centered Medical Homes
Burlington Pediatrics
Kernodle Clinic Pediatrics
• Suburban & rural
population
• Suburban & rural
population
• 3 locations
• 1 location
• Annual 0-8 Population
• Annual 0-8 Population
served: 3000
served: 1460
• # of Medical Staff: 26
• # of Medical Staff: 7
• % of Medicaid : 60%+
• % of Medicaid : 58%
• EMR: in development
• EMR: yes
SAMHSA funded to NC Division of PH - Implementation awarded to Alamance County Health Department, Burlington, NC
FCMH Practice Enhancements
 Social Emotional Screenings: ASQ-SE, PSC, PHQ2
 Full–time on-site Early Childhood MH Team in both practices
 Positive Parenting Program (Triple P)
 Reach Out and Read
 Wellness Discussion Guide*
 Family Wellness Plan*
 Secure, real-time web-based communication & collaboration
- OnPulse**
*Kaufman, MC 2013
**http://www.onpulse.com/
Early Childhood MH Team
We l l C h i l d V i s i t s
Pediatrician
Nurse
Early Childhood
MH Specialist
Family Centered
Health
Navigator
Early Childhood MH Team
Family Centered Health
Navigator
Early Childhood MH
Specialist
• Engagement & Partnership
• Screening
• Triple P 3/Primary Care
• Child Development
• Identify Priority Health
• Triple P 3/Primary Care
Strengths & Risks
• Establish Online Family
Health Plan & Team
• Care Coordination
• Assessment, Evaluation
• Brief Interventions
• Triple P 4 Standard
• TFCBT, etc.
• Clinical referrals
ECMH Teams are currently funded by NC Project LAUNCH with plan for practices to absorb by end of grant
Health Information Technology
Encouraging collaboration & empowering families
through engagement *
Build Real-Life
Relationships
Encourage and
Support Collaboration
Engage and
Empower Families
* http://www.onpulse.com/
We’re Here to Help You!
Have a question about medical home?
Contact us!
[email protected]
800/433-9016 ext 7605