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The Data Resource Center is supported by the federal Maternal and Child Health Bureau

The MCH Epi Contribution: Leveraging what comes naturally to advance quality improvement partnerships Christina Bethell, PhD, MBA, MPH The Child and Adolescent Health Measurement Initiative Oregon Health & Sciences University.

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The Data Resource Center is supported by the federal Maternal and Child Health Bureau

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  1. The MCH Epi Contribution: Leveraging what comes naturally to advance quality improvement partnershipsChristina Bethell, PhD, MBA, MPHThe Child and Adolescent Health Measurement InitiativeOregon Health & Sciences University The Data Resource Center is supported by the federal Maternal and Child Health Bureau

  2. Goals1. Own your existing strengths and resources to advance quality improvement partnerships2. Inspire your leadership to address key barriers and maximize existing data to empower QI Partnerships (DRC and WVP “tour”)3. Open a dialogue about key areas to evolve and develop to optimize your leadership and contribution in QI Partnerships

  3. MCH Epi Skills in Action!

  4. MCH Epi and QI Partnerships: A Common Measurement Mantra!

  5. Maternal and Child Health Leadership CompetenciesVERSION 2. 0—12 key skills focus on data! Understand population data collection and analysis and the strengths, limitations, and utility of such data. Use data to identify issuesrelated to the health status of a particular MCH population group. Describe health disparities within MCH populations and offer strategies to address them. Use population data to assist in determining the needs of a population for the purposes of designing programs, formulating policy, and conducting research or training. Formulate hypotheses or research questions, retrieve information and pertinent data and evidence, complete a comparative analysis, and draw appropriate conclusions to solve a problem. Compile pertinent data to develop an evidence-based practice or policy. Translate research findings to meet the needs of different audiences Synthesize and translate MCH knowledge into understandable information Craft a convincing MCH story designed to motivate constituents and policymakers to take action. Solicit and use family input in a meaningful way in the design or delivery of clinical services, program planning and evaluation. (all data is family reported) Frame problems based on key data, including economic, political, and social trends that affect the MCH population. Use data, levels of evidence, and evaluative criteria in proposing policy change.

  6. What Comes Naturally?! • Whole population view • Whole systems view • Data driven partnerships view • Knowledge of validity and importance of person centered and reported information • Collaborative imperative—including with the public and families! • Surveillance habits (continuous evaluation) • Continuous learning built in! • The resilience of the underdog! • The power of the honest broker!

  7. Providing National and State Data NSCH and NS-CSHCN Indicators by CHIPRA Core Measure Domain

  8. MCHB’s System of Service Model for CSHCN

  9. Persistent gaps in health care quality and system capacity for CSHCN Proportion of CSHCN Meeting MCHB CSHCN Systems of Care Quality Indicators, Nationwide (2009/10 NS-CSHCN)

  10. Keeping things in perspective with a whole system, whole child view

  11. Timing: health trajectories are particularly affected during critical or sensitive periods of development (3) Transition to Adulthood Services Association with parent employment

  12. Environment: the broader community environment – biologic, physical, and social – strongly affects the capacity to be healthy Home environment impacts the well being of CSHCN across all stages of growth and development Problematic social behaviors by home environment

  13. Addressing Fundamental QI Questions • Partnerships falter or proceed on faulty ground as assumptions go unannounced and unchecked • How are we doing? • What and who should we focus on? • How do we know if anything improved? Annual Maternal and Child Health Epidemiology Meeting, 2011

  14. Myth Busting Is Essential Assumption: Most Children in the US Get Adequate Health Care: Minimal Quality of Care Composite Measure (Insurance usually or always adequate, at least 1 preventive care visit in previous 12 months, and care meets medical home criteria)

  15. Checking Assumptions Is Essential Assumption: Very few children have special health care needs. Who do we agree are CSHCN? Can range from 3% to up to 50% of children depending on definition and inclusion of “risk” concept. Association of Maternal & Child Health Programs Annual Conference, 2012

  16. Myth Busting Is Essential Assumption: Most CYSHCN Have 1 major condition, often asthma or ADHD and have non-complex needs

  17. Myth Busting Is Essential Publicly Insured Myth: Children Always Fare Worse Adjusted OR: 2.25 (1.72-2.93) Adjusted OR: .50 (.41-.60)

  18. Myth Busting Is Essential Myth Busting Is Essential: Being a watch dog for relative vs. absolute risk and characterizing needs and change An assumption we hear: “Most overweight or obese children are poor and lack neighborhood amenities” Distribution among children who are overweight or obese

  19. Supporting Coherence: “Swamping” the System: Same Metrics Applied at All Levels of Change National, State, geographic region, county Health plan, type of health care provider (Pediatrician, Family Medicine) Medical group, office, individual health care provider Patient: Parent & Child

  20. Partnering with Families and Parents to Improve QualityGetting the Patient Voice into the Electronic Medical Record: Using Parent-Completed Pre-Visit Tools to Customize and Improve Well Child Care

  21. Impact of Using Person-Centered Measurement in Electronic Health Records • Increasing Efficiency to Provide • More Patient-Provider Interaction • Increases efficiency in standard processes increases opportunity to build patient-provider relationship • Increases time available for health care counseling, care coordination and addressing psychosocial issues • Quality Measurement • Standardized comparison across clinical populations and providers • EHR data can be combined for population-based measurement • Identifies areas to leverage quality • improvement efforts Meaningful Use Measures Measures that are clinically relevant, useful for quality monitoring and improvement, and patient engagement Ex: PHDS & WVP • Disparities Analysis (CSHCN, SES) • With increasing technology and opportunities for access to care, monitoring disparities becomes essential • Encompasses need to monitor performance across clinical populations to analyze impact of new policies and procedures • Patient Engagement • Patient has access to own medical records • Patient is empowered to understand and control the health care experience • Patient experience of care is important measure of quality

  22. The Vision: Empowering A Cycle of Engagement (1) PHDS; (2) WVP; (3) PHDS

  23. Step 2: Implement the “Plan My Child’s Well Visit” Tool(now call Well Visit Planer)

  24. Examples of the EHR Feed: Open Ended items [Parent report: Should she be interested in toilet training?] [Parent report: She can say so much lately. It is fun to hear the new ]

  25. Top 5 Priorities Picked for Each Age Group

  26. What we hear! Parents: “I didn’t get my email!” Providers: “I can’t live without my CAHMI visits”

  27. Overview of the National MCH Data Resource Center The Data Resource Center is supported by the federal Maternal and Child Health Bureau

  28. What’s Data is Available on the DRC Website • Data Snapshots • View Multiple Indicators from each survey • Compare Multiple Indicators Across Years • View Topic Specific Snapshots • Individual Indicators • Available by state, region, and nationwide • Can be stratified by subgroups • Compare all states on individual indicators • State Ranking Maps

  29. What normally would have to be done to get data findings: • Download raw data files, study content and sample size sufficiency, select topics, upload data into statistical analysis software, conducting file linking (household, family, state), clean, code for missing data, conduct imputation if needed, etc. • Determine measure scoring, construct variables, learn about concepts and coding, confirm valid coding • Subpop to your state, construct subgroup variables • Conduct weighting and adjustment to standard errors for complex sampling • Produce data findings and format into tables and graphs. • Now you can: • Click on a topic • Get tables and graphs already made • Compare across all states and subgroups of children with a point and a click! • Download and use in presentations, reports, one pagers, etc.

  30. Data Resource Center Tour www.childhealthdata.org

  31. NSCH and Healthy People 2010

  32. NS-CSHCN and Systems of Care NS-CSHCN and Systems of Care

  33. Key Topics Addressed by the Data Resource Center • Coverage and Access • Insurance coverage, gaps in coverage and impact of uninsurance and type of coverage • Adequacy of insurance • Timely access to covered/needed care • Quality and Equity • Six MCBH System Performance Measures • Medical home for all children and children and youth with special health care needs • Transition to adulthood for CSHCN • Mental, emotional and behavioral health • Health disparities for vulnerable populations (minorities, low income, by health status/CSHCN)

  34. Key Topics Continued… • Prevention and Healthy Development • Childhood obesity (BMI, Activities, TV watching, etc) • Early childhood development • Transition to adulthood

  35. How the DRC can support Programs Improvement Partnerships

  36. How the DRC can support Programs Improvement Partnerships

  37. OPTION 1: The DRC 360 “Get Started” Tour Step 1: Just click on your state

  38. Step 2: View a range of measures and select any of your choice

  39. …takes you to your state’s findings for that measure

  40. Step 3: Select a subgroup to view your state findings for

  41. …takes you to your state’s Medical Home findings by insurance type

  42. Subgroup Comparison Options • All 50 states, D.C., & 10 HRSA regions • Age • Sex of child • Race/ethnicity of child • Primary household language • Household income level • Household income (SCHIP) • Family structure • Special Health Care Needs Status • Type of insurance • Consistency of insurance • Presence of a medical home • Presence of an emotional, behavioral or developmental problem • Adequacy of health insurance Association of Maternal & Child Health Programs Annual Conference, 2012

  43. Step 4: See where your state ranks across all states by selecting “all states” as comparison group

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