The Importance of Building Collaboratives: Improvement Partnerships

1. The Importance of Building Collaboratives:Improvement Partnerships Judith S. Shaw EdD, MPH, RN Executive Director, VCHIP Research Associate Professor of Pediatrics, UVM College of Medicine Co-Chair, Bright Futures Education Center Steering Committee, AAP December 12, 2007

3. Agenda • Improvement Partnerships: Vermont Example • Improvement Partnerships: National Perspectives • A look to the future

4. VERMONT CHILD HEALTH IMPROVEMENT PROGRAM Improvement Partnerships…one model Vermont Child Health Improvement Program

5. VERMONT CHILD HEALTH IMPROVEMENT PROGRAM Missionto optimize the health of Vermont children by initiating and supporting measurement-based efforts to enhance private and public child health practice.In partnership with:Vermont Department of Health University of Vermont Department of Pediatrics, OB, FP & Psychiatry Vermont Chapter of the American Academy of Pediatrics Vermont Chapter of the American Academy of Family PhysiciansOffice of Vermont Health Access (Medicaid) Vermont Agency of Human ServicesBanking, Insurance, Securities & Health Care Administration (BISHCA)Three Vermont Managed Care Organizations (BCBSVT, TVHP, MVP)

6. Improvement Partnerships Care of the Opiate Exposed Newborn Child Development Child Mental Health Improving Prenatal Care Youth in Foster Care EQRO contract Youth Health Improvement Initiative (YHII) VCHIP Executive Director Hired Formal presentation of VPSI to the AAP-VT Spring Meeting; VCHIP core funding obtained for preventive services work Vermont Periodicity Schedule developed by Vermont Department of Health in collaboration with the AAP-VT and AAFP-VT Chapters VCHIP Timeline 2005 2004 2003 2002 Vermont Hospital Preventive Services Initiative (VHPSI) 2001 2000 Vermont Preventive Services Initiative (VPSI) 1999 1994-1998

7. Vermont Preventive Services Initiative • 89% (31/35) of pediatric practices participated • Practices serve > 80% of VT children < 5 years • Preventive Services (PS) 2 year old • Immunizations • Screening / Risk Assessment / Counseling - Environmental tobacco smoke (ETSRA) - Lead (Pb) - Back to sleep (BTS) - Tuberculosis (TB) - Anemia 4 year old: - Blood Pressure (BP) - Vision

8. Improvement of Preventive Services Mean pre and post audit changes: ETSRA, Pb screening, BTS counseling, TB risk, Anemia screening, Blood Pressure, & Vision ns p=.001 p=.03 ns p=.001 p=.001 p=.001 ETSRA Pb BTS TB Anemia BP Vision 4 Year Olds 2 Year Olds Shaw JS et. al., Pediatrics, 2006, 118(4)

9. Improvement in Preventive Services Practices setting an improvement goal and not setting a goal p=.001 p=.001 p=.002 p=.004 p=.031 p=.001 ALL ns VZ ETSRA Pb BTS TB Vision VZ ETSRA Pb BTS TB Vision Goal Not a Goal Shaw JS et. al., Pediatrics, 2006, 118(4)

10. Vermont Hospital Preventive Services • All 12 Vermont hospitals with obstetrical services participated, covering 89% of Vermont births to Vermont residents • Baseline and follow-up chart audits (30 per hospital each time) • Hospital improvement teams ran PDSA cycles, received coaching from the VCHIP project director, and conducted monthly chart audits

11. Vermont Hospital Preventive Services Aggregate baseline and follow-up data (percentages) * significant X2 at p < .05; ** significant X2 at p < .01. Mercier CE et. al., Pediatrics, 2007, 120(3)

12. Number of VT practices participating in at least one VCHIP project • 85% Pediatric Practices (33/39) • 23% Family Practices (24/106) • 27% OB Practices (7/26) • 39% Certified Nurse Midwife Practices (5/13) • 100% VT Hospitals (12/12)

13. Maternal and Child Health Continuum Newborn Prenatal Youth Health Care Pediatric Primary Care

14. Improvement Partnerships: National Perspectives

15. Improvement Partnership …a durable, regional collaboration of public and private partners that uses measurement-based efforts and a systems approach to improve the quality of children’s health care. Collaborating organizations may include • practice and hospital-based health care providers • state government agencies and programs (e.g., public health, Medicaid) • academic institutions • professional organizations (e.g., chapters of the AAP and AAFP) • insurers and other health care payers • policymakers • parent organizations • other organizations in the region that have an interest in child health (e.g., community organizations, consumer groups, businesses, and quality improvement organizations).

16. Rationale for a statewide/regional approach • Improvement requires action at multiple levels in a system • Credo that all improvement is local • State or regional effort at improving the health care of children are often innovative and successful, but not connected nor broadly disseminated – thereby limiting their impact on child health outcomes.

17. Improvement Partnerships Vermont Child Health Improvement Program (VCHIP) envision new mexico The Initiative for Child Health Care Quality Utah Partnership to Improve Child Healthcare Quality (UPIQ) kidnitative West Virginia: Quality Improvement Partnership

18. Improvement Partnerships Washington DC Phase I sites: ARIZONA NEW YORK RHODE ISLAND WASHINGTON WASHINGTON D.C. Phase II sites: OHIO MICHIGAN MINNESOTA OKLAHOMA WEST VIRGINIA Existing sites: VERMONT NEW MEXICO UTAH

19. Unique features of an Improvement Partnership • Can be focus for research (scientific approach to data collection, systematic analysis, publish findings) • Redirect faculty/researchers to local improvement/research • Inform policy through published reports, testifying • Viewed as a “solution to problems” and a “honest broker” • Often joint leadership or leader has joint appointment between academia and state government • Advisory Group focuses on strategy/implementation

20. A look to the future….

21. Improvement Partnerships • Simpson (Health Affairs, 2004) calls for knowledge brokers to be the champions and intermediaries between the researchers and those providing care, suggesting that the federal government has a responsibility to support child health improvement and it should build on the improvement partnership model established in states to bring together state agencies, private payers and provider communities.

22. Partnerships “the academic agency partnerships can address the increasing demands on public health systems with sparse resources” • Livinggood, WC, et. al. AJPH (2007) • Assessing the Status of Partnerships Between Academic Institutions and Public Health Agencies

23. Are You Ready? Editors: Joseph F. Hagan, Jr, MD, FAAP Judith S. Shaw, RN, MPH, EdD Paula M. Duncan, MD, FAAP Published October 2007

24. The business case for what we do…

25. THANK YOU Judith S. Shaw EdD, MPH, RN University of Vermont College of Medicine St Joseph’s 7, UHC Campus One South Prospect Street Burlington, VT 05401 phone: (802) 656-8210 fax: (802) 656-8368 judith.shaw@uvm.edu www.vchip.org