Family Roles & Relationships: Opportunities for Partnership

1. Family Roles & Relationships: Opportunities for Partnership R.J. Gillespie, MD, MHPE, FAAP Medical Director, Oregon Pediatric Improvement Partnership Betsy Anderson, Family Voices Director, Family Voices IMPACT, Boston, MA Preventive Services Improvement Project Learning SessionJanuary 21-22, 2011

2. Objectives • Learn examples of eliciting and incorporating family concerns into visit planning • Identify ways to incorporate family feedback into how care is delivered at a practice level

3. Eliciting parent concerns: a snapshot • Parents reporting important unmet needs by pediatric clinicians: 94% • Parents reporting they were not asked about learning, development, or behavior concerns: 40% • Pediatricians who agree they have sufficient time to address family psychosocial problems: 16.3% • E. Schor, “Rethinking Well Child Care”, Pediatrics 114 (July 2004)

4. 3 year old Well Child Care:Anticipatory Guidance Subjects • Car Seat • Stranger Awareness • Safe Touch • Helmets • Burns • Street Safety • Water Safety • Poison Control • Guns • Trampolines • Discipline Consistency • Allow Decision Making • TV • Dental Evaluation • Body Mass Index, Nutrition, Sleep patterns not even included in AG section

5. Attending to parent concerns • What are ways to ensure parent concerns are elicited? • Formal screening tools • Pre-visit questionnaires • Enhanced encounter

6. Family Expectations & Knowledge • Parents understanding of well child care • Parent hopes for well child visit experience - assurance that their child is ok - assurance that they’re doing a good job - Pediatrics: Well Child Care as Viewed by Families + Clinicians • Parent reports of partnership w/primary care - Nat’l Survey of Children’s Health - Nat’l Survey of CYSHCN 6

7. Families of Children w/Special Health Care Needs • Of necessity, changed the dynamic • Helped to create partnerships at all levels • Importance of Medical Home and Primary Care • Recognition of the need for well child care for CYSHCN 7

8. Bright Futures: Health & Wellness • Health promotion / disease prevention is carried out - or not - by families at home every day. • Families need a broad(er) understanding of health / health care and their roles • Families need reinforcement, encouragement • Families need opportunities to share ideas, successes and resources (not only problems and questions) 8

11. Family Involvement – Health Visit • Well Child Care – so much more than (most) families imagine • Family Priorities #1 Concern • “Health Care/ Healthy practices – by any other name. . . • Carried out by families every day • Families can be resources to practices and to other families 11

12. Learning about (and using data about) families’ experience of care • Patient surveys • Delivery system • Clinical content • Parent advisory groups • Parent consultants on QI projects

13. The Online PHDS • Previous data we were getting only spoke to quality of care and service. • HEDIS Measure: did well child care occur on schedule? • We wanted actionable data about parent satisfaction with regard to the clinical content of well child visits. • The PHDS provided us areas of improvement at the regional, office and (in some cases) provider level.

14. What we hoped to learn… • Implemented for baseline quality measurement • QI efforts focused on developmental screening • Questioned whether current Anticipatory Guidance delivery is effective • Is there a more effective way to deliver Anticipatory Guidance subject matter? • Assess for other opportunities for future QI efforts

15. Now what? • Confirmed our suspicions about developmental screening, family risk assessment • Patients given opportunity to engage in improving how well child care is delivered • Able to drive future QI projects

16. Opportunity for Improvement: Assessing for Parental Depression Source: 2008-2009 CAHMI Online PHDS Data

17. Parent Advisory Group • Parking • Telephone System • Accessibility • Wait times • Patient Portal • Communication • EMR • Evening/Weekend Care • Physician Hours • Marketing

18. Family Involvement – Practice Level • Ideas and Strategies. . . • Advisory - often or occasionally - specific or broad • Resources • Education and Training • Quality and Evaluation • Other Specific Initiatives 18

19. Family InvolvementTools to use, share, or adapt AAP BF Toolkit Generating Community Resources FV Identifying Family Needs, Interests, Skills BF Resources for Families Family Voices AAP BF VA Dept of Health CAHMI BF 19

20. Finally. . . Health promotion works!Families matter!Raising healthy children is everybody’s business 20

21. What are you doing, what can you do… …to actively elicit patient concerns? …to learn from families about their experiences of care? …to use family feedback to drive quality improvement in your practice?