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Part I (AAP QI) - Results to Date . Ruth S. Gubernick, MPH Quality Improvement Advisor Florida Pediatric Medical Home Demonstration Project Learning Session 2 April 27-28, 2012. Disclosure.
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Part I (AAP QI) - Results to Date Ruth S. Gubernick, MPH Quality Improvement Advisor Florida Pediatric Medical Home Demonstration Project Learning Session 2 April 27-28, 2012
Disclosure I have no relevant financial relationships with the manufacturers of any commercial products 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 their presentation.
Chart Review Aggregate DataPre-work (August 2011) vs. End of Phase 1 Action Period (March 2012)
% of patients with an identified primary care pediatrician or physician-led care team
% of patients with whose primary care pediatrician or physician-led care team member provided the most recent health supervision visit
% of patients with patient and/or family concerns elicited at this visit
% of patients with all expressed concerns addressed or with plans made to address them
% of patients who have a medical summary or comprehensive care plan created or updated/maintained at this visit
% of patients who have a current copy of their medical summary or comprehensive care plan reviewed and offered to them at this visit
% of patients with a follow-up visit scheduled or recommended
Part 1 - Practice Survey Aggregate DataAugust 2011 and March 2012
Provide and Document Planned, Proactive, Comprehensive Care (continued)
What has been the impact of the FL Ped MH collab activities on your clinical and operational work this month (where 5=much easier and 1=much more difficult)?
What is the biggest barrier encountered? How did you overcome it (or not)? • Staffing changes. Will be training new staff on Medical Home and EMR • Scheduling our medical home patients (level 4) with specific providers and finding behavioral health resources for our families in need of those services. • Need more time/Time management • Expanding care coordination to all our complex patients • Difficult to do huddles every day. Trying in afternoon, rather than mornings. • Fine tuning/perfecting a care plan for our patients with complex needs • Completing all components of the comprehensive care plan. Met with staff to review importance. • Lack of an EMR. We’ve chosen one! • Not having a care coordinator and a patient registry. In the process of trying to get a care coordinator position approved in the budget. • Difficult to make it work having only a single parent partner. Recruiting for a parent council. • Residency program undergoing re-accreditation has been all consuming. Will be over in April. • Coordinating personnel, medical records and schedules for our upcoming move. Will be orienting/training everyone on our new EMR
Share something important that you learned… • Huddles have proven valuable. • Patients’ positive response in seeing the same provider at each visit. • How happy people are to give feedback. Staff/Parents like to be involved and they like to share their ideas. • Coordination between community organizations is key. • The local CMS team was very eager to meet with us and provide info on management and available resources. We will continue to meet! • Learned how to present the medical home concept as an efficient business model when care coordination is maximized. • That we have a great team, even being short staffed they all pulled together for care plans. • Care plans have been very useful and a very good way to summarize the office visit and follow up instructions with patients/parents. • There are many resources available to guide us in becoming a successful medical home. • Families appreciate information they can take home and read to learn more about our services or those we’re referring them to. • Switching completely to EMR is a lot harder and more time consuming than anticipated • Small changes can make a BIG difference.
What, if anything, surprised you…? • How much we are now relying on our care coordinator. • How organized the parents of medically complex children are. • That more physicians don’t use the resources available from the local CMS team. • Families visit the office just to speak with their nurse case manager, even though she is available by phone and e-mail. • That our ADHD follow ups are only 75% when I thought we would be at nearly 90%. • People work better with personal requests, motivation and communication. • We have more computer tracking capabilities than originally thought. • The patients like technology. They were excited to use the iPad. • The responses to the survey were overwhelmingly positive. • Parents thought a 15-minute wait time is too long. • Our patient population is rapidly expanding. • After reading the NCQA Standards and Elements, we realized our office has met at least one factor in each element.
