Quality Counts for Kids:First STEPS (Strengthening Together Early Preventive Screening)

Learning Initiative: Shared Vision for the First Learning Session

Amy Belisle, MDSeptember 23, 2011

Partnering Organizations: Maine Quality Counts, Maine DHHS, MaineCare, Maine CDC, Maine Office of Information Technology, Muskie School of Public Service, USM, Vermont Child Health Improvement

Program, Maine Chapter of the American Academy of Pediatrics, Maine Academy of Family Physicians, Maine Primary Care Association MaineHealth, Eastern Maine Health Systems, Central Maine Medical

Group, MaineGeneral Health, Martin’s Point Health Care

Amy Belisle’s Disclosure I 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.

Objectives for First STEPS, LS 1 Setting the Stage: Why we are focusing on

Immunizations, the PCMH, and Bright Futures

Reviewing the Model for Improvement Teamwork: Conducting a Gap Analysis,

Crafting an Aim Statement, and Developing PDSA cycles

Next Steps: Moving Forward over the Next 8 months

Learning Session Ground Rules Be respectful - always Limit side conversations Keep phone conversations out of meeting room Respect confidentiality of conversations Encourage everyone to contribute Respect all opinions Keep patient records confidential (breakout room

available in the Carriage House for confidential computer work or taking calls)

Welcome to our Special Guests VCHIP IHOC/Muskie MaineCare Office of Information Technology Maine CDC, Maine Immunization Program Maine AAP, AAFP, MOA Maine Vaccine Board Maine Immunization Task Force Maine Immunization Coalition Maine Child Health Improvement Partnership (ME

CHIP)

We have lots of experts in the room!

First STEPS MAINE

Norway Western Maine Pediatrics

Saco:MMP Saco

PortlandMMP PortlandBBCH Pediatric and Med-Peds ClinicMMC Family Medicine CenterBBCH Pediatric Hospitalists

South PortlandMMP South Portland

MMP Westbrook Pediatrics-Westbrook

Ellsworth-Maine Coast Pediatrics

Rockland- PenBay Pediatrics

BangorPenobscot PediatrcsHusson PediatricsEMMC Family MedicineInpatient Pediatric Hospitalists

Bridgton Pediatrics

Falmouth-MMP Falmouth

LewistonCMMC Pediatrics,CMMC Family Medicine CMMC Pediatric Hospitlaistss

Brunswick:Bowdoin Medical GroupBrunswick Pediatrics

Waterville PediatricsWinthrop PediatricsKennebec Pediatrics

Practices Demographics 21 outpatient groups and 3 inpatient

hospitalists groups 96 physicians 30, 666 children with MaineCare covered

by practices by Aug 2010 numbers # practices in ImmPact 2: 16 practices and

1 joining in October Chart review: 3 outpatient and 3

hospitalists groups

Practices by the Numbers Practice coaches from the following

systems: Central Maine Medical Center Eastern Maine Healthcare Maine Coast Memorial Hospital MaineGeneral Maine Medical Center PHO/MaineHealth Martin’s Point Maine Primary Care Association

What is the Quality Gap?The gap between the care we know is

best and our ability to deliver it, every time, to every patient in the way they need it.

Maine is 41st in the nation in immunization rates (Commonwealth Fund, 2010)

We need to move from thinking about each patient we immunized in our office last week to managing our entire population of patients

Why Is this Important to Your Practice? Meaningful Use Requirements Universal Childhood Immunization

Program–January 2012 Pathways to Excellence

Prevent Illness, Save Lives!

Immunizations Save Lives and Money

Immunizations are the most cost-effective health prevention activity for children,

$1 spent= $6.30 direct medical cost savings and $18.40 of indirect cost savings

95% decline in most vaccine-preventable childhood diseases in 20th century

Currently only 18% of children in the United States receive all vaccinations at the recommended times

(Maine Primary Care Association. “LD 1408: An Act to Establish the Universal Childhood Immunization Program – a Winning Combination for patients, providers and health plans in Maine,” 2010., Briss, P., Rodewald, L., Hinman, A., Shefer, A., Strikas, R., Bernier, R.,…Williams, S. “Reviews of Evidence Regarding Interventions to Improve Vaccination Coverage in Children, Adolescents and Adults.” American Journal of Preventive Medicine, 2000, 18(IS), 97-100.

Omer, S., Salmon, D., Orenstein, W., deHart, M., Halsey, N. “Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases.” NEJM, 2009, 360(19), 1981-1988., Gust, D., Strine, T., Maurice, E., Smith, P., Yusuf, H., Wilkinson, M…Schwartz, B. “Underimmunization among children: effects of vaccine safety concerns on immunization status.” Pediatrics, 2004, 114(1), e16-22.

Moving from Specific QI Initiatives to Changing

Systems IHI Model for

Improvement Lean Six Sigma Dartmouth ClinicalMicrosystems PCMH

(Making Health Care Work: A Microsystems Approach, Nelson, 2006)

“Systems are perfectly designed to get the results they achieve” -Paul Batalden

Current “Systems”

Atlanta’s infamous ‘Spaghetti Junction’

What We Have Learned So Far: Measurement is Complicated Data Collection is even more Complicated Practices have a lot of turnover in the

summer months Collaboration is a challenge when trying to

connect groups across health care systems and independent sites

When we work together, we can identify problems and solutions much faster

How Today’s Topics Fit Together

Bright Futures

PCMH as the Foundation

Immunization QI

4 Questions When we meet 8 months from now to

discuss immunization rates, what needs to happen in that time period for you to consider this pilot a success?

What are the barriers that you have to face and work around to achieve progress?

What are the biggest opportunities that you need to focus on and capture to achieve success?

4 Questions What strengths will you need to reinforce

and maximize and what skills and resources will you need to develop that you don’t currently have to capture these opportunities?

Let’s make it fun! Games and Prizes!Prize Categories for Today: Prize for 1st Person to Complete Ice

Breaker Game Prize for Best Theme Song Prize for Best Slogan for Raising

Immunization Rates/Learning Collaborative Best idea to improve office flow around

immunizations Closest delivery date for the twins!

First Teams to Win: Prize for 1st team to complete their

paperwork 1st team to submit baseline data 1st team to submit immunization survey