Bright Futures Ahead: Preventive Care Guidelines Update and Strategies for Implementation   Judy Shaw, EdD, MPH, RN, FAAP March 18, 2017

Judy Shaw, EdD, MPH, RN, FAAP Bright Futures Ahead: Preventive Care Guidelines Update and Strategies for Implementation Judy Shaw, EdD, MPH, RN, FAAP Bright Futures Co-Editor Executive Director, Vermont Child Health Improvement Program Executive Director, National Improvement Partnership Network Professor of Pediatrics & Nursing, The Robert Larner, M.D. College of Medicine at The University of Vermont

Disclosure In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

Learning Objectives Discuss changes to the Bright Futures guidelines and associated Periodicity Schedule Understand the revision process and the evidence/reason for the changes Review strategies for implementing the revised recommendations for preventive pediatric health care  

Bright Futures Guidelines: History 1st Edition was published in 1994 2nd Edition was updated in 2000; revised in 2002 3rd Edition was revised and released in 2008 4th Edition was revised and released in 2017

Bright Futures/AAP Periodicity Schedule (2017)

Bright Futures Guidelines, 4th Edition Part 1: Health Promotion Themes 12 chapters highlighting key health promotion themes 3 new themes Part 2: Health Supervision Visits Evidence and Rationale for screening recommendations 32 age-specific visits (including prenatal visit) 5 health supervision priorities for each visit Designed to focus visit on most important issues for child that age Includes: social determinants of health (risks and strengths and protective factors)

Bright Futures Guidelines, 4th Edition Child Healthy Development Family Support Mental Health and Emotional Well-Being Nutritional Health Physical Activity Healthy Weight Promoting Lifelong Health for Families and Communities Oral Health Healthy Adolescent Development Safety and Injury Prevention Community Relationships and Resources Promoting the Healthy and Safe Use of Social Media Children and Youth with Special Health Care Needs

Components of a Bright Futures Visit History Surveillance Physical examination Screening Immunizations Anticipatory guidance

Priorities in the 4th Edition 12 Month Visit 15-17 Year Visit Social determinants of health Risk Factors: living situation and food security; tobacco, alcohol and drugs Strengths & Protective Factors: social connections with family, friends, childcare and home visitation program staff, and others Establishing routines Feeding and appetite changes Establishing a dental home Safety Social determinants of health Risk Factors: interpersonal violence; food security and living situation; family substance use Strengths & Protective Factors: connectedness with family and peers; connectedness with community; school performance; coping with stress and decision-making Physical growth and development Emotional well-being Risk reduction Safety

Priorities for the 12 Month Visit

Screening: 12 Month Visit

Priorities for the 15 Through 17 Year Visits

Screening for the 15 Through 17 Year Visits

Evidence and Rationale Chapter Rigorous Guidelines Review Evidence and Rationale Described Evidence Consultant: Alex Kemper, MD, FAAP Recommendations interpreted with caution Based in science Consensus based What Evidence grounds our Recommendations?

Summary of Changes to Periodicity Schedule Maternal Depression Screening Oral Health Fluoride Varnish Fluoride Supplementation Adolescent Hearing Adolescent Depression Screening Dyslipidemia HIV Tobacco, Alcohol, or Drug Use Assessment

Evidence and Rationale Example: Anemia

Integrated System Documentation Forms Enables Provider to document all pertinent information and fulfill Quality Measure Patient/Parent Education Handouts Provides Parental Education all the Bright Future Priorities for the visit Previsit Questionnaires Allows healthcare provider to gather pertinent information without using valuable time asking questions

Examples: CHIPRA 2017 Core Measures Adoption of the Bright Futures Guidelines can help to meet some of the CHIPRA Core Measures and MCH National Performance Measures related to pediatric preventive care. Examples: Title V MCH Services Block Grant National Performance Measures Examples: CHIPRA 2017 Core Measures Percent of children with and without special health care needs having a medical home Percent of infants placed to sleep on their backs Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool Well-Child Visits in the First 15 Months of Life Developmental Screening in the First Three Years of Life Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Adolescent Well-Care Visit Child & Adolescent Immunization Status mchb.hrsa.gov/programs/titlevgrants/blockgrantguidance.pdf https://www.medicaid.gov/medicaid/quality-of-care/downloads/2017-child-core-set.pdf

Preventive Services Implementation State Spread Project (PreSIPS2) Pediatric Practices Approx. 10 per Chapter + residency program Chapter Leadership Teams Lead Physician, Project Mgr./QI Coach, State MCH rep, Family rep AAP National Leadership Team & Staff AAP Chapter Participants: Georgia New Jersey South Carolina Virginia 21

Preventive Services Components 9 Month & 24 Month Visits Elicit & Address Parental Concerns Age Appropriate Medical Risk Assessment/Screening Weight For Length or BMI Developmental Screening/Follow-up Autism Specific Screening/Follow-up Addressing 3 Bright Futures Priorities in AG Evaluation Of Parental Strengths Oral Health Risk Assessment Maternal Depression Screening Plan Do Study Act

*Three of five Bright Futures priorities were used for anticipatory guidance delivery **Bright Futures PSS is a summed score of all preventive services; each service is a value of 1 and each chart received a summative score of 0 to 7 for 9-mo visit and 0 to 8 for 24-mo visit at baseline and completion

Virginia: PreSIPS2 Why We Applied Multidisciplinary and diverse team approach (clinical and non-clinical) Monetary stipend (and TA) to kick start reconnection among partners Family representative on leadership team was valued and integral Reinforced value of data collection and improving the system(s) Designed with clear and practical goals and objectives PDSA cycles gave practices opportunity to fine tune improvements Provided framework to build and strengthen – Practice team & Chapter leadership team Opportunity to broaden perspectives and have community partners work directly with AAP Chapter Added more bricks to foundation of the medical neighborhood Opportunity to identify gaps in the system at all levels (clinical, public health, state, family)

EQIPP The EQIPP Bright Futures courses, online learning programs, weave improvement principles and concepts with pediatric-specific clinical content to improve health outcomes. It is designed to identify and continuously close gaps in practice using practical tools. EQIPP Bright Futures Infancy & Early Childhood is launched and the and Middle Childhood & Adolescence is expected to launch this year. EQIPP participants simultaneously earn CME credit and meet MOC Program Part 4: Performance in Practice requirements.

brightfutures.aap.org

American Academy of Pediatrics Bright Future National Center Jane Bassewitz, MA Manager, Bright Futures National Center Kathy Janies Manager, Bright Futures Implementation Phone 847-432-4223 E-mail brightfutures@aap.org Web site brightfutures.aap.org