Where Do We Go From Here? Joseph J. Abularrage, MD, MPH, M.Phil, FAAP, President, NYS AAP - Chapter 2 Jennifer Powell, MPH, MBA, Quality Improvement Consultant Elie Ward, MSW, Project Manager

Commercial Interests Disclosure Joseph J. Abularrage, MD, MPH, M.Phil, FAAP Jennifer Powell, MPH, MBA Elie Ward, MSW I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved or investigative use of a commercial product/device in my presentation.

Learning Objective Determine key activities for action period 3.

1-day in-person meeting Institute for Healthcare Improvement Breakthrough Series Collaborative Model Chapter Quality Network ADHD Project (12-month timeframe) Focus: Standardizing, Delegating and Building Reliable Systems Focus: Diagnosis & Early Follow-Up Learning Session 1 January 2016 1-day in-person meeting Learning Session 2 April 2016 Webinar Learning Session 3 Summer 2016 Learning Session 4 November 2016 Action Period 1 Action Period 2 Action Period 3 Source: The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. Available at: http://www.ihi.org/resources/pages/ihiwhitepapers/thebreakthroughseriesihiscollaborativemodelforachievingbreakthroughimprovement.aspx.

What Needs to Happen in Action Period 3? Continue to strengthen your QI skills Distribute roles and responsibilities across care team/QI team members Move to full implementation when testing is complete – start to build a sustainable infrastructure Develop plan to ensure MOC requirements are met

1. Continue to Strengthen QI Knowledge Meet at least 2 times per month; consider short weekly huddles to ground your testing Continuous data review; create theories/hunches and test them Develop new PDSA cycles with focus on key drivers 3, 4 & 5; use the Change Activity Log to guide your work over the next period Continue to build PDSA ramps until fully tested and confident Actively participate in monthly practice webinars – share, network, pose questions across the network!

Building a PDSA Ramp DATA Implement Change: Changes That Result in Improvement Multiple PDSA Cycles – Sequential Building of Knowledge – include a wide range of conditions in the sequence of tests before implementing the change A P S D Implement Change: DATA D S P A A P S D Wide-Scale Tests of Change: A P S D Hunches Theories Ideas Follow-up Tests: Very Small Scale Test:

2. Distribute Roles Across Your Practice Using the Share the Care Worksheet (where you identified your practice’s current state) to: Consider ways to redistribute roles and responsibilities of care team members Consider ways to determine whether your changes are working. This will help you improve your processes, better allocate resources, and create meaningful professional experiences

3. Move to Full Implementation Consider updating/creating written protocols for diagnosis and follow-up visits Update workflows as you modify processes and roles Determine denominator of your ADHD population Work on the NHS Survey with appropriate stakeholders

Assignment: ADHD Patient Denominator In action period 3, we will introduce the idea of population management. By August 10, please determine the total number of ADHD patients at your practice (required for MOC) You can do this via billing/EHR query, chart pull, etc. In late July, National will send a link for you to enter your number; we will discuss on a future practice call

The NHS Sustainability Model and Guide “Quality improvement often takes longer than expected to take hold and longer still to become widely and firmly established within an organization.” Harn et al. 2002 Source: Maher L, Gustafson D, Evans A. Sustainability Model and guide. National Health Services Institute for Innovation and Improvement. 2007.

NHS Sustainability Survey Developed for use by individuals and teams involved in local improvement initiatives in an attempt to increase the sustainability of improvements for health care and patients. Can be used to predict likelihood of sustainability and guide teams to things they could do to increase the chances that changes for improvement will be sustained. 12 page document that includes an introduction, how to use the survey/guide, including the score sheet And a section that provides ideas for improvements. Source: Maher L, Gustafson D, Evans A. Sustainability Model and guide. National Health Services Institute for Innovation and Improvement. 2007.

NHS Sustainability Survey: Process Factors Source: Maher L, Gustafson D, Evans A. Sustainability Model and guide. National Health Services Institute for Innovation and Improvement. 2007.

NHS Sustainability Survey: Staff Factors Source: Maher L, Gustafson D, Evans A. Sustainability Model and guide. National Health Services Institute for Innovation and Improvement. 2007.

NHS Sustainability Survey: Organizational Factors Source: Maher L, Gustafson D, Evans A. Sustainability Model and guide. National Health Services Institute for Innovation and Improvement. 2007.

NHS Survey: Next Steps Determine who should fill out each section of the survey and when Aim: complete survey by the end of Action Period 3 (end of September-early October) We’d like to feature your teams’ results on webinars in those months – what you learned and ideas it gave you for sustainability

MOC Reminders Cycle 1 ends July 2016! Need to enter into mehealth an average of 5 unique patients (ages 4-17) per month over 5 (of a possible 7) data collection cycles (at least 25 patients total, per provider) If you need to transfer patients from a nurse or admin, refer to the handout distributed. If you have trouble contact Allie Stevens or Ed Wise. This is NOT the only MOC requirement; you must be actively participating. Refer to MOC handouts for participation and attestation requirements.

MOC Reminders Cycle 2: July 2016 – January 2017 Need to initiate follow-up assessments with an average of 5 patients (ages 4- 17) per month over 4 (of a possible 7) data collection cycles (follow-up assessments for 20 patients total, per provider) You can choose whether you get the 25 points in 2016 or 2017 If you want credit in 2016, you need to have requirements completed by the end of November 2016. If you want the points in 2017, you must be actively entering patients in January 2017. This is NOT the only MOC requirement; you must be actively participating. Refer to MOC handouts for participation and attestation requirements.

Upcoming Practice Webinars We will continue with our regular monthly calls (3rd Friday of the month) through the end of the project (January 2017) Learning Session 4 (LS4) will be a webinar in November (Exact date TBD)

Reminders Complete the LS3 evaluation – required for CME! Will come via email.

Thank you!