CMHICMHI Building Primary Care Medical Homes for CSHCNs & Assessing the Quality 1 st Annual National EHDI Meeting February Vienna, Virginia Jeanne W. McAllister, Co-Director Center for Medical Home Improvement Hood Center for Children and Families Dartmouth Medical School, Lebanon, NH Funding USMCHB

CMHICMHI Center for Medical Home Improvement Mission The mission of CMHI is to establish and support networks of parent/professional teams to improve the quality of primary care medical homes for children and youth with special health care needs and their families.(2001)

CMHICMHI

CMHICMHI A Medical Home Is not so much a place… Is not so much a place… But a structure and process of care But a structure and process of care That emphasizes home as a: That emphasizes home as a: Centralizing headquarters for care Centralizing headquarters for care Place to feel recognized, welcomed, supported Place to feel recognized, welcomed, supported Connection to other community resources Connection to other community resources

CMHICMHI Primary Care Medical Homes Agree? Disagree? All primary care practices are medical homes All primary care practices are medical homes Family feedback is difficult to obtain & to hear Family feedback is difficult to obtain & to hear Care coordination activities occur in most practices Care coordination activities occur in most practices Improvement is key to building a medical home Improvement is key to building a medical home Measurement discourages providers Measurement discourages providers Families report (CMHI) experiencing high levels of: Families report (CMHI) experiencing high levels of: understanding & listening understanding & listening care & respect care & respect

CMHICMHI Primary Care Medical Homes Agree? Disagree? All primary care practices are medical homes(D) All primary care practices are medical homes(D) Family feedback is difficult to obtain & to hear (D) Family feedback is difficult to obtain & to hear (D) Care coordination activities occur in most practices (A) Care coordination activities occur in most practices (A) Improvement is key to building a medical home (A) Improvement is key to building a medical home (A) Measurement discourages providers (D) Measurement discourages providers (D) Families report (CMHI) experiencing high levels of: Families report (CMHI) experiencing high levels of: understanding & listening understanding & listening care & respect(A) care & respect(A)

CMHICMHI Improvement Strategies in Primary Care… Why are they needed?

CMHICMHI Pediatric primary care Designed for the 80% of children who do not have special health care needs Designed for the 80% of children who do not have special health care needs Designed to provide well child preventive care services and acute illness management Designed to provide well child preventive care services and acute illness management Designed to support a single service unit: the provider – patient encounter Designed to support a single service unit: the provider – patient encounter

CMHICMHI Changing a pediatric practice is like trying to change the tire on a bicycle while you are riding it

CMHICMHI CMHI methodology emphasizes: Partnerships with parents Partnerships with parents Primary care-based care coordination Primary care-based care coordination Provider leadership Provider leadership Continuous improvement process Continuous improvement process Linkages to community resources Linkages to community resources Improved office systems that: Improved office systems that: Identify CSHCNs Identify CSHCNs Track and monitor progress Track and monitor progress Evaluate outcomes Evaluate outcomes

Clinical: preventive services for CSCHN illness episodes acute encounters Satisfaction: communication office responsiveness care plan/continuity family involvement Functional: stress/worry school absence dx/rx information access family caregiving competence Cost: ER, hospital visits unnecessary specialty & office visits lost parental work time care coordination activities received Center for Medical Home Improvement - Outcomes, 2001 Clinical Value Compass for Medical Home CMHICMHI

Not everything that can be counted counts, and not everything that counts can be counted. Albert Einstein

CMHICMHI Levels of measurement Population level measures Population level measures What percentage of CSHCNs receive care in a Medical Home? What percentage of CSHCNs receive care in a Medical Home? Practice level measures Practice level measures Where is the practice on the medical homeness continuum Where is the practice on the medical homeness continuum Intra-practice measures Intra-practice measures Which changes in care constitute improvements? Which changes in care constitute improvements? Data that can feed forward and feedback Data that can feed forward and feedback

CMHICMHI The Medical Home Index Validation/Classification Tool 6 Domains (25 Themes) Organizational Capacity (7) Organizational Capacity (7) Chronic Condition Management (6) Chronic Condition Management (6) Care Coordination (6) Care Coordination (6) Community Outreach (2) Community Outreach (2) Data Management (2) Data Management (2) Quality Improvement/Change (2) Quality Improvement/Change (2)

CMHICMHI Achieving medical homeness MHI measures movement toward a Medical Home MHI measures movement toward a Medical Home Basic (good) pediatric primary care (Level 1) Basic (good) pediatric primary care (Level 1) Responsive pediatric primary care (Level 2) Responsive pediatric primary care (Level 2) Proactive pediatric primary care (Level 3) Proactive pediatric primary care (Level 3) Comprehensive pediatric primary care (Level 4) Comprehensive pediatric primary care (Level 4)

Points: ( )

CMHICMHI MHI results from 43 practices Mean Score Median Score 98 Standard Deviation Score range Possible score range

CMHICMHI Distribution of overall mean item scores

CMHICMHI ( ) Medical Home Index - pre-improvement (*Rated by interviewer using primary care audit responses).

CMHICMHI Medical Home Index - post-improvement ( )

CMHICMHI Medical Home Index scores 2001 & 1998 (estimate)

CMHICMHI The Medical Home Family Index - practice level measurement Short family survey available in English and Spanish Short family survey available in English and Spanish Maps to the Medical Home Index Maps to the Medical Home Index Blends parent/professional perspectives as a basis for improvement Blends parent/professional perspectives as a basis for improvement

CMHICMHI Building Medical Homes -Model Measurement/Improvement/Measurement Measurement/Improvement/Measurement Learning collaborative/ network Learning collaborative/ network brings energy, support and family input to primary care brings energy, support and family input to primary care contributes to their vitality contributes to their vitality outcome of strong medical homes for children and families outcome of strong medical homes for children and families

CMHICMHI

CMHICMHI Center for Medical Home Improvement Improvement kit keyed to Medical Home Index Improvement kit keyed to Medical Home Index Building a Medical Home – Improvement Strategies in Primary Care for Children with Special Health Care Needs Building a Medical Home – Improvement Strategies in Primary Care for Children with Special Health Care Needs Web site: Web site: Download kit and measurement tools Download kit and measurement tools Links to other resources Links to other resources News News Interactive self-assessment (future) Interactive self-assessment (future)

Home is the place where When you have to go there They have to take you in Robert Frost