Affiliated with Children’s Medical Services Affiliated with Children’s Medical Services Introduction to the Medical Home Part 3 What Tools Can We use to Assess the Medical Home Qualities of our Practice? Webinar Presentation ~ June 2010 ~

Affiliated with Children’s Medical Services Affiliated with Children’s Medical Services Questions to:

1 - What is the Medical Home Model? 2 - -What Tools Can We use to Assess the Medical Home Qualities of our Practice? 4 - How Can Assessment Tools be Used to Quantify and Support a Practice’s Quality Improvement Process? 1 - What is the Medical Home Model? 2 - How does a Practice adopt the Medical Home Model?  3 - What Tools Can We use to Assess the Medical Home Qualities of our Practice? 4 - How Can Assessment Tools be Used to Quantify and Support a Practice’s Quality Improvement Process? Introduction to the Medical Home ~ 4 Part Webinar Presentation Series ~

Objectives for Today… Introduce – the Medical Home Index and Medical Home Family Index Describe – how the tools can be used to assess the medical home qualities of the practice

“Building” a Medical Home requires…  Vision and leadership by physician Collaboration in all learning and improvement efforts  Commitment from: - lead physician - all office staff - care coordinator

Let’s Review Your Progress!   Step # 1. Educate and engage all physicians and practice staff   Step # 2. Identify the children with special health care needs in the practice Step # 3. Unite the medical home team and assess the current medical home qualities of the practice Step # 4. Implement a quality improvement process

Identify lead physician Engage staff person for role of medical home facilitator Identify and involve a “Parent Partner” Establish protocol for communication to work closely with CMS nurse care coordinator Step # 3. Unite the medical home team and assess the current medical home qualities of the practice

Building Your Medical Home Toolkit

- Use the Medical Home Index to determine baseline of medical home qualities of the practice. - Collect family feedback by administering Medical Home Family Index tool to a group of parents to collect family perspective and offer ideas for change.

Medical Home Index - Developed by Center for Medical Home Improvement (CMHI) - Endorsed by the American Academy of Pediatrics “The Medical Home Index is a validated self-assessment and classification tool designed to translate the broad indicators defining the medical home (accessible, family- centered, comprehensive, coordinated, etc.) into observable, tangible behaviors and processes of care within any office setting.” (CMHI) “The Medical Home Index is a validated self-assessment and classification tool designed to translate the broad indicators defining the medical home (accessible, family- centered, comprehensive, coordinated, etc.) into observable, tangible behaviors and processes of care within any office setting.” (CMHI)

Medical Home Index It is a way of measuring and quantifying the “medical homeness” of a primary care practice.

- 25 areas to assess how well the practice functions as a Medical Home - 25 areas to assess how well the practice functions as a Medical Home - Divided into 6 Domains 1. Organizational Capacity 4. Community Outreach 2. Chronic Condition Management 5. Data Management 3. Care Coordination 6. Quality Improvement/Change Each domain has from 2 to 7 themes. Overall, there are a total of 25 themes in the six domains. Each theme is further subdivided into activities that represent a progression of care that are expressed as a continuum from Level 1 to Level 4.

Medical Home Index Basic  Responsive  Proactive  Comprehensive Basic  Responsive  Proactive  Comprehensive (Levels of service)

Instructions 1. Read the description of each theme across its progressive continuum from Level 1 to Level 4. progressive continuum from Level 1 to Level Select the Level (1, 2, 3, or 4) which best describes how your practice currently provides care. describes how your practice currently provides care. 3. When you have selected the Level, then determine whether practice performance within that level is whether practice performance within that level is “PARTIAL” (some activity within the level) or “PARTIAL” (some activity within the level) or “COMPLETE” (all activity within that level). “COMPLETE” (all activity within that level). 4. Check the box that best matches your practice performance performance

Medical Home Index

Case Study

Access to the Medical Record Example: # 1.3 (Domain 1, Theme 3): Sunny State Pediatrics has an orientation brochure for the practice that they provide to each new patient and they also keep copies in their lobby, the brochure includes a paragraph on the importance of the child’s chart and how copies of records can be provided at parent’s request. They can’t recall a time when a parent has asked for access but the item on the index has sparked discussion.

 6/1/10 7 Example: # 1.3 (Domain 1, Theme 3): Access to the Medical Record

Example: # 1.1 (Domain 1, Theme 1): Quality Improvement Activity – when Sunny State’s team got together they discussed that it would be most efficient to post a sign in the lobby, “You are welcome to review your child’s chart with one of our staff, just ask!” The staff agreed that the best process for their practice would be for a medical assistant to provide an open exam room for the parent to view the record and stand by for any questions or requests for copies or appointments that the parent may have.

Continuity Across Settings Example: # 2.3 (Domain 2, Theme 3): Sunny State Pediatrics recently began communicating with the school nurse to better manage some of their children, particularly diabetics, asthmatics, and ADHD kids. But, they haven’t really made it formal yet. They are documenting in the chart as encounters with external providers arise or are requested by parents and the nurse care coordinator facilitates the encounter.

 6/1/10 5 Example: # 2.3 (Domain 2, Theme 3): Continuity Across Settings

Example: # 2.3 (Domain 2, Theme 3): Quality Improvement Activity – to move the practice closer to completion of Level 3, the practice team determines to get more organized with their relationships to other providers and key community resources specific to the children in their practice. They develop a form as part of their new patient documentation that gathers information from the family on who the child interacts with, therapists, schools. The office manager develops a packet of information about this project for the community and sets out to establish contacts with each entity.

Assessment of Needs / Plans of Care Example: # 3.4 (Domain 3, Theme 4): Our Sunny State Pediatrics’ physician has always been the task master of his practice. He waits until the family makes contact, then assesses their needs. He delegates tasks to his staff to have the needs met and trusts that all tasks are completed and the issues of the family are closed. He has noticed that follow-ups are more frequent on many of his special needs children and that they appear for pieces of the same problems repetitively.

 6/1/10 4 Example: # 3.4 (Domain 3, Theme 4): Assessment of Needs / Plans of Care

Example: # 3.4 (Domain 3, Theme 4): Quality Improvement Activity – Our practice team looks at several examples of action plans and ask their parent partners for input as to which of the action plans have a format that is easiest for them to read and follow. They determine that the nurse care coordinator will set up reminders for herself to review and update the care plan every 3 months with the family. She will then take any new needs to the physician who will determine if a visit or referral is needed.

Community Assessment of Needs for CSHCN Example: # 4.1 (Domain 4, Theme 1): Sunny State Pediatrics is used to hearing from the local school nurse and have a good working relationship with the nurse manager of the closest medical daycare to them. They have responded to requests from both in the past to make referrals and seek options for physical therapists, etc.

 6/1/10 4 Example: # 4.1 (Domain 4, Theme 1): Community Assessment of Needs for CSHCN

Example: # 4.1 (Domain 4, Theme 1): Quality Improvement Activity – The practice team determines that they would like to know more about the communities involvement, resources, and weaknesses for the various special needs children in the community and decide there is none better to ask than the parents in their own practice, so they decide to host an open house to draw parents out. They call every family on their roster of CSHCN and tell them the purpose of the open house, the questions that will be asked, and promise to limit the time involved.

Electronic Data Support Example: # 5.1 (Domain 5, Theme 1): Sunny State Pediatrics has an advanced electronic health record as part of their relationship with the university health care system. They have the ability to pull lists of children by diagnosis and have recently developed a complexity scale system. They are working on other parameters to explore in their electronic data system, but it has plenty of “blank” areas in the records that could be used multiple ways.

 6/1/10 5 Example: # 5.1 (Domain 5, Theme 1): Electronic Data Support

Example: # 5.1 (Domain 5, Theme 1): Quality Improvement Activity – while working to improve in this level the group decides to further develop their complexity scores. They believe they might be able to use the scores to help determine the amount of time most appropriate to book for an appointment later. They will make this their first project in this area and then reevaluate.

Quality Activities (processes) Example: # 6.2 (Domain 6, Theme 2): Sunny State Pediatrics is a newer practice that has been mostly caught up in the rigors of establishing clients and training staff. They haven’t had a chance to consider what quality activities might be or review any of their processes yet….

 6/1/10 1 Example: # 6.2 (Domain 6, Theme 2): Quality Activities (processes)

The Family Perspective

Medical Home Family Index - Developed by Center for Medical Home Improvement - Endorsed by the American Academy of Pediatrics Medical home activities cannot be fully measured and/or evaluated without including the family perspective.

Medical Home Family Index

Collect feedback from as many parents / caregivers of children with special health care needs as possible. Collect feedback from as many parents / caregivers of children with special health care needs as possible.

Review results for potential areas of needed improvement. Review results for potential areas of needed improvement.

Re-survey in one year to capture family perspective of your progress Re-survey in one year to capture family perspective of your progress

One Step at a Time…. Next Step… View Introduction to the Medical Home Webinar # 4 – “How Can Assessment Tools be Used “How Can Assessment Tools be Used to Quantify and Support a Practice’s Quality Improvement Process?” to Quantify and Support a Practice’s Quality Improvement Process?”

Please send us your questions and comments! And return to the project website: and click on the to take a brief survey Q & A