2. 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.

3. 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

4. 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)

5. 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)

6. We have lots of experts in the room!

7. First STEPS MAINE Norway Western Maine Pediatrics Saco: MMP Saco Portland MMP Portland BBCH Pediatric and Med-Peds Clinic MMC Family Medicine Center BBCH Pediatric Hospitalists South Portland MMP South Portland MMP Westbrook Pediatrics- Westbrook Ellsworth- Maine Coast Pediatrics Rockland- PenBay Pediatrics Bangor Penobscot Pediatrcs Husson Pediatrics EMMC Family Medicine Inpatient Pediatric Hospitalists Bridgton Pediatrics Falmouth- MMP Falmouth Lewiston CMMC Pediatrics, CMMC Family Medicine CMMC Pediatric Hospitlaistss Brunswick: Bowdoin Medical Group Brunswick Pediatrics Waterville Pediatrics Winthrop Pediatrics Kennebec Pediatrics

8. 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

9. 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

10. 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 41 st 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

11. Why Is this Important to Your Practice?  Meaningful Use Requirements  Universal Childhood Immunization Program–January 2012  Pathways to Excellence  Prevent Illness, Save Lives!

12. 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 20 th 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.

13. Moving from Specific QI Initiatives to Changing Systems  IHI Model for Improvement  Lean  Six Sigma  Dartmouth Clinical Microsystems  PCMH (Making Health Care Work: A Microsystems Approach, Nelson, 2006)

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

15. Current “Systems” Atlanta’s infamous ‘Spaghetti Junction’

16. 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

17. How Today’s Topics Fit Together Bright Futures PCMH as the Foundation Immunization QI

18. 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?

19. 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?

20. Let’s make it fun! Games and Prizes! Prize Categories for Today:  Prize for 1 st 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!

21. First Teams to Win:  Prize for 1 st team to complete their paperwork  1 st team to submit baseline data  1 st team to submit immunization survey