1. Incorporation of the Bright Futures Program in Rural, KS Dr. Ellen Squire Dr. Michelle Pope Lisa Gagnon RN Preventive Services Improvement Project Learning Session 2 November 11-12, 2011

2. 2 Disclosures We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. We do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation.

3. 3 About HaysMed Pediatric Center  Ave. number of visits per year: 15,600 Number of well checks per year: 7,200  We have added providers! 4 full-time and 1 part-time pediatricians 1 part-time physician assistant  Only pediatricians for a large referral area

4. 4 Where we started

5. 5  Paper based system, old paper forms Limited anticipatory guidance No standardized developmental screening No standardized autism screening No maternal depression screening No dental screening  Great variability between physicians Inconsistent BMI, Wt/Lgth, vision, hearing

6. 6 Initial Barriers and Concerns  Physician resistance  Nursing/Staff concerns  Parental cooperation  Paper obligations  Insurance/payment concerns  Referral agent/agency availability  Time!!

7. 7 Our 1st Approach  Gradual Progression 2 month and 18 month WCC Concurrent office systems/referral tracking 1-2 forms/month throughout the year with gradual incorporation of Dental, ASQ, MCHAT, etc.  Forms Only Previsit Questionairre WCC form

8. 8 Gradual Progression???  February: forms - 2 mo. & 18 mo. Previsit Questionnaire Referral Tracking/CYSHCN tracking Preventative Services Prompting Sheet  March: 2 more forms - 9 mo. & 2 yr. Community Resources Update Supplemental Quentionnaires  April: 2 more forms - 4 mo. & 6 mo. ASQ  May: 2 more forms - 1,2 week & 1 yr. Dental Screening/Fluoride

9. 9 Gradual Progression???  June: All visit forms MCHAT  July: All visit forms Maternal Depression  August: All visit forms Parental Strengths  September/October: Review

10. 10 Our Biggest Barriers  Nursing/Staff resistence Perceived “extra work”  Referral Tracking  Plethora of Paper!  Maternal depression/Dental

11. 11 Our Biggest Barriers

12. 12 What Surprised Us  It was relatively easy Physicians were a minor barrier Feel like WCC are more complete  Little time for supplemental forms  Time was the same  Brought us together

13. 13 Any changes?  Less paper?  Strength based approach - cue on form

14. 14 Conclusions  We had a great time  Learned a lot about our office: physicians, staff, and ancillary agencies  Went from doing a good job on WCCs to “pride” in our WCCs