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Learning Collaboratives - Medical Home
...to narrow
the gap between what is and what can be for the growing population
of children and youth with special health care needs. -
NICHQ
NICHQ Medical Home Learning Collaboratives
The National Initiative for Children’s Healthcare
Quality, Inc. (NICHQ) with support from the US Maternal
and Child Health Bureau ran two National Medical Home Learning
Collaboratives. These fifteen-month programs helped facilitate
the improvement of care for the growing population of children
and youth with special health care needs by:
One Practice Teams' Story of Achievements and Insights:
Chapel Hill Pediatrics Presentation
- Almost 600 CSHCN identified in registry and in Medical
Manager with complexity scores
- Care Coordinator does Pre-visit Contacts for 11 docs;
from 3 hrs./wk to full-time
- 93 % of Families find PVC’s helpful
- Printing 3rd ed. CSHCN pocket phonebook; 3rd edition
of transition referral options
- Year 3 of tracking improved patterns of ED and after-hours
utilization
- Boardmaker used for communication-impaired CSHCN
- Planning for Statewide MHLC
- Docs re-educated on coding for CSHCN
- Title V 3 year grant on MH Implementation
- Creating pilot project with BCBS around metrics for
Medical Home measurement
- Held forum with CHPA, Parents and School Admin. around
partnering for CSHCN in schools
- Held “Listening Session” with CHPA parents
to identify needs
- Streamlined “checkout” process
- Joining NC Medicaid Managed Care Network
- Computer Access to Duke/UNC
2003 Participants
This 15-month Learning Collaborative
supported 11 state Title V agencies, each working with three
primary care practices in their state to implement the Medical
Home model. In 2003, the following states applied to participate:
Colorado, Connecticut, Florida, Louisiana, Michigan,
New York, + North Carolina, Ohio, Oklahoma, Utah, Virginia,
Wisconsin
2005 Participants
This 15-month Learning Collaborative supports 9 state Title
V agencies, each working with three primary care practices
in their state to implement the Medical Home model. In 2005,
the following states applied to participate: District of
Columbia, Illinois, Maine, Maryland, Minnesota, Pennsylvania,
Texas, Vermont, West Virginia.
Collaborative Mission
The Collaborative mission is to transform care for CYSHCN
and their families so that:
- Care is coordinated, comprehensive, and satisfying both
to deliver and receive.
- Care is planned, monitored and measured throughout
childhood and transitioned smoothly into adulthood.
- Community-based pediatricians, family physicians, nurse
practitioners, and physician’s assistants are active
co-managers with specialists.
- Children and their families are supported as the primary
caregivers, decision-makers, and lead partners in the
health care process.
- Community resources are integrated into the care process,
and community cultures are effectively supported.
Strategy
This Learning Collaborative will operate over a 15-month
period. Title V agencies and primary child health care offices
will work together with faculty from the National Center
for Medical Home Initiatives at the American Academy of
Pediatrics, the Center for Medical Home Improvement, and
NICHQ with support from the US Maternal and Child Health
Bureau to improve care for CYSHCN and their families.
Teams from participating primary care organizations will
achieve dramatic results by the application of effective
quality improvement methods (the Model for Improvement and
methods for spread of innovation). In addition, Title V
agencies will develop the internal capacity to support teams
as they learn and put into action improvements over the
life of the Collaborative and beyond. As part of this process,
Title V programs will increase their understanding of community-based
primary care practice and statewide primary care professional
organizations.
Vitally important to the success of this Collaborative
is the concept of “spread,” the dissemination
of innovation. This Collaborative will devote substantial
time, energy, and learning to strategies for Title V agencies,
in conjunction with state-level pediatric and family practice
professional organizations and family advocacy groups, to
successfully expand breakthroughs and improvement to primary
child health care practices
Expectations
Each Title V agency recruits 3 practice teams; NICHQ encourages
state Title V agencies to work closely with their state
AAP and AAFP chapter to identify interested practices. Both
tiers of teams—Title V and primary care practice—complete
Pre-work before attending a national two-day Learning Session
to learn best practices, plan tests of change, analyze their
progress, and develop strategies to overcome barriers to
change. Learning Session 2 is conducted using distance-learning
technology, and Learning Session 3 is conducted as a second
face-to-face two-day training. Throughout MHLC II, teams
report on and share progress monthly. NICHQ uses these data
along with other qualitative measures and before and after
assessments to evaluate the Collaborative.
Summary of findings, conclusions,
and recommendations from the 2003 Project
The project was overwhelmingly successful. Examining
feedback from a variety of sources collected through surveys,
interviews, evaluations, and monthly data, shows the overall
response to the collaborative on the part of Title V teams,
practice teams and faculty was very positive. Connections
have been made between Title V and primary care practices
that simply did not exist before; and improvements in the
delivery of care to children with special health care needs
and their families have come about as a result of those
connections.
As a result of their participation in the Medical Home Learning
Collaborative, nearly 60% of the practices in the project report that they
are partnering with families to assess needs, plan care,
and set goals. Nearly 70% report improvements related to
access to providers. Half of the practices are now maintaining
some sort of registry of CSHCN. At the end of the collaborative,
faculty unanimously agreed that the model was highly successful
in moving these states forward to build lasting medical
homes for children with special health care needs.
The most dramatic outcome results were seen in unplanned
hospitalization and Emergency Department visits (ED). Unplanned
hospitalization also dropped 13-18% and the decline was
statistically significant (p<.05). ED visits were reduced
overall; one site experienced a 20% drop, which was suggestive.
For more information click
here.
Forms
Presentations
Using Learning Collaboratives to Implement the
Medical Home in Primary Care 
Presented at the CATCH & Medical Home National Conference
- July 16, 2004
Deborah
Allen, ScD, MS (38.5 KB)
Associate Professor
Health and Disability Working Group at Boston University
School of Public Health
W. Carl Cooley, MD, FAAP (5.15 MB)
Co-Director, Center for Medical Home Improvement
Medical Director, Crotched Mountain Rehabilitation Center
Molly Gatto
Project Coordinator
Educating Physicians in Community Integrated Care (EPIC
IC)
Pennsylvania Chapter, AAP
Charles
Homer, MD, MPH, FAAP (385 KB)
Chief Executive Officer
National Initiative for Children's Healthcare Quality
Alan Kohrt, MD, FAAP* (4.12 MB)
General Pediatrician
Children's Hospital of Philadelphia
If you would like more information on this project
contact Emily Crites at ecrites@nichq.org
with any questions.
Or you can find out more about this opportunity by clicking
here for the project overview.
These training programs
are not directly managed, nor sponsored by the national
American Academy of Pediatrics. Local organizations are
responsible for hosting and sponsoring these programs.
Last updated
August 7, 2008
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