Illinois Medical Home Project

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Illinois Medical Home Project

• Presented by Kathy Sanabria, MBA, PMP Project
  Director

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Illinois Medical Home Project (IMHP) Evaluation
Status

• American Public Health Association
• 134th Annual Meeting and Exposition
• November 7th, 2006
• Boston, MA

Principle Investigator Charles Onufer,
MD Project Director Kathy Sanabria, MBA,
PMP Administering Organization Illinois
Chapter, American Academy of Pediatrics
(ICAAP) Evaluators CADE Research Data Management
Group University of Illinois Chicago (UIC)
School of Public Health Kristin Rankin, MSPH
(PhD Candidate) Andrew Cooper, MPH Wendy Guo, BS
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Theres No Place Like a Medical Home

• A medical home is not a building, house, or
  hospital, but rather an approach to providing
  comprehensive primary care. A medical home is
  defined as primary care that is accessible,
  continuous, comprehensive, family centered,
  coordinated, compassionate, and culturally
  effective.

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Illinois Medical Home Project

• In July 2004, the ICAAP was awarded a
  four-year 1,000,000 federal grant through the
  Division of Services for Children with Special
  Health Care Needs, Maternal and Child Health
  Bureau, to spread the medical home concept to
  primary care providers throughout Illinois. This
  presentation provides evaluation results for
  Phase I of the project, which occurred July 2004
  through June 2006, and outlines Phase II of the
  project. The project is being administered by
  the Illinois Chapter of the AAP in collaboration
  with the Division of Specialized Care for
  Children (DSCC), Title V Program, University of
  Illinois.

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IMHP Evaluation Subcommittee

• Charles Onufer, MD, Chair,
• Principle Investigator
• Helen Binns, MD, MPH
• Jenifer Cartland, PhD
• Andrew Cooper, MPH
• Colleen Monahan, DC, MPH
• Kristin Rankin, MSPH
• Kathy Sanabria, MBA
• This project has received Institutional Review
  Board (IRB) approval through the University of
  Illinois at Chicago School of Public Health.

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OUTLINE

• Phase I Evaluation Results
• Phase II Evaluation Plan
• Phase II Evaluation Baseline Results

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Participating Sites

• During Phase I of the project, 6 core pediatric
  primary care practices participated and received
  the following
• Modest annual mini-grant stipends for 2 years
• Quality Improvement (QI) teams at each site
  participated in 3 Learning Sessions
• Medical home resources from the AAP, NICHQ, CMHI,
  ICAAP and DSCC
• Access to trained facilitators to help organize
  and guide the QI teams and hold monthly meetings

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Phase I Evaluation Results

• Practice Assessment Checklist
• Medical Home Index (MHI)
• QI Team Evaluations
• Family Surveys

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Practice Assessment Checklist

• Developed for IMHP and piloted in Phase I
• Administered on-site at baseline and 18 months
  later at follow-up as an outcome measure (sites
  did not have access to the instrument or baseline
  results throughout the project)
• Inventories practice environment, resources, and
  characteristics of a medical home
• Will be useful to control for potential
  confounding factors affecting changes over time
  observed with other instruments

Phase I Evaluation Results
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Practice Assessment Checklist

• All 6 Phase I sites (pediatric practices)
  completed baseline survey
• To date, 5 sites have completed follow up survey

Phase I Evaluation Results
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Practice Assessment Checklist
Phase I Evaluation Results
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Medical Home Index

• Completed by lead physician jointly with
  practice/clinic staff
• Defines and quantifies organization and delivery
  of primary care in 6 practice domains

Phase I Evaluation Results
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Medical Home Index

• Questions are grouped into 6 domains
• Domain 1 Organizational Capacity
• Domain 2 Chronic Condition Management
• Domain 3 Care Coordination
• Domain 4 Community Outreach
• Domain 5 Data Management
• Domain 6 Quality Improvement/Change

Phase I Evaluation Results
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Medical Home Index (Phase I)
Phase I Evaluation Results
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Medical Home Index (Phase I)
Distribution of Scores For All Sites, Across All
Domains
Phase I Evaluation Results
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Medical Home Index (Phase I)
Phase I Evaluation Results
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QI Team Evaluation

• QI Team members are surveyed
• Elicit feedback on effectiveness of QI Team
  meetings, facilitators, and success of QI Teams
  of achieving goals
• Administered twice for Phase I
• At 6 months (February 2005)
• At end of study (July/August 2006)

Phase I Evaluation Results
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QI Team Evaluation

For all sites, Baseline n32 Follow-up n25
Phase I Evaluation Results
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QI Team Evaluation (Phase I)

• Sample Question I have a good understanding of
  the teams goals and what next steps are needed
  to achieve them.

Phase I Evaluation Results
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Family Surveys (Phase I)

• Medical Home Family Index (MHFI)
• Family/Caregiver Survey

Results pending completion of more follow up
surveys.
Phase I Evaluation Results
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Phase II Evaluation Plan Includes a Control
Component

• Updated Instruments
• Practice Assessment Checklist
• Medical Home Index (MHI)
• QI Team Evaluations
• Family Surveys
• Enrolled 10 demographically paired sites
  including pediatric practices, family practices,
  and public health clinics 5 sites will receive
  assigned facilitators and 5 sites will receive
  technical assistance to organize and implement
  their QI efforts. All sites will receive small
  mini-grants, three training sessions, and
  resources. The study attempts to determine what
  effect facilitators vs technical assistance
  brings to the process and outcomes.

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Practice Assessment Checklist (Phase II)

• Updated slightly from version used in Phase I
• Checklist and baseline results are shared with
  Phase II sites to be used as a tool for them to
  select activities to work on to increase their
  level of medical homeness
• Fielded summer 2006

Phase II Evaluation Plan
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Medical Home Index (Phase II)

• Same instrument as was used in Phase I
• Fielded summer 2006

Phase II Evaluation Plan
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Family Surveys (Phase II)

• Modified instrument for Phase II
• Combines two separate Family Surveys used in
  Phase I
• Medical Home Family Index (MHFI)
• Family/Caregiver Survey
• Modified slightly to improve data quality
• Updated for improved readability
• Letters distributed to sites September/October
  2006, to be mailed same month (pending IRB
  approval for some sites)

Phase II Evaluation Plan
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Future Activities

• QI Team evaluations
• Will be fielded to QI Teams twice
• First round of evaluations will take place around
  April 2007
• 2-year follow up at conclusion of Phase II (June
  2008)
• Practice Assessment Checklist
• Medical Home Index (MHI)
• Family Surveys

Phase II Evaluation Plan
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Phase II Baseline Results

• 9 of 10 sites have completed medical home
  Practice Assessment Checklist baseline survey
• 9 of 10 sites have completed Medical Home Index
  (MHI) baseline survey
• Sites are in the process of mailing out family
  surveys (or receiving IRB approval to do so)

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Practice Assessment Checklist (Phase II
Baseline)
Phase II Baseline Results
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Medical Home Index (Phase II Baseline)
Phase II Baseline Results
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Family Survey (Phase II Baseline)

• Baseline results pending completion of more
  surveys
• Online responses have begun to come through
• Paper responses expected in coming weeks

Phase II Baseline Results
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Illinois Medical Home Project

• For more information about the project, please
  contact
• Kathy Sanabria, MBA, PMP, Project Director
• 1358 West Randolph Street, Suite 2 East
• Chicago, IL 60607
• Phone [phone], ext 208
• ksanabria_at_illinoisaap.net
• Thank you for your interest!