National Medical Home Learning Collaborative

1
National Medical Home Learning Collaborative

• National Initiative for Childrens Healthcare
  Quality
• Center for Medical Home Improvement
• Funded by US Maternal and Children Health Bureau

2
National Medical Home Learning Collaborative

• Partnership among CMHI, NICHQ, AAP, and Family
  Voices with US MCHB funding
• Expert panel convened June 2002
• Collaborative from 4/03 through 1/04
• Project Director Jeanne McAllister
• Collaborative Chair Carl Cooley
• Co-Chair for Title V Debby Allen
• Core Team Alan Kohrt, Charlie Homer, Jane
  Taylor, Divvie Powell, Lisa Horvitz, Colleen
  ORourke, and Sandi Cragin

3
Medical Home Learning Collaborative

• 11 states participating teams from 13 states
• UT, CO, OK, LA, OH, CT, NY, VA, FL, WI, MI (NC
  PA)
• Two-tiered collaborative
• 3 practices teams from each state
• Physician, office staff member, parent
• 15 month process with 3 national mtgs
• Each state conducts learning collaborative within
  state for 30 more practices (or other spread
  strategy)

4
Care Model for Child Health in a Medical
Home Adapted from Institute for Chronic Illness
Care Model
Supportive, Integrated Community
Informed, Activated Patient/Family
Prepared, Proactive Practice Team
Prepared, Proactive Practice Team
5
Medical Home LC Modeladapted from IHI
Breakthrough Series
Participants (10-100 teams)
Select Topic (develop mission)
Prework
Congress, Guides, Publications etc.
P
Develop Framework Changes
P
P
A
D
A
D
A
D
Expert Meeting
S
S
S
LS 1
LS 2
LS 3
Planning Group
Supports Email Visits Phone Assessments
Monthly Team Reports
6
MHLC
Participants
Select Topic
Pre-work
P
P
A
D
A
D
Develop Change Framework
S
S
Expert Panel
NICHQ Forum
LS 1
LS 2
LS 3
Team Formation, Basic Skills PDSAs Getting the
Idea ID Population, Family Feedback, Care
Coordination/Care Plans
7
MHLC
Participants
Select Topic
Pre-work
P
P
A
D
A
D
Develop Change Framework
S
S
Expert Panel
NICHQ Forum
LS 1
LS 2
LS 3
Repeat Learning/ Adaptation Partnerships Cross
Fertilization Business Case tests of change
8
MHLC
Participants
Select Topic
Pre-work
P
P
A
D
A
D
Develop Change Framework
S
S
Expert Panel
NICHQ Forum
LS 1
LS 2
LS 3
Teams Presenting Improvement Efforts Planning
with their state partners for sustainability and
spread
9
Core Steps

• Measurement
• Improvements
• Help/Technical Assistance/Facilitation
• Measurement
• Sustain and Spread

10
Medical Home Learning CollaborativeMHI Pre and
Post Measures
11
MHLC Highs, Lows, Most Improved

• Pre High
• Pre Low
• Post High
• Post Low
• Biggest Shift toward Medical Homeness

• Cooperative Management
• Quality Standards
• Care Coordination/Role
• Staff Education CSHCN
• Quality Standards

12
Largest Shifts toward Medical Homeness

• Quality standards
• Resource information and referral
• Identification of the population
• Care coordination/role
• Office environment

13
In place 7 months into MHLC

• Title V and Primary Care Partnerships
• Parent Partners on (most) teams
• Identification 80 56 enter registry
• Care coordination
• 64 of sites (16/24) 75 budgeted
• 50 time dedicated 20-40 hours

14
Medical Homes If do nothing else

• Identify your population of CSHCN
• Gain family participation/feedback
• Develop the capacity for practice-based care
  coordination and the use of care plans

15
Care Model

• Health Systems
• Administrative support, coding and R
• Community
• Resources agencies
• Care Partnership Support
• Parent Partnerships
• Delivery System Design
• Care Coordination/Care Plans
• Decision Support
• Cross organizational communication (e.g. fax
  back)
• Clinical Information Systems
• Identification/Registry

16
MHLC II applying lessons

• Prepare Title V programs up front
• Recruitment of practices
• Understanding of primary care office systems
• Understanding of Title V role with 1o care
• Prepare parent partners prior to LS1
• Parent as a collaborative co-chair
• Provide practices with more direct support

17
Rural Medical Home Expansion Project Outcome
Snapshot

• VERMONT
• Hagan and Rinehart Pediatricians
• Berkner Team
• Newport Pediatrics
• Mousetrap Pediatrics
• Gifford Pediatrics
• Upper Valley Pediatrics

• NEW HAMPSHIRE
• DH- Concord Pediatrics
• Monadnock Regional Peds
• DH - Keene Pediatrics
• Lamprey Health Center
• Exeter Pediatric Associates
• DH -Plymouth Pediatrics

18
Medical Home Index Mean Item Scores (MHIP 8
sites Fall 2001, 2002, and 2003)
19
Medical Homes - Snapshots (10 sites)

• 100 Staff in designated practice-based Care
  Coordinator role
• 100 Develop Care Plans
• 90 Carry plans out
• 80 Systematic identification
• 70 Registry
• 50 Meet 2x/mo 40 1/mo
• 100 PP (all 40) (most 20) (some 40) time

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In place now, not before

• Identification process, registry, EMR ?
• Complexity scoring
• Care coordination ?
• Care plans ?
• Brochures/flyers (MH, CC)
• Care coordination staff assignments
• Care coordination activity documentation
• Resource books/directories ?

? most proud of
21
Center for Medical Home Improvement

• Moved as of April 1, 2004
• Crotched Mountain Foundation in Greenfield, New
  Hampshire
• www.medicalhomeimprovement.org
• Presented MHLC results at NICHQ Forum on
  Childrens Healthcare Quality
• Providing technical assistance to several state
  Medical Home initiatives including two state-wide
  learning collaboratives
• Whats a Medical Home video bite CDs
• GearBox web-based coordinate the coordinators
  tool
• Beyond the Medical Home depending on funding
• Study outcomes of practices in relation to
  medical homeness