Illinois Medical Home Project

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Illinois Medical Home Project

• Phase I Results and Project Update
• March 2008
• Prepared by Kathy Sanabria, MBA, PMP
• Medical Home Project Director
• Illinois Chapter of the American Academy of
  Pediatrics (ICAAP) and Division of Specialized
  Care for Children (DSCC)

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Illinois Medical Home Project

• We make a living by what we get, but we make a
  life by what we give. -- Sir Winston Churchill

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The Medical Home A Personal
Passion Emily Sanabria VATERS Syndrome
Variance, TEF Surgery, Mild Spina Bifida, Grade
III IVH, Shunted Hydrocephalus, Tethered Cord
Surgery, ...
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The Medical Home A Family Affair
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The Medical Home The Sooner We Start...the
Farther They Go
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The Medical Home Together We Can Make A
Difference
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Illinois Medical Home Project

• Funded by the U.S. Department of Health and Human
  Services, Health Resources and Services
  Administration, Maternal and Child Health Bureau
• Project period July 1, 2004 June 30, 2008
• Funding level 1 million over four years
• Principal Investigator Charles Onufer, MD,
  FAAP
• 217-793-2340
• cnonufer_at_uic.edu
• Project Director Kathy Sanabria, MBA, PMP
• 312-733-1026, ext 208
• ksanabria_at_illinoisaap.net
• Project Manager Jana Stringfellow-Estell, BS
• 312-733-1026, ext 209
• jestell_at_illinoisaap.net www.illinoisaap.org/medica
  lhome.htm

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Organizational Setting

• Administered by ICAAP in collaboration with the
  Division of Specialized Care for Children (DSCC),
  the Illinois Title V program for children and
  youth with special health care needs (CYSHCN)
• Project Advisory Committee provides guidance to
  project implementation
• Evaluation subcommittee formulates the measurable
  evaluation plan

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Purpose

• The IMHP supports development of community-based
  medical homes for CYSHCN by
• Informing primary care providers and others about
  the medical home model
• Providing access to quality improvement (QI)
  processes involving partnerships with parents,
  linkages to community resources, and modest
  mini-grants.
• Facilitating QI teams at practices
• Sponsoring Leadership Forums to spread the
  medical home model across the state

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AAP Policy StatementThe Medical Home

• Medical care that is provided in the context of a
  medical home will be
• Accessible
• Family centered
• Continuous
• Comprehensive
• Coordinated
• Compassionate
• Culturally effective

Pediatrics Vol. 110 No. 1 July 2002
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IMHP Methodology

• Establishes systems in 19 primary care
  practices/clinics to support medical home
  initiatives (for phases I and II)
• Utilizes Plan-Do-Study-Act (PDSA) cycle of
  practice improvement
• Utilizes knowledge of medical home concepts and
  family involvement to support practices
• Provides training through Learning Sessions
• Organizes Leadership Forums
• Implements a public relations campaign

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IMHP Phase I Sites

• Pediatric Center of Chicago, Chicago, IL
• DuPage Pediatrics, Darien, IL
• Melrose Park Pediatrics, Melrose Park, IL
• The Sterling Rock Falls Clinic, Sterling, IL
• Childrens Health Center, Gurnee, IL
• Childrens Healthcare Associates, Chicago, IL
• Pediatrics Center, Ottawa, IL
• North Arlington Pediatrics, Arlington Heights, IL
• Pediatric Health Associates, Naperville, IL

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Childrens Health Centers QI TeamGurnee,
ILSara Parvinian, MD, Lead Pediatrician
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IMHP Phase II Sites

• Crusader Clinic, Rockford, IL, Public Health
  Clinic
• Elmhurst Pediatric Association, Elmhurst, IL,
  Private Pediatric Group Practice
• Fox Valley Women and Childrens Health Partners,
  Elburn, IL, Public Health Clinic
• Friend Family Health Center, Inc., Chicago, IL,
  Federally Qualified Health Center
• Kidz Health, Chicago, IL, Private Pediatric
  Practice
• Loyola University Medical Center, Maguire Center,
  Department of Pediatrics, Maywood, IL,
  University-Affiliated Health Clinic
• PCC Community Wellness Center, Oak Park, IL,
  Federally Qualified Health Center
• Premier Kids Program, LaRabida Childrens
  Hospital, Chicago, IL, University-Affiliated
  Health Clinic
• University of Illinois at Chicago Children and
  Adolescent Center, Department of Pediatrics,
  Chicago, IL, University-Affiliated Health Clinic
• Young Family Health Center, Chicago, IL, Private
  Pediatric Practice

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Elmhurst Pediatric Association103 Haven Road,
Elmhurst, ILEd Pont, MD, Lead Pediatrician
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IMHP Goals

• Plan, develop, and implement the IMHP
• Provide IMHP participating sites and others with
  education, training, resources, and technical
  assistance to build community-based medical homes
• Promote/support community inclusion of CYSHCN by
  better linking sites with community resources
• Enlist the involvement of providers at large,
  community groups, insurers, and other
  stakeholders in the IMHP
• Improve capabilities at the practice/systems
  levels statewide for developing medical homes
• Evaluate and measure the efficiency/effectiveness
  of
• the IMHP

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IMHP Evaluation

• IMHP subcontracted with the University of
  Illinois at Chicago School of Public Healths
  Center for the Advancement of Distance Education
  (CADE) to develop and carry out evaluation plan
• IMHP Evaluation Subcommittee formulated the
  evaluation plan and oversees implementation

www.uic.edu/sph/cade/
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IMHP Evaluation Phase I (Project years 1 and 2
late 2004 to mid 2006)

• Baseline evaluation data collected from 6 core
  practices and families 9 medical home teams
  participated in Phase I
• Practices re-evaluated 18 months later
• Analyzed change between pre- and post- IMHP
  implementation
• Change was measured in the following areas
• Delivery of care
• Access to community services
• Satisfaction with care received
• Changes in provider and family competencies
• Phase I evaluation results are available on our
  Web site
• www.illinoisaap.org/medicalhome.htm

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IMHP EvaluationTools

• Center for Medical Home Improvement (CMHI)
  Medical Home Index
• CMHI Medical Home Family Index
• CMHI Family/Caregiver Survey
• IMHP In-Office Practice Assessment Checklist
• Learning Session and QI Team Meeting satisfaction
  evaluations
• IMHP 2nd Annual Newsletter provides more
  information.
• Visit www.illinoisaap.org/medicalhome.htm

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Medical Home IndexLevels of Medical Home
Health Care Delivery

• LEVEL 1 (Score 1.00-2.99) Individualized ways of
  delivering care Good Basic Pediatric Primary
  care
• LEVEL 2 (Score 3.00-4.99) Child-centered rather
  than family- centered care
• Responsive Pediatric Primary Care
• LEVEL 3 (Score 5.00-6.99) Family feedback
  influences office policies
• Proactive Pediatric Primary Care
• LEVEL 4 (Score 7.00-8.00) Parent practice
  advisory groups promote family-centered
  strategies
• Comprehensive Pediatric Primary Care

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Highlights of Phase I Evaluation Results

• Phase I practices registered higher total scores
  on the Medical Home Index at follow up than they
  did at baseline, with a mean improvement of 74.9
  at original baseline to follow up and 54 at the
  start of the IMHP to follow up.

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MHI Follow-Up Results
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MHI Follow-Up Results
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Practice Assessment Checklist Follow-Up Results

• The Practice Assessment Checklist was developed
  by the ICAAP and DSCC to independently measure
  medical home outcomes at the practice level.
• Administered pre- and post-intervention via
  in-person interview with lead physician and a
  staff member.
• Phase I practices registered higher overall
  scores on the Practice Assessment Checklist at
  follow up than they did at baseline, with mean
  scores of 68.4 at baseline and 78.4 at follow
  up, with a mean improvement of 15.

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Family Caregiver Survey Follow-Up Results

• Families reported some improvements in their
  use of the health care system.
• Post-intervention, fewer children had experienced
  an overnight stay in the hospital in the prior
  year (n28, pre 32 versus post 11)
• Fewer had missed ?six days of school in the past
  3 months (n26, pre 19 versus post 4)
• Fewer parents had missed ?six days of work in the
  past 3 months (n26, pre 23 versus post 8).

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Medical Home Family Index Follow-Up Results

• Improvement was observed in 75 of the items
  included in the Medical Home Family Index survey
  however, due to low sample size few of the
  results were statistically significant.
• All 18 Parent Partners indicated they were very
  satisfied with the IMHP and their participation
  on QI teams.
• All Parent Partners indicated they felt the QI
  teams efforts are improving care delivered.

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QI Team Survey Follow-Up Results

• Of team members responding to QI team surveys
• 95 either agreed or strongly agreed with a
  series of positive statements about the
  effectiveness of the QI teams.
• 96.9 at baseline and 92.3 at follow up
  indicated the QI team facilitator is an integral
  part of the success of their QI teams.
• Of Phase I Learning Session participants who
  completed evaluations about the three required
  trainings, 97 agreed or strongly agreed they
  were satisfied with the sessions.

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Implications and Findings for the Healthcare
System

• More efficiently managed healthcare through
  better care coordination and improved continuity
  of care
• Reduction in stress levels for families
  increased satisfaction with provider and care
  received
• Better adherence to medication and therapy
  recommendations
• Increase in development of chronic condition care
  plans
• Better adherence to health supervision visits and
  more emphasis on preventive care
• Reduction in sick visits (over time)
• Fewer days missed from school and work
• Reduction in ER visits and hospitalizations (over
  time)
• Reduction in overall healthcare costs (over time)
• Better and enhanced use of community resources

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EvaluationPhase II (Project years 3 and 4)

• Revised evaluation protocol based on lessons
  learned from Phase I
• Added 10 primary care practices/clinics to Phase
  II of project
• Evaluation plan includes a controlled study to
  measure the effect facilitators have in
  building medical homes
• 5 sites receive project resources with assigned
  facilitators 5 sites receive project resources
  without facilitators (technical assistance
  provided)

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Next Steps to Sustain Building Medical Homes in
Illinois

• In February 2008, ICAAP submitted a grant
  proposal to the Commonwealth Fund to work with 4
  to 8 Child and Family Connections Offices (CFCs)
  and 12 primary care medical homes in IL to
  develop/test interventions to improve
  collaboration between Early Intervention (EI) and
  practices. (If funded, project period is July
  2008 to June 2011)
• Following focus groups and other data collection,
  tools and training programs for primary care
  providers and EI staff will be developed in
  multiple formats.
• A universal EI referral form that can be
  individualized to a practice or CFC is being
  developed.
• The project will be spread across the state and
  possibly the nation.

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Next Steps to Sustain Building Medical Homes in
Illinois

• ICAAP has prepared a large grant proposal to
  train 20 new medical home sites throughout IL
  (July 2009 to June 2013).
• ICAAP is approaching local and national
  philanthropic groups and funders to support the
  program. Response to date has been encouraging.
  Collaborations with additional funding partners
  are welcome.

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Next Steps to Sustain Building Medical Homes in
Illinois

• The DSCC and ICAAP have established a work group
  to explore the feasibility of applying for a
  federal grant to expand statewide medical home
  efforts around transition issues.

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Next Steps to Sustain Building Medical Homes in
Illinois

• ICAAP staff will meet with state leaders and
  legislators to discuss opportunities to apply for
  grants or request appropriations to bills to
  obtain funding to more rapidly expand training on
  medical home to pediatric primary care providers
  around the state.
• ICAAP will explore opportunities to help
  pediatric practices upgrade to Electronic Medical
  Records.

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IMHP Resources

• Annual Newsletters
• Report of IMHP Phase I Evaluation Results and
  Survey Instruments
• Peer-reviewed article on Phase I of project
  titled Illinois Medical Home Project Pilot
  Intervention and Evaluation submitted February
  2008 to Maternal and Child Health Journal for
  publication.
• Resource Packet
• http//www.illinoisaap.org/medicalhome.htm

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Illinois Medical Home Project

• A childs life is like a piece of paper on which
  every person leaves a mark. Chinese Proverb