Title: Illinois Medical Home Project
1Illinois Medical Home Project
- Project Update
- March 2008
- Prepared by Kathy Sanabria, MBA, PMP,
- Project Director
- Illinois Chapter of the American Academy of
Pediatrics (ICAAP)
2Illinois Medical Home Project
- We make a living by what we get, but we make a
life by what we give. -- Sir Winston Churchill
3 The Medical Home A Personal
Passion Emily Sanabria VATERS Syndrome
Variance, TEF Surgery, Mild Spina Bifida, Grade
III IVH, Shunted Hydrocephalus, Tethered Cord
Surgery, ...
4The Medical Home A Family Affair
5The Medical Home The Sooner We Start...the
Farther They Go
6The Medical Home Together We Can Make A
Difference
7Illinois 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
8Organizational 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
9Purpose
- 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 develop
statewide action plans
10AAP 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
11Methodology
- Establishes systems in 19 primary care practices
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
12IMHP 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
13Childrens Health Centers QI TeamGurnee,
ILSara Parvinian, MD, Lead Pediatrician
14IMHP 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
15Elmhurst Pediatric Association103 Haven Road,
Elmhurst, ILEd Pont, MD, Lead Pediatrician
16IMHP Goals
- Plan, develop, and implement the IMHP
- Provide IMHP participating sites and others with
education, 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
17IMHP 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/
18IMHP 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
19IMHP 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
20Medical 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
21Highlights 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.
22MHI Follow-Up Results
23MHI Follow-Up Results
24Practice 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.
25Family 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, WSRT
p0.03), fewer had missed ?six days of school in
the past 3 months (n26, pre 19 versus post 4,
WSRT p0.05), and fewer parents had missed ?six
days of work in the past 3 months (n26, pre 23
versus post 8, WSRT p0.05).
26Medical 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.
27QI 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.
28EvaluationPhase 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)
29Next Steps to Sustain Building Medical Homes in
Illinois
- In January/February 2008, ICAAP submitted a grant
proposal to the Commonwealth Fund to work with 4
to 8 CFCs and 12 primary care medical homes in
IL to develop and test interventions to improve
collaboration and communication between 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 rolled out across the state
and possibly the nation.
30Next 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.
31Next 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 2009
Health Resources and Services Administration
statewide implementation grant to expand medical
home efforts around transition issues birth to
young adulthood.
32Next 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 rapidly expand training on
medical home to primary care providers around the
state. - ICAAP will explore opportunities to help
pediatric practices upgrade to Electronic Medical
Records.
33IMHP 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
34Illinois Medical Home Project
- A childs life is like a piece of paper on which
every person leaves a mark. Chinese Proverb