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Illinois Medical Home Project

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Title: Illinois Medical Home Project


1
Illinois Medical Home Project
  • Project Update
  • March 2008
  • Prepared by Kathy Sanabria, MBA, PMP,
  • Project Director
  • Illinois Chapter of the American Academy of
    Pediatrics (ICAAP)

2
Illinois 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, ...
4
The Medical Home A Family Affair
5
The Medical Home The Sooner We Start...the
Farther They Go
6
The Medical Home Together We Can Make A
Difference
7
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

8
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

9
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 develop
    statewide action plans

10
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
11
Methodology
  • 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

12
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

13
Childrens Health Centers QI TeamGurnee,
ILSara Parvinian, MD, Lead Pediatrician
14
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

15
Elmhurst Pediatric Association103 Haven Road,
Elmhurst, ILEd Pont, MD, Lead Pediatrician
16
IMHP 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

17
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/
18
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

19
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

20
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

21
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.

22
MHI Follow-Up Results
23
MHI Follow-Up Results
24
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.

25
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, 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).

26
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.

27
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.

28
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)

29
Next 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.

30
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.

31
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 2009
    Health Resources and Services Administration
    statewide implementation grant to expand medical
    home efforts around transition issues birth to
    young adulthood.

32
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 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.

33
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

34
Illinois Medical Home Project
  • A childs life is like a piece of paper on which
    every person leaves a mark. Chinese Proverb
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