Maine Quality Counts presents August Provider Lunch & Learn August 2nd 12 Noon

First STEPS 2014: (Strengthening Together Early Preventive Services) Improving Developmental and Autism Screening: Kick Off & Orientation Call

Amy Belisle, MDDirector of Child Health Quality ImprovementSue Butts-DionFirst STEPS Program Manager, QI SpecialistMaine Quality Counts

February 13, 2014 and Repeated March 13, 2014

1AgendaWelcome Teams and Roll CallReview First STEPS Year 5 Aim and LogisticsExpectations for Teams and for MOCQI TeamspaceQ & A

Maine Child Health Improvement Partnership (ME CHIP)Mission To optimize the health of Maine children by initiating and supporting measurement-based efforts to enhance child health care by fostering public/private partnership.

VisionAll practices providing health care to children will have the skills, support, and opportunities for collaborative learning needed to deliver high quality health care.

Aim for First STEPS 2014Raise Screening Rates: Improve Developmental and Autism Screening RatesWork Together: Work collaboratively with other primary care practices and community partners to learn from each other and to improve systems and to test changes (using the Model for Improvement and Plan-Do-Study-Act Cycles as a frame)Welcome Parent-Partners: Enhance how we are including the voice of the parent partners in our improvement work.Optimize Existing Work: Build on the work of the Patient Centered Medical Home, Health Homes, healthcare organizations, and community organizations.

Participating PracticesNon-MOCAroostook PediatricsBethel Family CenterBlue Hill MemorialBridgton PediatricsD.F. Russell Medical CenterEMMC Family MedicineEleanor Widener Dixon Community CenterElmwood Family PracticeFoden Road PediatricsHealthreach Community CenterLincoln Medical PartnersLovejoy Health CenterMayo PsychiatryMayo Regional HospitalMid Coast PediatricsMMP Family MedicineMMP PediatricsYarmouth PediatricsYork County Community CorpMOCCMMC Family Medicine Residency, LewistonEllsworth Family Practice, EllsworthElmwood Family Practice, WatervilleFore River Family Medicine, PortlandIntermed Foden Road, South PortlandIntermed Marginal Way, PortlandIntermed Yarmouth, YarmouthMartins Point Healthcare-Brunswick Pediatrics, BrunswickWaterville Pediatrics, Waterville

https://teamspace.mainequalitycounts.org/5First STEPS andCommunity PartnersMaineCareMuskie School of Public Service, USMMaine Developmental Disabilities CouncilMaine Autism SocietyMaine Parent FederationMaine CDCChild Development ServicesOffice of Child and Family ServicesMaine Childrens AllianceMaine Childrens Growth CouncilHead StartFamilies and Parent PartnersState Agencies Interdepartmental Early Learning and Development Team (SAIEL)Developmental Systems Integration (DSI) Project

Why is this important?Developmental delays and conditions affect 10% of children1/88 kids with autism*

*(March 30, 2012, MMWR, Prevalence of Autism Spectrum Disorders Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008)

Periodicity Schedule for Developmental Screening and MetricsThe American Academy of Pediatrics (AAP) recommends the following:Developmental Surveillance: at every well-child care visit (Bright Futures)Children receive general developmental screening with a standardized tool at ages 9, 18, and 24 or 30 months.Children receive screening for autism at 18 and 24 or 30 months.

Children's Health Insurance Program Reauthorization Act (CHIPRA)/Maine Health Homes metric is a documented developmental screening by ages 1, 2, and 3 years.

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AMCHP January 25, 2014

Our Challenge

MaineCare claims documented rates for developmental screening is 1-6% for children ages 1, 2, and 3. Source: MaineCare claims data, 2011

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Source: Improving Health Outcomes for Children (IHOC) Summary of Pediatric Quality Measures for Children Enrolled in MaineCare FFY 2009-FFY 2012, Muskie School of Public Service, University of Southern Maine, April 2013, p. 25.2014 work focused on creating a circle of strength around kids to promote healthy development.SEvEvaluationAssessSurveillanceScreeningAssessAssessAssessSEvaluationScreeningSurveillanceScreeningSurveillance

10Requirements for Provider Champions Desiring MOCSubmit MOC sign up forms and BAA (data agreement) to QC for KidsThe First STEPS Practice Teams will:lead office practice improvement by identifying goals and processes for improvement, removing barriers and providing resourcesattend 1 Regional Training (must include provider champion)submit data monthlyPDSA and Process datameet as a team on a monthly basis for quality improvement discussionparticipate in monthly phone calls to share improvements made and to receive coachingIn collaboration with the practice team, the practices physician champion will complete a pre and post practice profile describing the practice structure and changes in office systems.

Quality Counts will keep track of attendance at all conferences, teleconference calls, etc.

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Mention that this counts.12DATETOPICFebruary 13th or March 13th, 2014Intro to new practices; QI Methodology: Understanding the model for improvement; creating aim statements, effectively designing and using PDSA cycles, metrics for developmental screening, intro to QI Team SpaceApril 10, 2014Making the Connection with the Medical Home and Child Development Services, Part C, and other Early Childhood Partners doing Developmental screening in the Community- Dr. Bob Holmberg and Cindy BrownMay 8, 2014Brief Review of New MCHAT-R. What is Next? When a Child Doesnt Pass Initial Autism Screening, Review of the MCHAT 2/F Interview- Dr. Carol HubbardJune 12, 2014Planned Coordinated Care in Patient and Family-Centered Medical Home- Dr. Bob Holmberg and Nancy CroninJuly 10, 2014Management of Behavioral Issues in Children with Autism Spectrum Disorders- Dr. Carol HubbardAugust 15, 2014**Note the only day that is a Friday and not Thursday.Translating Developmental Science into Healthy Lives: Realizing the Potential of Pediatrics and the Science of Early Brain and Child Development (EBCD)- Dr. Andrew Garner, National AAP

First STEPS 2014 Webinars, 2nd Thurs 12-1 pmPractice Team Preparation ChecklistReview the orientation packetSave the important dates on your calendar (Regional Training Sessions, monthly calls/webinars, data reporting deadlines)Complete and submit Office Systems Survey by February 28, 2014Submit baseline data measures to the online collection tool by March 15, 2014. (MOC)

Meet as a Team

Complete an office system survey to help your office identify opportunities for improvement. Emailed to practices following this callDiscuss and write a rough draft of your teams improvement aim and targets for improving developmental and autism screening.

Office Systems Assessment ComponentsDevelopmental Surveillance practicesDevelopmental and Autism Screening practicesReferral and Follow up practicesInforming and engaging parents and care giversWorking with community partnersQuality Improvement practicesBilling and coding practices

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Method for ChangeWhat are we trying to accomplish?How will we know that a change is an improvement?What change can we make that will result in improvement?ActPlanStudyDoModel for Improvement APIs Demings PDSA cycle

17Explain it teach it first as just a model to use for testing

Do an improv related to a problem to show them how it can work in problem solving when we dont know the answer ?

Can be used when we get ideas that we think might makes things better ? Like when we were talking

can also be used for conflict management .. Mayo story

Can also be used in large planning session .. Lets talk about it a bit more in depth at that level

Year 5: High Level Aim & Goals2014 First STEPS Aim Statement: To improve the rate of developmental and autism screening for children ages 0 to 3 by 50% from March 2014 to September 2014 using chart review data. Goals75% of children will have a documented developmental screening using a validated tool (ASQ or PEDS) at the 9 mo, 18, and the 24/30 mo well child visits75% of children will have a documented autism screening (MCHAT R or MCHAT F) at 18 and 24/30 mo.75% of children identified with a concern of developmental delay will have a documented follow-up plan (observation, recheck in office, or referral) 75% of all visits with developmental and autism screening will be billed and coded correctly.

Your Aim StatementThe (name of your team/practice):intends to accomplish (This is a general over arching statement describing what you intend to accomplish during the time you work on this process it answers the first question of the Model for Improvement. The process is identified in the statement, any specific or segmented area is mentioned and words like improve, reduce, and increase are often utilized) by (time frame, i.e. month/year in which you intend to accomplish improvement)for (what group are you doing this for who is the customer)because (the rational and reasons to work on this improvement project)Our goals include: (your measures it answers the second question of the Model for Improvement. Here they are stated as numeric goals)

Soon is not a time, some is not a number, hope is not a plan.-Donald Berwick, MD, Former CEO, Institute for Healthcare ImprovementExample Aim & GoalsBy September 30, 2014, our practice will improve our autism screening rates for children at the 18 or 24/30 month appointments from 45% having completed to 90% having them completed.By September 30, 2014, 100% of Developmental and Autism Screening results will be reviewed with family/care givers.By September 30, 2014, 100% of Developmental Screening results with a referral or follow up indicated will have a documented action plan in their charts (currently at 65%).

The goals should be directed by your baseline data. Your practice, for example, may be at 100% for the Autism Screening measures and choose to focus the improvement work on Developmental Screening. We will, however, still expect practices to report all of the process measures for both Development Screening and Autism Screening each month.

Optional Quality Improvement Science Webinars with QI CoachApril 23rd noon June 4th noonJuly 23rd noon Introduction to the Model for Improvement and the Science of ImprovementAssessing Processes and Establishing AimsMeasurement for ImprovementHolding the Gains

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If you currently work with your systems or PHOs Quality Improvement (QI) Coach on other initiatives, alert them to your involvement in this collaborative. If you are an independent practice, we will work with your practice to identify a coaching resource. Quality Improvement Coaching

Data Submission Submission DatesMarch 15 (Baseline), April 15, May 15, June 15, July 15, and August 15Randomly select 20 charts from ages 9 mo- 30 months for children seen in your practice for WELL CHILD VISITS for the month that you are doing the chart review. For sampling purposes, please select approximately 5-7 charts per month from the 9 and 18 month categories and 10 from the 24/30 month category. Enter chart data into your QI Team Space each month. (Note: You can use the paper chart review tool if helpful.) Collecting data at three levels:Level 1: Total number of children general developmental and/or autism screening AND results documented in chart.Level 2: Of those in a), number with a referral or follow-up indicated.Level 3: Of those in b), number with documented follow-up plan in chart.

1. Bright Futures/AAP recommends developmental screening (ASQ/PEDS) at 9, 18, and 24/30 months well child visits and autism screening at 18 and 24/30 months.

23First STEPS 2014 Measures% documented use and results of a developmental screening tool (PEDS or ASQ-3) at 9, 18 and 24/30 months.% documented that the screening results were reviewed and discussed with the family.% Documented use and results of an autism-specific screening tool at 18 and 24/30 mo of age (MCHAT R or F)% of children identified with a concern of developmental delay (referred on PEDS/ASQ-3 or MCHAT R/F) that have a documented follow-up plan (observation, recheck in office, or referralTotal number of referrals to Child Developmental Services (CDS) and Developmental Pediatricians each month under age 5% of charts where billing was done with correct modifiers for developmental screening and autism screening

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ExampleGeneral Developmental Screening Example: Level 1: Of 20 charts, total of 12 had screening results documented in chart. (Num=12 and Den=20 for 60%)Level 2: Of 12 with documented screen and results, 3 w/ referral or f/u indicated. (Num=3 and Den=12 for 30%)Level 3: Of the 3 with referral or f/u indicated, 2 had a documented follow-up plan in chart. (Num=2 and Den=3 for 77%)Autism Screening Example: Level 1: Of 20 charts, 9 were eligible for autism screening (18 or 24/30 month visit). Of 9, total of 4 had screening results documented in chart. (Num=4 and Den=9 for 53%)Level 2: Of 4 with documented screen and results, 4 w/ referral or f/u indicated. (Num=4 and Den=4 for 100%)Level 3: Of the 4 with referral or f/u indicated, 2 had a documented follow-up plan in chart. (Num=2 and Den=4 for 50%)25

Summary NotesStill opportunity for practices to participate for MOCwould need to get paperwork submitted ASAPIf you are participating for MOC and have not submitted your paperwork, please do so!Another orientation call on March 13th for any teams member wanting to attend.See you at the Regional Meeting!Those participating for MOC (and anyone interested in the on-line QI Team Space) please remain on the line for additional training.

Take a deep breathtechnical support available AFTER this call and throughout the projectQI Team Space: System RequirementsTested and supported web browsers:Mozilla Firefox 17.0 or greaterGoogle Chrome Apple Safari 5.1.4 or greaterMicrosoft Internet Explorer 9.0 or greater.Microsoft Internet Explorer 8.0 (on Windows 7 or greater) is partially supported through June 30, 2014, but may not be supported after this date.Note: Windows XP users must use the most recent version of Google Chrome or Mozilla Firefox. Microsoft Internet Explorer on Windows XP is NOT supported by TeamSpace.

Mention resources.32

We will send out outlook invites. You can register for each call in constant contact.34

THIS DATA IS TEST DATANOT ACTUAL DATA FROM A PRACTICE. FOR DEMONSTRATION PURPOSES ONLY!!

THIS DATA IS TEST DATANOT ACTUAL DATA FROM A PRACTICE. FOR DEMONSTRATION PURPOSES ONLY!!

THIS DATA IS TEST DATANOT ACTUAL DATA FROM A PRACTICE. FOR DEMONSTRATION PURPOSES ONLY!!Tips from PracticesInitial entry might take 2-5 minutes/chart until you get used to itSue Butts-Dion will set up individual meetings as needed to train and work with practicesDont wait until the last minute to enter all 20 chartsYou know you need 20 charts total (@5-7 each for 9 mo. and 18 mo. and @6-10 for 24/30 mo.)Plan to pull 5 each week and spend 30+ minutes enteringThen, submit on the due date of the 15th of the month starting with baseline on March 15th Would need some combination to get them to 2042

Getting StartedNeed your signed MOC paperwork and BAA (Data Sharing Agreement) returned to Maine Quality Counts to activate your QI TeamspaceSet up your system requirements (See Getting Started document sent out prior to call.)Questions & ReactionsContact InformationAmy Belisle, MD, Director of Child Health Quality Improvement, Maine Quality Counts, abelisle@mainequalitycounts.org/ 207-847-3582Sue Butts-Dion, First STEPS Project Manager, 207-283-1560, sbutts@maine.rr.comDebra Gilbert, Administrative Coordinator, Maine Quality Countsdgilbert@mainequalitycounts.org, 207.620.8526 ext. 1017Nan Simpson, MSW, DSI Project Manager, nsimpson@mainequalitycounts.org, 207-441-3722Sue Mackey Andrews, Consultant to QC for Kids on DSI Project, sdmandrews@aol.com, 207-564-8245Kyra Chamberlain, BS, RN, IHOC Project Manager, Maine, 207-228-8085, kchamberlain@usm.maine.eduKim Fox, MPA, Research Associate, Muskie School of Public Service, kfox@usm.maine.eduJoanie Klayman, LCSW, IHOC Project Director, Maine and Vermont, jklayman@usm.maine.edu, 207-780-4202

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