CHIPRA QUALITY DEMONSTRATION GRANT:

Two Year Review of “Going Where No Man Has

Gone Before…”

• What we accomplished

• What we still need to do

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South Carolina chose categories:

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CHIPRA Measures: Category A – Experiment with, and evaluate the use of, new measures for quality of Medicaid/ CHIP children’s health care

EHRs:Category B – Promote the use of Health Information Technology (HIT) for the delivery of care for children covered by Medicaid/CHIP

Medical Home/Behavioral Health: Category C – Evaluate provider-based models which improve the delivery of Medicaid/CHIP children’s health care services

The South Carolina grant has four key goals:

• Quality: demonstrate that newly developed quality measures can be successfully utilized in pediatric practices;

• Technology: share key clinical data through a statewide electronic quality improvement network;

• Innovation: develop a physician-led, peer-to-peer quality improvement network; and

• Pediatrics: expand the use of pediatric medical homes to address mental health challenges of children in our state. 4

Year One = Planning YearFebruary 2010 – January 2011

• Staff and Contractors Selected• 18 Practices Selected• HIT and reporting development• Evaluation planning• Baseline data gathering• Implementation of blog and tracking

mechanisms

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Year One = Planning YearFebruary 2010 – January 2011

• First Learning Collaborative held – January 23-24, 2011; attended by 66 QTIP pediatric

office staff– 4 quality indicators introduced

ADHD, Emergency Department Visits, 15 Month Well Child Visits and Developmental Screenings

– Overview of Patient Centered Medical Homes presented

• Participation payments made6

Year 2 February 2011 – January 2012

2nd Learning Collaborative: – July 23-24, 2011 and attended by 63 staff from 18

pediatric practices– 3 quality measures introduced; 2 NCQA – PCMH

standards; and Mental HealthCAHPS, Access, Preventative Dental; PCMH standards (1 and 6): Access and Continuity: Measure and Improve Performance

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Year 2 February 2011 – January 2012

HIT assistance/development– Behind the scenes work with each practice to

capture data for the reports• Historical data has been down loaded from 2 practices• Adapter and Driver development• VPN (site to site)• CHIPRA data registry is available for practices without an

EMR

Quality reporting– Work is being performed to review and incorporate

data download from CareEvolution– Anticipate reports to practices (submitting data)

Spring 2012 8

Year 2 February 2011 – January 2012

• Evaluation– CAHPS survey completed and results provided to

the 15 non-academic practices– Baseline data gathered on the CHIPRA quality

HEDIS and HEDIS-like measures – Analysis on practice’s stated successes/challenges

and reporting via PDSA and QI meeting is occurring– Development of evaluation tools– Coordination of evaluation activities with the

National Evaluation Team9

Year 2 February 2011 – January 2012

• Mental Health:– Data gathering and resource sharing– 9 practices currently have a Mental Health provider

of some capacity within their practice– 4 meetings facilitated by QTIP staff in communities

increase awareness and coordinate services• One meeting resulted in plans for co-location of a DMH

staff 1 afternoon/week in a QTIP practice

– CHADIS screening tool is being piloted by 3 practices

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Year 2 February 2011 – January 2012

• 37 Technical Assistance visits by Dr. Rushton

– 228 pediatric staff participated in the Spring visits– 180 pediatric staff participated in the Fall visits– 13 peers participated in the on-site visits

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QTIP AWARD

Most Peer Site Visits

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Katie Stephenson

QTIP AwardMost Interesting

Staff Bathroom ArtFebruary 2012

Carolina Pediatrics

in Cheraw

Year 2 February 2011 – January 2012

• Academic Detailing: – ADHD informational on-site visits conducted– 129 practitioners participated in the initial

ADHD visit– 82 practitioners participated in

the follow-up ADHD visit– 28 practitioners have submitted

requests for CEU certificates– Work started on Asthma

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Quality - To Date: “To demonstrate that newly developed quality indicators can be successfully utilized in pediatric practices”

Collection of CHIPRA Quality Measures– Part IV MOC Credits were earned by 9 doctors in 4

QTIP practices for their work on ADHD– 7 measures introduced at January and July 2011

Learning Collaboratives– As of January 31, 2012, 298 PDSA cycles have been

documented.

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Quality - To Date:

WHAT DID YOU DO? Collection of CHIPRA Quality Measures– 207 PDSA cycles have been documented reflecting

work done between July to January 2012.

Top 4 Categories/Frequencies– 90 Developmental Screening – 60 Preventative Dental– 39 ED – 38 ADHD 16

QTIP AWARD

Most DocumentedPDSA Cycles

(July 2011 – January 2012)

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Beaufort Pediatrics

WHAT DID YOU DO?

Quality improvement team within the pediatric setting– Over 217 quality meetings documented from

January 2011 to January 2012.– 138 meetings were documented between July

2011 and January 31, 2012.

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QTIP AWARD

Most DocumentedQI Meetings

(July 2011 – January 2012)

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Children’s HospitalOutpatient Clinic

Years 1 and 2Let’s Not Forget….

• All MOAs have been signed!• $tipend payments made for 5 quarters• QTIP trained and certified 126 practice staff to

administer fluoride varnish • There have been 136 Postings and

66 comments on the blog between July and January 2012.

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QTIP AWARD

Most Staff Trained in Fluoride Varnish

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Center for Pediatric Medicine

QTIP AWARD

Most Blog Entries (July 2011 – January 2012)

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Debbie Greenhouse

Now… Where are we going?

• Where We Are

• Where We Want to Go

Year 3 TasksFebruary 2012 – January 2013

• Learning Collaboratives – Introducing additional quality measures – NCQA – PCMH standards

• Expansion of MOC Part IV credits

• Technical assistance site visits will be conducted between March – June 2012– Dr. Rushton (and QTIP team): to discuss QTIP and

work on quality measures– SCORxE: to present information on Asthma

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• Review of family involvement and family-centered care

• Behavioral Health– Training/certification program available– Incorporation of prevention strategies and treatment

strategies– Assessment tools– Brokering with community resources

• Evaluation Activities– In-State and National – CAHPS– Feedback 25

Year 3 TasksFebruary 2012 – January 2013

Year 3 HIT assistance– Continue to work on SCHIEx connection– Connectivity and data gathering from EMR– Installing CHIPRA Data Registry in practices without

and EMR

Quality Reports available Spring 2012 – Report Data Sources:

• EHR (or QTIP Data Registry)• Claims

– Reports By: • Practice and Month

– Report Design• Metrics: Supportive of HEDIS • Display: Graphical 26

Report Template

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Now For Today…

TODAY • Introducing 4 additional quality measures

– Asthma– Low Birth Weight– C-Section rates– Prenatal Care

• Presenting 2 additional NCQA – PCMH elements– Identify and Manage Patient Population– Track and Coordinate Care

And Within the Next 6 Months…

• Work on the 4 new quality measures, NCQA- PCMH and Behavioral Health

• Actively take part in evaluation efforts (State, National)

• Send and receive data through your EMR or CHIPRA Data Registry

• Connect to SCHIEx• Participate in on-site visits (peer, Dr. Rushton, QTIP

staff and SCORxE)

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If it’s not documented…it’s not done…

DOCUMENT

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Help us show what you are doing is working……….

DOCUMENT

Thank you for your continued work and devotion to this project. Focus of SC Grant

South Carolina believes that children will achieve the

best health outcomes when they receive care through

an integrated medical home that addresses all their

health needs—both physical and mental—and

participates in continuous quality improvement efforts.33