Putting children with complex conditions at the center of collaborative care An Aerodigestive Center Approach Amy Painter MSN, FNP Aerodigestive Clinical Program Manager and Nurse Practitioner
Value Statement The Aerodigestive Center coordinates healthcare needs for chronic and complex children through a cost- effective, multidisciplinary model that improves quality, continuity of care and access to specialty services 2
Who are Aerodigestive Patients? Children with disorders involving the upper digestive tract, ear-nose-throat and pulmonary systems GERD with lung complications or sleep apnea Aspiration syndromes of liquids or food Congenital malformations of heart, trachea, esophagus and larynx Vascular anatomy that constricts the trachea and impedes regular breathing 2+ ADA disabilities (cannot eat, breath, or sleep) Most travel from outside the metro Atlanta area (>120 miles) 3
2014 System Utilization by Aero Population In 2014, of 179 patients seen by the Center they had a total of 2526 system wide visits Insert key fact connected with photo High utilizers of the healthcare system due to their medical complexity How do we create most effective utilization? 4
Current Model Serves as a medical home for complex patients Patient is seen by all specialties in one setting Cross-campus team collaboratively develops each patient care plan Referrals for complex, ongoing care (~75%) or consultative (~25%) Clinical Encounters and Care Coordination Team Clinic (Monthly): includes GI, ENT, Pulmonary, Surgery, Nutrition, Speech, Respiratory Therapy, Nurse Practitioner (NP), RN Team Surgery Day (Monthly): GI, ENT, Pulmonary, NP NP Clinic (weekly) telemedicine (monthly): NP, RD Care Navigation (Daily): NP, RN 5
Before enrollment in the Center 6
After enrollment in the Center 7
NP and RN Navigators provide efficient care NP/RN care navigators help patients overcome challenges to plan of care instead of parents acting alone Insert key fact connected with photo Helps overcome challenges to care plan (orders, insurance authorization) Guides patients to use system effectively 8
Comparision Hypothetical Eval vs. Aero Model Evaluation at same time allows for many episodes of direct communication among clinicians and evaluation of diagnostic evidence leading to correct interpretation, diagnoses and treatment plans that may have otherwise never happened This results in a timely diagnosis and efficient treatment instead of many episodes over months that delay resolution of underlying condition 9
Case Study Four year old presents to clinic with 2.5 year history of chronic croup and coughing. Has seen Pulmonary, GI, and Allergy/Immunology separately and been diagnosed with GERD, Asthma and Low IgA. Mom presents a written report of over 5 inhaled corticosteroids tried and over 12 treatments with antibiotics as well as >20 visits to the ER. He undergoes an evaluation by the Aerodigestive team that shows that his immune markers are normal, he did not react sufficiently to his pneumococcal vaccines and has no protective immunity. A 3 day calorie count shows that he is orally averse and often consumes <75% of daily caloric need. After triple endoscopy and ph impedance probe it shows he has GERD, a type 1 laryngeal cleft, and chronic inflammation of lungs from secondary aspiration. His impedance probe shows 80 reflux episodes, 50% of which are going proximal to his cleft and aspirating into his lungs. A CT of his chest is normal showing no lung damage yet. Plan: revaccination, Nissen + G tube to resolve GERD then second step cleft repair 10
Quality Improvement Summary for 2014 Having a team work to bridge practice silos often creates innovation and system quality improvement that adds overall value and quality improvement at an organizational level 11
Quality Improvement Summary for 2014 Team worked to implement a multidisciplinary encounter in EPIC complete with joint scheduling, one encounter with multiple progress notes, one charge capture section with multiple evaluation and management charges, and multidisciplinary intakes/order sets for all to utilize 12
Value to all Stakeholders 13
Contact information: Aerodigestive Center 404-785-1161 www.choa.org/aerodigestive amy.painter@choa.org Acknowledgements Administrative and Executive Team especially Diane Spencer, Mary Beth Bova, Dr. Fortenberry, Lamarvia Stinson, Vicki Gore, and Dr. Wulkan Aerodigestive Friends and Supporters throughout the Medical/Surgical Service Line and Children s Physician Group Aerodigestive Team: Medical Director: Dr. Dawn Simon MDs: Dr. Roy Rajan, Dr. Ben Gold, Dr. Cary Sauer, Dr. Jose Garza, Dr. Kara Prickett, Dr. Amina Bhatia Program Manager/NP: Amy Painter FNP Nisha Nair RN and RN Case Manager: Shannon Luetkemeyer RT: Donna Williams RD: Abby Johnson Speech Therapists: Laura Brooks, Anna Vance, Sarah Harmon, Kristin Hall 14