Enhancing the Medical Home for Children with Special Health Care Needs: A Quantitative Approach The Quality Colloquium August 20, 2008 Angelo P. Giardino, MD, PhD, MPH Renee M. Turchi, MD, MPH
Overview Definitions Medical Home Children and youth with special heath care needs (CYSHCN) The Center for Children w/ Special Health Care Needs Medical Home Index Definitions Center specific data Educating Practices in the Community Integrated Care Program (EPIC-IC)
Joint Statement Medical Home Core Principles Personal physician Physician directed medical practice Whole person orientation Care coordination across multiple systems Quality and safety Enhanced access Appropriate payment for services
Who are children and youth with special health care needs (CYSHCN)? Children who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.
How many children and youth have special health care needs? Approximately 13-18% (9-12.5 million) of children in the U.S. Approximately 15.4% of children in PA have special health care needs (430,640 total)
Care Model for Child Health in a Medical Home Community Resources & Policies Health System Health Care Organization (Medical Home) Care Partnership Support Delivery System Design Clinical Information Systems Decision Support supportive, integrated community family-centered, timely, efficient informed, activated patient/family evidence-based & safe Functional and Clinical Outcomes prepared, proactive practice team coordinated & equitable
The Center for Children with Special Health Care Needs
What is our mission? To work together with families of children and youth with special health care needs to provide ongoing, comprehensive, family-centered medical care and to improve access to services, community resources and advocacy to assure that children obtain optimal support through life stages as well as promote their independence with dignity and respect.
The Center for Children with Special Health Care Needs Located at St. Christopher s Hospital for Children Inception: 2003 Staff 3 pediatricians 2 nurse care coordinators Social Worker Office Manager Patient Service Rep
Patient Population at The Center 2003-04 2005 The number of CYSHCN identified at The Center has increased 50% since 2003. The Center also treats siblings of CYSHCN. 2006 2007 +
Data and Tracking our Progress..
Description of our Services Well-child and acute illness management Develop care plans Collaborate with schools Coordinate care across multiple systems (i.e. community resources) Special Programs
Medical Home Index (MHI) Nationally validated measurement tool Measures 25 indicators across six domains Organizational capacity Chronic condition management Care coordination Community outreach Data management Quality management Each domain scored 1-8 Overall MHI score transformed 1-100 Center for Medical Home Improvement, www.medicalhomeimprovement.org
Medical Home Index Scores Year 1 Year 2 Item score 8 6 4 2 6.4 4.3 3.8 2.6 2.7 6.7 3.0 4.2 7.5 3.0 2.5 4.5 4.0 3.5 3.0 2.5 5.5 6.0 Year 3 0 Organizational Capacity Chronic Condition Mgmt. Care Coordination Community Outreach Data Mgmt. Quality Improvement p<0.05 Domain
Complexity Scores of CYSHCN 50 40 St. Chris PA 30 20 10 0 1 2 3 4
Types of Insurance- The Center for CSHCN Public + Private 5% Private 13% Public 82%
Time Spent on Care Coordination Care Coordinators 76% (15,496) PCP <1% (87) Social Worker 5% (951) Other 4% 756 Office Staff 15% (3118)
Center Activities Over Time 2004 2005 2006 2007 Referrals to specialists 2255 3213 3178 2907 Studies 1000 1509 1516 1407 Care Plans 243 120 244 261 Medical Summaries 157 175 245 285 Community resource referrals Mental Health referrals 739 570 370 715 169 80 64 76
Health Care Utilization 800 700 600 500 400 300 200 100 0 Admissions Ed Visits Total Patients 2004-05 2006 2007
Programs at The Center at SCHC Participate in EPIC IC Care Coordination Home Evaluations Joint Pulmonary Program FASD Initiative Transition Program Down Syndrome Program
How did the Center for CYSHCN evolve?
What is the EPIC IC program? Quality improvement initiative Works with pediatric practices to implement Medical Home principles within the practice Data Collection and Management Site visits/technical Assistance/Conferences
Summary of EPIC IC Participation 62 practices trained in medical home principles Over 33 practices received funding for care coordination Practices represent: 6 regions & 30 counties in PA urban, suburban, and rural communities Hospital systems
EPIC IC Medical Home Sites Medical Home Adopter (currently active in EPIC IC) Medical Home Adopter (Achieved implementation) Medical Home Adopter (First year of implementation) Medical Home Trainee (Received Training) In recruitment Satellite office
Average Practice MHI Scores By Domain 8 Year 1 Year 2 7 6 5 4 3.4 5.2 5.9 4.3 5.4 6 5.5 4 6.3 3.8 4.7 5.5 3.7 4.4 5.3 3.2 4.8 5.0 3.7 5.0 5.7 Year 3 3 2 1 0 Org. Cap. CCM Care Coor. Comm. Out. Data Mgt. QI Total Score All p values <0.05
Where are we going? Policy, research, practice Funding Adult Medical Home (IPIP) AAP and Chapter involvement NCQA Advanced Medical Home Cost effectiveness ABP Certification Co-management models
Contact Information Angelo P. Giardino, MD, PhD, MPH apgiardi@texaschildrens.org 832-828-1216 Renee M. Turchi, MD, MPH Renee.Turchi@drexelmed.edu 215-427-5331
References Joint Principles of the Patient Centered Medical Home. American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA). March, 2007. http://www.medicalhomeinfo.org/joint%20statement.pdf McPherson M, Arango P, Fox H, et al. A new definition of children with special health care needs. Pediatrics. 1998; 102: 137-140 vandyck PC, Kogan MD, McPherson MG et al. Prevalence & Characteristics of Children w/ Special Health Care Needs.Arch Pediatr Adolesc Med 2004;158: 884-890 www.cshcndata.org Center for Medical Home Improvement, www.medicalhomeimprovement.org Newacheck PW., Strickland B, Shonkoff JP, et al. An epidemiologic profile of children with special health care needs. Pediatrics. 1998;102:117 122. Strickalnd BB, McPherson M, Weissman G, et al. Access to the medical home: Results of the National Survey of Children with Special Health Care needs. Pediatrics. 2004; 113(5):1485-1492. www.pamedicalhome.org