Illinois Medical Home Project Overview

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Illinois Medical Home Project Overview

• By Kathy Sanabria, MBA, PMP
• Director, IMHP

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Illinois Medical Home Project

• Funded through grants from the Department of
  Health and Human Services, Health Resources and
  Services Administration, Maternal and Child
  Health Bureau.
• Project Period 4 years from July 1, 2004 to
  June 30, 2008.
• Funding Level 1,000,000 over four years.

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Illinois Medical Home Project

• Project Number 1 H02MC02609-01-00 (CFDA
  93.110, Priority Three Integrated Services for
  Young Children with Special Health Care Needs).
• Principal Investigator Charles N. Onufer, MD,
  FAAP
• Phone [phone] E-Mail cnonufer
  _at_uic.edu
• Project Director Kathy Sanabria, MBA, PMP.
• Phone [phone] E-Mail
  ksanabria_at_illinoisaap.net
• Project Manager Kathryn Hawley.
• Phone [phone] E-Mail
  khawley_at_illinoisaap.net
• Organization Name Illinois Chapter, American
  Academy of Pediatrics (ICAAP).
• Address 1358 W. Randolph St., Suite 2 East,
  Chicago, IL 60607.

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Organizational Setting

• The Illinois Medical Home Project (IMHP) is
  administered by ICAAP with the Illinois Title V
  Agency for Children and Youth with Special Health
  Care Needs (CYSHCN), the Division of Specialized
  Care for Children (DSCC), University of Illinois.
  
• A Project Advisory Committee (PAC) of physicians,
  community liaisons, and parent representatives
  has been established to provide guidance and
  counsel regarding program administration.
• An Evaluation Subcommittee has been established
  to formulate a measurable evaluation plan.

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Purpose

• The IMHP supports development of
  community-based medical homes for CYSHCN by
• Informing primary care providers about the
  medical home model
• Providing access to quality improvement (QI)
  processes involving partnerships with parents,
  linkages to community resources, and
  reimbursement
• Facilitating QI Teams at practices
• Sponsoring Leadership Forums to develop statewide
  action plans.

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Challenges

• Primary care providers lack information and
  understanding about the
• medical home model and benefits of providing
  community-based,
• family-centered care. Barriers to implementing
  such health care
• services include
• Lack of understanding of the Medical Home Model.
• Reimbursement issues.
• Lack of knowledge regarding existing
  community-based services.
• Lack of needed services.
• Time and staffing constraints.
• The result is poor communication, uncoordinated
  care, and absence of reimbursement.

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Methodology

• Utilizing and building upon the resources
  developed by the Center for Medical Home
  Improvement (CMHI) and the Medical Home Learning
  Collaborative (MHLC) of the National Initiative
  for Childrens Healthcare Quality (NICHQ), the
  IMHP uses the Plan-Do-Study-Act cycle of
  practice improvement.

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Methodology

• The IMHP establishes systems within demonstration
  practices to support medical home initiatives
  utilizing the CMHI Tool Kit, training materials
  from the National Initiative for Childrens
  Health Care Quality Learning Collaborative,
  trained QI team facilitators, technical
  assistance, and funding to support practice
  teams.
• Project leaders, staff, and facilitators utilize
  knowledge of medical home concepts, family
  involvement, and practice improvement strategies
  to support practices.
• The IMHP sponsors three medical home learning
  sessions for phase 1 of the project (years 1 and
  2).

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Methodology

• Outreach at the state level includes planning and
  hosting two Leadership Forums to motivate the
  development and implementation of statewide
  action plans for CYSHCN.
• A public relations firm will be hired to help
  refine the medical home message for providers and
  parents.

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Goals and Objectives

• Goal 1 Plan, develop, and implement the IMHP.
• Hire staff
• Formalize relationships with the Illinois Title V
  program
• Establish Project Advisory Committee
• Establish Evaluation Subcommittee
• Train staff and Quality Improvement team
  facilitators.

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Project Advisory Committee

• Members
• Charles Onufer, MD, FAAP, Chair, Principal
  Investigator
• Karen Belcher, Parent
• Helen Binns, MD, MPH, FAAP
• Larry Desch, MD, FAAP
• Jerie Beth Karkos, MD, FAAP
• Christeen Mauerman, Parent
• Edward Pont, MD, FAAP
• Jamil Rana, MD, FAAP
• Marian Sassetti, MD, FAAFP
• Shelly Shallat, MD, FAAP
• Organizational Representatives
• Faye Manaster, Family Voices
• Kate Valentine, American Association of Family
  Physicians
• Margie Harkness, Ill Council on Developmental
  Disabilities
• Anne Marie Murphy, PhD, Illinois Department of
  Public Aid
• Staffed by Scott Allen, BA Kathy Sanabria, MBA
  and Kathryn Hawley, BS

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Goals and Objectives

• Goal 2 Provide IMHP demonstration sites and
  others with education, resources, and technical
  assistance to build community-based medical
  homes.
• Establish systems within 12 primary care
  practices to support initiatives 6 practices
  during phase I for years 1 and 2 and a new group
  of practices during phase II for years 3 and 4
  
• Collect baseline data and identify quality
  improvement needs
• Improve the ability of practices to become
  medical homes through training, monthly QI team
  meetings, implementation of individualized action
  plans, and facilitation
• Enlist all demonstration sites as DSCC-enrolled
  providers
• Increase reimbursement to primary care sites.

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Goals and Objectives

• Goal 3 Promote/support community inclusion of
  CYSHCN by better linking sites with community
  resources.
• Improve quality/frequency of communication
  between practices and community partners
• Improve quality/frequency of communication
  between practices and families
• Improve quality/frequency of communication among
  practices statewide and state/community-level
  CYSHCN systems.

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Goals and Objectives

• Goal 4 Enlist the involvement of providers at
  large, community groups, insurers, and other
  stakeholders in IMHP.
• Develop and implement a public relations
  strategy
• Develop IMHP posters
• Develop an IMHP website
• Expand the ICAAP provider database to include
  medical home providers.

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Goals and Objectives

• Goal 5 Improve capabilities at the
  practice/systems levels statewide for developing
  medical homes.
• Ensure commitment and action of decision makers
  to improve systems through Leadership Forums
  (Leadership Forums sponsored by ICAAP and DSCC to
  be held March 2006 and October 2007)
• Evaluate progress and identify needs in adapting
  statewide systems
• Enable practitioners and community service
  representatives to improve coordination of
  services.

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Goals and Objectives

• Goal 6 Evaluate and measure the
  efficiency/effectiveness of goals for the IMHP.
• This section will be addressed by Kristin
  Rankin, MSPH, with the University of Illinois at
  Chicago (UIC) School of Public Health, CADE
  Research Data Management group. This group is the
  evaluation subcontractor for our project.

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Illinois Medical Home Project Overview

• Presented by Kathy Sanabria, MBA, PMP
• IMHP Director
• ICAAP
• 1358 W. Randolph St, Suite 2 East
• Chicago, IL 60607-1522
• Phone [phone]
• ksanabria_at_illinoisaap.net
• www.illinoisaap.org

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IMHP Evaluation Protocol University of Illinois
Chicago (UIC), School of Public Health, CADE
Research Data Management Group Kristin Rankin,
MSPH Amy Kletzien, BS
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CADE Research Data Management Group

• Web-based technology center
• Databases and online surveys
• Analysis and Statistical Support
• GIS mapping
• Research consulting for health projects

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History of Evaluation Project

• July 2004 MCHB grant funded with included
  Evaluation Component.
• August 2004 ICAAP met with DSCC staff to develop
  coordinated work plan to implement project goals
  and objectives. UIC CADE was contacted to discuss
  collaboration.
• November 2004 Evaluation subcommittee met and
  chose CADE to head project.
• December 2004 Submittal of protocol to
  Institutional Review Board (IRB).
• February 2005 IMHP receives IRB approval of
  protocol.

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Evaluation Subcommittee

• Charles Onufer, MD
• Helen Binns, MD, MPH
• Jenifer Cartland, PhD
• Colleen Monahan, DC, MPH
• Kristin Rankin, MSPH
• Kathy Sanabria, MBA
• Kathryn Hawley
• Scott Allen

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Phase I (Years 1 and 2)

• Baseline evaluation data collected from practices
  and families
• Practices re-evaluated 18 months later
• Analyze change between pre- and post- IMHP
  implementation
• Change will be measured in the following areas
• delivery of care
• patient outcomes
• access to community services
• satisfaction with care received
• changes in provider and family competencies

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Phase II (Years 3 and 4)

• Revise Evaluation Protocol based on lessons
  learned from Phase I
• Add 6 control practices (with no medical home
  involvement) and 6 interventions to see if
  Medical Home intervention results in change in
  practice

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Evaluation Objectives

• 1) Determine the quality of the IMHP training
  materials and the satisfaction of those attending
  all training events
• 2) Determine the effectiveness of the QI Teams
  and the satisfaction of those participating on
  the teams
• 3) Determine whether or not demonstration
  practices are more familiar with Medical Home
  concepts after the IMHP has been implemented for
  18 months

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Evaluation Objectives (Contd)

• 4) Determine whether or not the implementation of
  the IMHP has improved the quality of care for
  families, within the domains of the Medical Home
• 5) Measure the change in family satisfaction with
  the practice after the IMHP has been implemented
  in their practice for 18 months
• 6) Measure the improvement in communication with
  parents and referral to community services after
  the IMHP has been implemented for 18 months.

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Objective 1
Determine the quality of the IMHP training
materials and the satisfaction of those attending
all training events -Instrument Learning
Session Evaluation -Anonymous -Data analyzed and
feedback used throughout IMHP to improve events
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Training Conference Evaluation
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Objective 2
Determine the effectiveness of the QI Teams and
the satisfaction of those participating on the
teams -Instrument QI Team Evaluation -Confiden
tial by practice -6, 12, 18 months for Phase
I -Data analyzed and feedback used throughout
IMHP to improve QI team experience
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QI Team Evaluation
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Objective 3
Determine whether or not demonstration practices
are more familiar with Medical Home concepts
after the IMHP has been implemented for 18
months -Instrument Medical Home Index -Filled
out by practice staff as a team -Baseline and
after 18 months -Data analyzed and specialized
report given to practices to inform IMHP
process
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Medical Home Index Report
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Objective 4
Determine whether or not the implementation of
the IMHP has improved the quality of care for
families, within the domains of the Medical
Home -Instrument Medical Home Family
Index -Sent to Select Families from
practices -Offered as paper or online
survey -Baseline and 18 months -Data analyzed
and feedback given to practices to inform
IMHP process
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Objective 5

• Measure the change in family satisfaction with
  the practice after the IMHP has been implemented
  in their practice for 18 months
• -Instrument Family/Caregiver Survey
• -Sent to Select Families from practices
• -Offered as paper or online survey
• -Baseline and 18 months
• -Data analyzed and used for peer-reviewed
  publications

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Objective 6

• Measure the improvement in communication with
  parents and referral to community services after
  the IMHP has been implemented for 18 months.
• -Instrument In-Office Practice
• Assessment
• -Onsite interview with each practice
• -Baseline and 18 months
• -Data analyzed and used for peer-reviewed
  publications

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In-Office Practice Assessment
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Timeline for Practices

• Feb/Mar 2005
• -Evaluate first learning session
• -Complete first Medical Home Index
• -Complete first In-Office Practice Assessment
• -Send invitation letters to families from
• practices to participate in family surveys
• Mar/Apr 2005
• -Receive reports of analyzed data from Medical
• Home Index and Medical Home Family Index

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Timeline for Practices (Contd)

• Summer 2005
• -First QI Team Evaluation conducted
• Feb/Mar 2006
• -Second QI Team Evaluation conducted
• Summer 2006
• -Complete 18-mth follow-up Medical Home Index
• -Complete 18-mth follow-up In-Office Practice
• Assessment
• -Receive reports on follow-up data from Medical
• Home Index and Medical Home Family Index with
• comparison of pre/post IMHP implementation
• results

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CADE Contact Information

• If you have any questions,
• please contact
• Kristin Rankin, MSPH
• krankin_at_uic.edu
• 312-996-0179
• -OR-
• Amy Kletzien, BS
• akletz1_at_uic.edu
• 312-996-2691