State and National Initiatives to Improve the Quality of Health Care for Children

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State and National Initiatives to Improve the
Quality of Health Care for Children

• 13th Annual Maternal and Child Health
  Epidemiology Conference
• December 12, 2007
• Doris Hanna, RN, CPNP, ScD

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About NICHQ

• Founded in 1999
• Mission To eliminate the gap between what is
  and what can be in health care for all children.
• NICHQ is an action oriented organization
  dedicated exclusively to improving the quality of
  childrens health care
• NICHQ is a resource for health care and
  improvement organizations, foundations, and
  government agencies seeking to improve care for
  children
• NICHQ is a national organization
• Home Office Cambridge, MA
• National cadre of key advisors
• Geographically distributed staff

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What we doChange Practice to Improve Care and
Outcomes

• Innovate
• Discover, invent, and share good ideasready for
  use in childrens health care
• Demonstrate
• Undertake targeted initiatives to demonstrate the
  feasibility of improving care and outcomes
• Accelerate Adoption
• Facilitate widespread adoption through policy
  change, capacity building, and partnership with
  high leverage systems (including state and
  federal government)

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NICHQs Bold Improvement Agenda

• Prevent Childhood Obesity
• Provide Seamless, Evidence Based, Family Centered
  Care for Children with Chronic Conditions
• Purge Harm from Childrens Health Care
• Promote Equity in Care

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Our Services

• Training and Transforming Care
• Learning Collaboratives In person and across
  distance
• Action Networks and Spread Initiatives
  Accelerating learning, spreading better care
• Annual Childrens Forum
• Toolkits
• Jump Start and Jump Ahead Introductory and
  Advanced QI Methods and Tools for Childrens
  Health Care
• Creating and Sustaining Improvement Resources
• Local, State, Regional and Federal programs to
  sustain change
• Setting the National Agenda for Change
• Federal and State Childrens Quality Policy
• Measurement
• Improvement
• Health Information Technology
• Payment

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Numerous potential state based resources to
support improvement

• Professional society/medical association chapters
• Health Department
• MCH
• Children and Youth with Special Health Care Needs
• Medicaid Agencies
• State universities (medical and public health
  schools)
• State and local non-profits
• Combinations of the above

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The Breakthrough Series Learning Collaborative
Model (IHI, 1995)

• A quality improvement method to refine and spread
  improvements and ideas throughout a system or set
  of systems
• Typically, a group of stakeholders working
  together to make improvements in a focused topic
  area (care delivery system)
• Links subject matter experts, application
  experts, and front line staff for mutual learning
• Short term (6-15 month) learning system
• Uses data to support improvement
• NICHQ always includes parents/families

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Medical Home Learning Collaboratives

• To improve care for children with special health
  care needs/youth by implementing the Medical Home
  concept
• To foster substantial relationships between Title
  V programs and their states primary care
  community, enabling Title V to
• Support improvement in practices and
• Spread improvement across their State

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Hypothesis

• Application of four key concepts
• Medical Home/Care Model for Child Health
• Collaborative Model
• Model for Improvement
• Model for Spread
• Together with support from a capable
  regional/state/local resource (Title V)
• Will result in acceleration of spread of Medical
  Home

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Medical Home Learning Collaborative IMedical
Home Index Pre and Post Measures
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Results-MHLC II
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Broadening Beyond the Medical Home

• Vertical Coordination Primary and Specialty Care
• Case example Improving Access and Quality for
  Children with Epilepsy
• Horizontal Coordination Community/Public Health
  Resources
• Case example Strengthening handoffs between
  newborn hearing screening, specialty care,
  primary care, and early intervention

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Newborn HearingCollaborative Results
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Next Steps Building Systems of Care

• Improve the health and well being of Children and
  Youth with Special Health Care Needs (CYSHCN) and
  their families through building the capacity of
  state Title V programsin concert with other
  state based partnersto create and sustain
  effective community based systems of care
• CMS expressed interest in building state capacity
  to support improvement in perinatal care

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Lessons Learned

• Health care is one contributor to child well
  being
• Direct
• Indirect (Health Behaviors)
• State based approaches have key advantages
• Numerous entities at state level can lead
• Works best if all participate
• Key role for real time, pragmatic data capacity
  as one key ingredient for improvement process

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Health Care for Children Different?

• Greater level of financial access than non
  elderly adults (if tenuous)
• Quasi-public health function, particularly 0-3
  years
• Major focus on preventive health, health
  behaviors
• Anticipatory Guidance

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Relative Health and Safety of US Children
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But the Quality of Childrens Health Care is No
Better (and May Be Worse)
Percent Receiving Recommended Care
Source McGlynn et al, NEJM 2003, 348262635-45,
and Mangione-Smith, et al, NEJM, 2007.
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And Preventive Care is at the Bottom
Mangione Smith et al, NEJM, 2007
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Role of Health Care in Health
Schroeder SA, N Engl J Med 2007 3571222, from
McGinnis Health Affairs 2002
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Why A State Role?

• Childrens Health Care is
• Predominantly outpatient
• Locally delivered and organized
• State regulated
• Substantially funded through state programs
• Major state public health role (e.g.,
  immunizations, newborn screening)

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Together we can make health care better for every
child!
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Some Partnership Examples

• Partnership for Quality (ADHD)
• PA and CT EPIC programs
• NJ Immunization
• Medical Home, Epilepsy, Newborn Hearing Learning
  Collaboratives
• Neonatal Improvement Programs (OH, TN)
• Improvement Partnership (VCHIP, Envision NM)