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


State and National Initiatives to Improve the Quality of Health Care for Children 13th Annual Maternal and Child Health Epidemiology Conference – PowerPoint PPT presentation

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

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

  • 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
  • NICHQ is a national organization
  • Home Office Cambridge, MA
  • National cadre of key advisors
  • Geographically distributed staff

What we doChange Practice to Improve Care and
  • 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)

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

Our Services
  • Training and Transforming Care
  • Learning Collaboratives In person and across
  • 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

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
  • State and local non-profits
  • Combinations of the above

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

Medical Home Learning Collaboratives
  • To improve care for children with special health
    care needs/youth by implementing the Medical Home
  • 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

  • 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

Medical Home Learning Collaborative IMedical
Home Index Pre and Post Measures
Results-MHLC II
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
  • Case example Strengthening handoffs between
    newborn hearing screening, specialty care,
    primary care, and early intervention

Newborn HearingCollaborative Results
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

Lessons Learned
  • Health care is one contributor to child well
  • 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
  • Major focus on preventive health, health
  • Anticipatory Guidance

Relative Health and Safety of US Children
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.
And Preventive Care is at the Bottom
Mangione Smith et al, NEJM, 2007
Role of Health Care in Health
Schroeder SA, N Engl J Med 2007 3571222, from
McGinnis Health Affairs 2002
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)

Together we can make health care better for every
Some Partnership Examples
  • Partnership for Quality (ADHD)
  • PA and CT EPIC programs
  • NJ Immunization
  • Medical Home, Epilepsy, Newborn Hearing Learning
  • Neonatal Improvement Programs (OH, TN)
  • Improvement Partnership (VCHIP, Envision NM)