2010 Audubon Pediatric Practice Quality Improvement Project May

2010 Audubon Pediatric Practice Quality Improvement Project May 26, 2010

AIM Statement: To increase the percent of Audubon pediatric patients who see their primary care provider at scheduled visits from 53% to 80% by the end of the 2009 -2010 academic year (June 2010)

Practical Basis

The Medical Home 1967 – AAP was the first to introduce the concept; initially referred to a central location for archiving a child’s medical record Medical care of infants, children, and adolescents that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective Involves a physician that is known to the child and family, and is able to develop a partnership of mutual responsibility and trust AAP POLICY STATEMENT (initially published: PEDIATRICS Vol. 110 No. 1 July 2002, pp. 184 -186; reaffirmed August 1, 2008)

Theoretical basis CSHCN have better outcomes than children receiving care in a non-medical home (Homer et al. , 2008) Medical Home offers cost reduction, particularly for those with chronic disease

Background Data Paired Correctly NOT paired correctly Total Visits Percent Paired Correctly Resident 40 36 76 53% Attending 62 32 94 66% Total 102 68 170 60%

Background Survey Low PMD Awareness Visit Scheduling: 60% of visits scheduled within one month of appt. PMD Availability: 50% were always able to schedule appointments with their PMD

How a Clinic Appointment is Made? PFA Call Center ER

PDSA P: Increase correct PMD-Patient visits by identifying PMD in Eclypsis D: Designate PMD in Eclypsis

Study Total Patients Seen PMD Designated Mid-Block 26 3 (12%) End-Block 56 10 (18%) “To be honest with you, I haven’t added any of my patients during the last block. . . feels bad. ”

Act Abort Eclypsis PMD designation PMDs only sporadically self-identifying in Eclypsis Neither PFA nor call center utilized this information when making appointment Future Plans: Devise other methods of identifying PMD

How to Identify PMD? Business Card? The Face sheet? The Welcome sheet!

PDSA P: Increase PMD awareness by distributing Welcome Sheet at each visit D: Survey residents as to how often Welcome Sheets are provided by PFA S: 1 handout in 24 patient encounters A: How to improve Welcome Sheet Distribution? Welcome Sheets placed in clinic rooms Increase family awareness of providers in other ways Survey Families

PMD Photos

Family Survey 10 families questioned in waiting room after visit 0 received Welcome sheets 5 could name PMD immediately after visit All relied on call center to identify PMD when making an appointment. 7 said they would take appointment with first available provider if more convenient

Final Results • To increase the percent of Audubon pediatric patients who see their primary care provider at scheduled visits from 53% to 80% by the end of the 2009 -2010 academic year (June 2010) • A chart review was completed on 147 patients during April 2010

Final Results Paired Correctly Not paired correctly Total Visits Percent Paired Correctly Resident 41 23 64 64% Attending 65 18 83 78% Total 105 43 147 71%

Future Directions Continue to distribute Welcome Sheets Call center? Challenges • Multiple systems that do not communicate Patient literacy Further limitations on resident availability

Update Post partum depression AIM Statement: To screen 95% of mothers of patients less than 4 months of age for post-partum depression A chart review of 69 patients aged 0 -3 months was completed during 2 week period in March 2010. 59 patients were screened for post-partum depression (86%)

Thank you to Audubon PFAs, MAs, RNs, Residents, Fellows and Attendings Special Thanks to Connie Kostacos, Mariellen Lane and all the other ACN Clinics

Provider Survey • 14 residents and 2 Attendings • Majority distribute Welcome Sheet either “rarely/never” or “around 20% of time” • Majority indicated that they either simply forget to distribute or could not find in rooms • Majority indicated that Welcome Sheets should be handed out at every visit • 50% thought PFAs should distribute; 25% both.