Enhancing the Medical Home for Children with Special Health Care Needs: A Quantitative Approach

The Quality ColloquiumAugust 20, 2008

Angelo P. Giardino, MD, PhD, MPHRenee 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 HomeCore 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)

Functional and Clinical Outcomes

family-centered,timely,efficient

coordinated & equitable

evidence-based & safe

informed,activated

patient/family

supportive, integrated community

prepared,proactive

practice team

Health System

Health Care Organization (Medical Home)DeliverySystemDesign

Decision Support

ClinicalInformation

Systems

Care Partnership

Support

Community Resources & Policies

Care Model for Child Health in a Medical Home

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

The number of CYSHCN identified at The Center has increased 50% since 2003.

2007

2006

2005

2003-04

+

The Center also treats siblings of CYSHCN.

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

Domain

2.6 2.73.0

2.53.0

2.5

4.33.8

4.2

3.03.5

5.56.4

6.77.5

4.54.0

6.0

0

2

4

6

8

OrganizationalCapacity

ChronicCondition

Mgmt.

CareCoordination

CommunityOutreach

Data Mgmt.

QualityImprovement

Item

score

Year 1

Year 2

Year 3

p<0.05

Complexity Scores of CYSHCN

0

10

20

30

40

50

1 2 3 4

St. Chris

PA

Types of Insurance- The Center for CSHCN

Public82%

Private13%

Public+ Private

5%

Time Spent on Care Coordination

PCP<1%

(87)

Office Staff15%(3118)Other

4%756

Care Coordinators76%

(15,496)

Social Worker5%(951)

Center Activities Over Time2004 2005 2006 2007

Referrals to specialists 2255 3213 3178 2907

Studies 1000 1509 1516 1407

Care Plans 243 120 244 261Medical

Summaries 157 175 245 285

Community resource referrals

739 570 370 715

Mental Health

referrals169 80 64 76

Health Care Utilization

0

100

200

300

400

500

600

700

800

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

3.4

5.2

5.9

4.3

5.4

6

4

5.5

6.3

3.8

4.7

5.5

3.7

4.4

5.3

3.2

4.85.0

3.7

5.0

5.7

0

1

2

3

4

5

6

7

8

Org. Cap. CCM Care Coor. Comm. Out. Data Mgt. QI Total Score

Year 1 Year 2

Year 3

All p values <0.05

Where are we going?Policy, research, practice

Funding

AAP and Chapter involvement

Cost effectiveness

Co-management models

Adult Medical Home (IPIP)

NCQA Advanced Medical Home

ABP Certification

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