2010 audubon pediatric practice quality improvement project
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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.

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2010 Audubon Pediatric Practice Quality Improvement Project

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2010 audubon pediatric practice quality improvement project

2010 Audubon Pediatric Practice Quality Improvement Project

May 26, 2010


Aim statement

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

Practical Basis


The medical home

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

  • Medicalcare 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 andfamily, and is able to develop a partnership of mutualresponsibility and trust

AAP POLICY STATEMENT (initially published: PEDIATRICS Vol. 110 No. 1 July 2002, pp. 184-186; reaffirmed August 1, 2008)


Theoretical basis

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


2010 audubon pediatric practice quality improvement project

Background Data


Background survey

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

How a Clinic Appointment is Made?

  • PFA

  • Call Center

  • ER


2010 audubon pediatric practice quality improvement project

PDSA

  • P: Increase correct PMD-Patient visits by identifying PMD in Eclypsis

  • D: Designate PMD in Eclypsis


Study

Study

“To be honest with you, I haven’t added any of my patients during the last block... feels bad.”


2010 audubon pediatric practice quality improvement project

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

How to Identify PMD?

  • Business Card?

  • The Face sheet?

  • The Welcome sheet!


2010 audubon pediatric practice quality improvement project

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

PMD Photos


Family survey

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

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 results1

Final Results


Future directions

Future Directions

  • Continue to distribute Welcome Sheets

  • Call center?

    Challenges

  • Multiple systems that do not communicate

  • Patient literacy

  • Further limitations on resident availability


Update

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

Thank you

  • 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

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.


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