Illinois Medical Home Project

1. Illinois Medical Home Project Presented by Kathy Sanabria, MBA, PMP Project Director

2. Illinois Medical Home Project (IMHP) Evaluation Status American Public Health Association 134th Annual Meeting and Exposition November 7th, 2006 Boston, MA Principle Investigator: Charles Onufer, MD Project Director: Kathy Sanabria, MBA, PMP Administering Organization: Illinois Chapter, American Academy of Pediatrics (ICAAP) Evaluators: CADE Research Data Management Group University of Illinois Chicago (UIC) School of Public Health: Kristin Rankin, MSPH (PhD Candidate) Andrew Cooper, MPH Wendy Guo, BS

3. There’s No Place Like a “Medical Home” A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.

4. Illinois Medical Home Project In July 2004, the ICAAP was awarded a four-year $1,000,000 federal grant through the Division of Services for Children with Special Health Care Needs, Maternal and Child Health Bureau, to spread the medical home concept to primary care providers throughout Illinois. This presentation provides evaluation results for Phase I of the project, which occurred July 2004 through June 2006, and outlines Phase II of the project. The project is being administered by the Illinois Chapter of the AAP in collaboration with the Division of Specialized Care for Children (DSCC), Title V Program, University of Illinois.

5. IMHP Evaluation Subcommittee • Charles Onufer, MD, Chair, Principle Investigator • Helen Binns, MD, MPH • Jenifer Cartland, PhD • Andrew Cooper, MPH • Colleen Monahan, DC, MPH • Kristin Rankin, MSPH • Kathy Sanabria, MBA This project has received Institutional Review Board (IRB) approval through the University of Illinois at Chicago School of Public Health.

6. OUTLINE • Phase I Evaluation Results • Phase II Evaluation Plan • Phase II Evaluation Baseline Results

7. Participating Sites During Phase I of the project, 6 core pediatric primary care practices participated and received the following: • Modest annual mini-grant stipends for 2 years • Quality Improvement (QI) teams at each site participated in 3 Learning Sessions • Medical home resources from the AAP, NICHQ, CMHI, ICAAP and DSCC • Access to trained facilitators to help organize and guide the QI teams and hold monthly meetings

8. Phase I Evaluation Results • Practice Assessment Checklist • Medical Home Index (MHI) • QI Team Evaluations • Family Surveys

9. Practice Assessment Checklist • Developed for IMHP and piloted in Phase I • Administered on-site at baseline and 18 months later at follow-up as an outcome measure (sites did not have access to the instrument or baseline results throughout the project) • Inventories practice environment, resources, and characteristics of a medical home • Will be useful to control for potential confounding factors affecting changes over time observed with other instruments Phase I Evaluation Results

10. Practice Assessment Checklist • All 6 Phase I sites (pediatric practices) completed baseline survey • To date, 5 sites have completed follow up survey Phase I Evaluation Results

11. Practice Assessment Checklist Phase I Evaluation Results

12. Medical Home Index • Completed by lead physician jointly with practice/clinic staff • Defines and quantifies organization and delivery of primary care in 6 practice domains Phase I Evaluation Results

13. Medical Home Index Questions are grouped into 6 domains • Domain 1: Organizational Capacity • Domain 2: Chronic Condition Management • Domain 3: Care Coordination • Domain 4: Community Outreach • Domain 5: Data Management • Domain 6: Quality Improvement/Change Phase I Evaluation Results

14. Medical Home Index (Phase I) Phase I Evaluation Results

15. Medical Home Index (Phase I) Distribution of Scores For All Sites, Across All Domains Phase I Evaluation Results

16. Medical Home Index (Phase I) Phase I Evaluation Results

17. QI Team Evaluation • QI Team members are surveyed • Elicit feedback on effectiveness of QI Team meetings, facilitators, and success of QI Teams of achieving goals • Administered twice for Phase I • At 6 months (February 2005) • At end of study (July/August 2006) Phase I Evaluation Results

18. QI Team Evaluation For all sites, Baseline n=32 Follow-up n=25 Phase I Evaluation Results

19. QI Team Evaluation (Phase I) Sample Question: “I have a good understanding of the team’s goals and what next steps are needed to achieve them.” Phase I Evaluation Results

20. Family Surveys (Phase I) • Medical Home Family Index (MHFI) • Family/Caregiver Survey Results pending completion of more follow up surveys. Phase I Evaluation Results

21. Phase II Evaluation Plan Includes a Control Component Updated Instruments • Practice Assessment Checklist • Medical Home Index (MHI) • QI Team Evaluations • Family Surveys Enrolled 10 demographically paired sites including pediatric practices, family practices, and public health clinics: 5 sites will receive assigned “facilitators” and 5 sites will receive “technical assistance” to organize and implement their QI efforts. All sites will receive small mini-grants, three training sessions, and resources. The study attempts to determine what effect facilitators vs technical assistance brings to the process and outcomes.

22. Practice Assessment Checklist(Phase II) • Updated slightly from version used in Phase I • Checklist and baseline results are shared with Phase II sites to be used as a tool for them to select activities to work on to increase their level of “medical homeness” • Fielded summer 2006 Phase II Evaluation Plan

23. Medical Home Index(Phase II) • Same instrument as was used in Phase I • Fielded summer 2006 Phase II Evaluation Plan

24. Family Surveys(Phase II) • Modified instrument for Phase II • Combines two separate Family Surveys used in Phase I • Medical Home Family Index (MHFI) • Family/Caregiver Survey • Modified slightly to improve data quality • Updated for improved readability • Letters distributed to sites September/October 2006, to be mailed same month (pending IRB approval for some sites) Phase II Evaluation Plan

25. Future Activities QI Team evaluations • Will be fielded to QI Teams twice • First round of evaluations will take place around April 2007 2-year follow up at conclusion of Phase II (June 2008) • Practice Assessment Checklist • Medical Home Index (MHI) • Family Surveys Phase II Evaluation Plan

26. Phase II Baseline Results • 9 of 10 sites have completed medical home Practice Assessment Checklist baseline survey • 9 of 10 sites have completed Medical Home Index (MHI) baseline survey • Sites are in the process of mailing out family surveys (or receiving IRB approval to do so)

27. Practice Assessment Checklist(Phase II Baseline) Phase II Baseline Results

28. Medical Home Index (Phase II Baseline) Phase II Baseline Results

29. Family Survey (Phase II Baseline) Baseline results pending completion of more surveys • Online responses have begun to come through • Paper responses expected in coming weeks Phase II Baseline Results

30. Illinois Medical Home Project For more information about the project, please contact: Kathy Sanabria, MBA, PMP, Project Director 1358 West Randolph Street, Suite 2 East Chicago, IL 60607 Phone: 312-733-1026, ext 208 ksanabria@illinoisaap.net Thank you for your interest!