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Incorporation of the Bright Futures Program in Rural, KS

Incorporation of the Bright Futures Program in Rural, KS. Dr. Ellen Squire Dr. Michelle Pope Lisa Gagnon RN Preventive Services Improvement Project Learning Session 2 November 11-12, 2011. Disclosures.

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Incorporation of the Bright Futures Program in Rural, KS

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  1. Incorporation of the Bright Futures Program in Rural, KS Dr. Ellen Squire Dr. Michelle Pope Lisa Gagnon RN Preventive Services Improvement Project Learning Session 2 November 11-12, 2011

  2. Disclosures We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. We do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation.

  3. About HaysMed Pediatric Center • Ave. number of visits per year: 15,600 • Number of well checks per year: 7,200 • We have added providers! • 4 full-time and 1 part-time pediatricians • 1 part-time physician assistant • Only pediatricians for a large referral area

  4. Where we started

  5. Where we started • Paper based system, old paper forms • Limited anticipatory guidance • No standardized developmental screening • No standardized autism screening • No maternal depression screening • No dental screening • Great variability between physicians • Inconsistent BMI, Wt/Lgth, vision, hearing

  6. Initial Barriers and Concerns • Physician resistance • Nursing/Staff concerns • Parental cooperation • Paper obligations • Insurance/payment concerns • Referral agent/agency availability • Time!!

  7. Our 1st Approach • Gradual Progression • 2 month and 18 month WCC • Concurrent office systems/referral tracking • 1-2 forms/month throughout the year with gradual incorporation of Dental, ASQ, MCHAT, etc. • Forms Only • Previsit Questionairre • WCC form

  8. Gradual Progression??? • February: forms - 2 mo. & 18 mo. • Previsit Questionnaire • Referral Tracking/CYSHCN tracking • Preventative Services Prompting Sheet • March: 2 more forms - 9 mo. & 2 yr. • Community Resources Update • Supplemental Quentionnaires • April: 2 more forms - 4 mo. & 6 mo. • ASQ • May: 2 more forms - 1,2 week & 1 yr. • Dental Screening/Fluoride

  9. Gradual Progression??? • June: All visit forms • MCHAT • July: All visit forms • Maternal Depression • August: All visit forms • Parental Strengths • September/October: • Review

  10. Our Biggest Barriers • Nursing/Staff resistence • Perceived “extra work” • Referral Tracking • Plethora of Paper! • Maternal depression/Dental

  11. Our Biggest Barriers

  12. What Surprised Us • It was relatively easy • Physicians were a minor barrier • Feel like WCC are more complete • Little time for supplemental forms • Time was the same • Brought us together

  13. Any changes? • Less paper? • Strength based approach - • cue on form

  14. Conclusions • We had a great time • Learned a lot about our office: physicians, staff, and ancillary agencies • Went from doing a good job on WCCs to “pride” in our WCCs

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