2010 Audubon Pediatric Practice Quality Improvement Project

1. 2010 Audubon Pediatric Practice Quality Improvement Project May 26, 2010

2. 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)

3. Practical Basis

4. 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)

5. 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

6. Background Data

7. 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

8. How a Clinic Appointment is Made? • PFA • Call Center • ER

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

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

11. 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

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

13. 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

14. PMD Photos

15. 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

16. 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

17. Final Results

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

19. 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%)

20. 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

21. 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.