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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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Presentation Transcript
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)

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
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
slide9
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.”

slide11
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!
slide13
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
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
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.