0
Providing the Best Quality Care for Children   Medical/Dental Homes and Networks of Care Texas Medicaid Meeting Austin, TX...
What do we mean by :  “Best Quality?” <ul><li>Quality = Best science + Context (what the patient wants and needs) </li></u...
 
Quality: What our patients see <ul><li>54% of the time adults receive recommended appropriate care (McGlynn) </li></ul><ul...
Pediatric Quality - Underuse <ul><li>Immunization rate       75% </li></ul><ul><li>Speech and language evaluation   66% </...
Partnering with Pediatric Practices to  Improve Asthma Care Keith Mandel, MD Vice President of Medical Affairs,  Physician...
“ Perfect Care”: composite measure of severity classified, identified management plan, and controller medications for pati...
Cumulative % of Asthma Population with &quot;Perfect Care&quot;: Commercial vs. Medicaid/Uninsured Copyright © 2005 Cincin...
Models for Quality <ul><li>Successful sustained models of improving care have had common features: </li></ul><ul><ul><li>M...
Improving Care for Children <ul><li>Interdisciplinary teams </li></ul><ul><li>Measure performance and share data transpare...
Shared Data and Collaborative Practice (institutional autonomy is a barrier) <ul><li>Identified organized  systems  of car...
Why Prospective Multicenter Improvement Studies are Essential  <ul><li>Small sample size </li></ul><ul><li>Problems with a...
Acute Lymphoid Leukemia Simone J., Lyons, J: J Clin Oncology 1998 Sep;16(9):2904-5 5 year survival rate
Eliminating Bloodstream Infections In the first 6 months,  29 children’s hospitals reduced infection rates in the PICU by ...
Univ. Minnesota Survival Data For comparison, the US cystic fibrosis Foundation Registry survival curve for 1998 shows med...
Pediatric Pulmonology (Cystic Fibrosis) Median FEV1 CF Patients 6-12 yrs CFF National Patient Registry, 2004 *Wang & Hanki...
Vermont Oxford Neonatal Network Jeff Horbar Standard for Part 4 Infections Lung function Medical errors Nutrition Jaundice...
Neonatal Improvement
Percent of Patients Meeting the NKF-DOQI Target Urea Reduction Ratio of 65% figure 4.25, prevalent hemodialysis patients, ...
Quality of Care (ESRD)
Adequacy of Hemodialysis Sehgal A, JAMA 2003;289:1996-1000
<ul><li>“ the plural of anecdote is not data” </li></ul><ul><li>“ the plural of data is not knowledge” </li></ul><ul><li>“...
Brent James Patient Safety Reporting Systems and Applications IOM Looking for Bad Apples
Brent James Patient Safety Reporting Systems and Applications IOM Improving Good Apples
“ We take the data very seriously and I don’t know why we’re outside the normal range” Dr. Robert Schott, a cardiologist w...
Maintenance of Certification (MOC)  A New Approach to Standard Setting <ul><li>Looking for Bad Apples   (historic approach...
Health Care Quality  <ul><li>From “trust me, I am a physician, nurse, etc.” to “show me the data” </li></ul><ul><li>Care t...
ABP and AAP related efforts <ul><li>Primary Care:  </li></ul><ul><li>Asthma, ADHD, preventive services, Medical Home </li>...
<ul><li>1.  Patient Safety </li></ul><ul><li>NACHRI Blood Stream Infection Collaborative (IP) </li></ul><ul><li>2.  Neonat...
Improving Care for Children <ul><li>Interdisciplinary teams </li></ul><ul><li>Measure performance and share data transpare...
Upcoming SlideShare
Loading in...5
×

Providing the Best Quality Care for Children

330

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
330
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Notes: 1) Prior to October 2006, the aggregate monthly collaborative rate is the average of the rates from all PICUs due to unavailability of line days data. Beginning in October 2006 the aggregate rate is calculated by dividing the total number of infections for the entire collaborative by the total number of line days. 2) Beginning November 2006 control limits have been recalculated to illustrate the apparent change in the process of care. The new control limits are variable, taking into account the number of line days for each month (u-chart) while the previous control limits were constant, only taking into account the change in average BSI rate from month to month (XmR chart)
  • Transcript of "Providing the Best Quality Care for Children"

    1. 1. Providing the Best Quality Care for Children   Medical/Dental Homes and Networks of Care Texas Medicaid Meeting Austin, TX November 26, 2007 Paul V. Miles, MD, FAAP Vice President, Director of Quality and Practice Assessment American Board of Pediatrics
    2. 2. What do we mean by : “Best Quality?” <ul><li>Quality = Best science + Context (what the patient wants and needs) </li></ul><ul><li>Quality = the gap between what we deliver and what we could deliver </li></ul><ul><li>IOM six dimensions of quality: safe, timely, effective, efficient, equitable, patient centered </li></ul>
    3. 4. Quality: What our patients see <ul><li>54% of the time adults receive recommended appropriate care (McGlynn) </li></ul><ul><li>46% of the time children receive recommended appropriate care (Mangione-Smith) </li></ul><ul><li>There is a gap between knowing and doing (“every system is perfectly designed to give the results it gets”) </li></ul>
    4. 5. Pediatric Quality - Underuse <ul><li>Immunization rate 75% </li></ul><ul><li>Speech and language evaluation 66% </li></ul><ul><li>Adolescent health behavior <50% </li></ul><ul><li>Chlamydia screening 25% </li></ul><ul><li>Long acting asthma meds 75% </li></ul><ul><li>Similar problems with overuse and misuse including patient safety </li></ul>The Commonwealth Fund: Chart book 2004
    5. 6. Partnering with Pediatric Practices to Improve Asthma Care Keith Mandel, MD Vice President of Medical Affairs, Physician-Hospital Organization Cincinnati Children’s Hospital Medical Center Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved
    6. 7. “ Perfect Care”: composite measure of severity classified, identified management plan, and controller medications for patients with persistent asthma Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved Cumulative % of Asthma Population with &quot;Perfect Care&quot;: Network and Select Practices 13,000 children, 160 pediatricians in 44 practices
    7. 8. Cumulative % of Asthma Population with &quot;Perfect Care&quot;: Commercial vs. Medicaid/Uninsured Copyright © 2005 Cincinnati Children’s Hospital Medical Center; all rights reserved 44% decrease in hospital admissions for asthma 22% decrease in urgent care/ED visits 30% decrease in missed school days
    8. 9. Models for Quality <ul><li>Successful sustained models of improving care have had common features: </li></ul><ul><ul><li>Multicenter shared data collection </li></ul></ul><ul><ul><li>Standardization of care </li></ul></ul><ul><ul><li>Systems to support sharing evidence/knowledge </li></ul></ul><ul><ul><li>Collaborative learning across practice sites </li></ul></ul><ul><li>Complex pediatric problems occur relatively infrequently making it difficult for any one center to see enough cases to adequately study and determine best care </li></ul>
    9. 10. Improving Care for Children <ul><li>Interdisciplinary teams </li></ul><ul><li>Measure performance and share data transparently </li></ul><ul><li>Work together across practice sites to improve processes of care (participate in collaboratives such as VON, NACHRI BSI, CF, CPQCC </li></ul><ul><li>Involve parents/patients </li></ul><ul><li>Use improvement science </li></ul><ul><li>Population based networks of Medical Homes </li></ul><ul><li>Commit to ongoing professional development </li></ul><ul><li>“ every child treated is a child studied” </li></ul>
    10. 11. Shared Data and Collaborative Practice (institutional autonomy is a barrier) <ul><li>Identified organized systems of care that have resulted in profound improvements </li></ul><ul><ul><li>Children’s Oncology Group </li></ul></ul><ul><ul><li>Northern New England Cardiovascular Group </li></ul></ul><ul><ul><li>End Stage Renal Disease Network </li></ul></ul><ul><ul><li>Neonatal efforts, (VON, CPQCC, others) </li></ul></ul><ul><ul><li>NHS primary care collaborative </li></ul></ul><ul><ul><li>Cystic Fibrosis Collaborative </li></ul></ul><ul><ul><li>NACHRI Catheter Related Blood Stream Infections </li></ul></ul><ul><ul><li>PIBDnet, Cardiology effort, IPIP </li></ul></ul>
    11. 12. Why Prospective Multicenter Improvement Studies are Essential <ul><li>Small sample size </li></ul><ul><li>Problems with attribution </li></ul><ul><li>Difficulty adjusting for confounding factors </li></ul><ul><li>Trust and buy in from clinicians </li></ul><ul><li>Opportunity to learn from “best” practices </li></ul>
    12. 13. Acute Lymphoid Leukemia Simone J., Lyons, J: J Clin Oncology 1998 Sep;16(9):2904-5 5 year survival rate
    13. 14. Eliminating Bloodstream Infections In the first 6 months, 29 children’s hospitals reduced infection rates in the PICU by nearly 70 percent by adhering to a rigid set of evidence- based practices shown to prevent infections in children. 70% improvement: estimated 20 lives saved, 160 infections prevented, $6.4 million not spent in the first 6 months
    14. 15. Univ. Minnesota Survival Data For comparison, the US cystic fibrosis Foundation Registry survival curve for 1998 shows median survival of 32 years of age and our median survival is 46 years of age. CF Foundation/NCHQ Collaborative CYSTIC FIBROSIS
    15. 16. Pediatric Pulmonology (Cystic Fibrosis) Median FEV1 CF Patients 6-12 yrs CFF National Patient Registry, 2004 *Wang & Hankinson equations CCHMC
    16. 17. Vermont Oxford Neonatal Network Jeff Horbar Standard for Part 4 Infections Lung function Medical errors Nutrition Jaundice HIV prevention Resuscitation Retinopathy NICU Quality Improvement
    17. 18. Neonatal Improvement
    18. 19. Percent of Patients Meeting the NKF-DOQI Target Urea Reduction Ratio of 65% figure 4.25, prevalent hemodialysis patients, 1999, by HSA Percent of patients USRDS Atlas
    19. 20. Quality of Care (ESRD)
    20. 21. Adequacy of Hemodialysis Sehgal A, JAMA 2003;289:1996-1000
    21. 22. <ul><li>“ the plural of anecdote is not data” </li></ul><ul><li>“ the plural of data is not knowledge” </li></ul><ul><li>“ measurement is not action” </li></ul>Improving Care
    22. 23. Brent James Patient Safety Reporting Systems and Applications IOM Looking for Bad Apples
    23. 24. Brent James Patient Safety Reporting Systems and Applications IOM Improving Good Apples
    24. 25. “ We take the data very seriously and I don’t know why we’re outside the normal range” Dr. Robert Schott, a cardiologist who is director of medical affairs for the Sutter Medical Center in Sacramento “ Isn't it amazing — 4,477 hospitals that treat heart attacks are all the same?&quot; asks Richard Lange, chief of clinical cardiology at Johns Hopkins University. “ I think we just try very hard” said Dr. Herbert Pardes, NewYork-Presbyterian’s president and chief executive. Report Rates Hospitals on Their Heart Treatment By GARDINER HARRIS Published: June 22, 2007 WASHINGTON, June 21 — The federal government has gingerly stepped back into rating the care delivered by the nation’s hospitals, releasing for the first time in nearly two decades a list of hospitals where heart patients are most likely to die. Medicare and Hospital P4P
    25. 26. Maintenance of Certification (MOC) A New Approach to Standard Setting <ul><li>Looking for Bad Apples (historic approach to physician quality) </li></ul><ul><li>Helping Good Apples Improve (new ABP focus) </li></ul><ul><ul><li>1. Valid License </li></ul></ul><ul><ul><li>2. Lifelong commitment to learning </li></ul></ul><ul><ul><li>3. Demonstration of knowledge </li></ul></ul><ul><ul><li>4. Measure and improve quality of care </li></ul></ul>
    26. 27. Health Care Quality <ul><li>From “trust me, I am a physician, nurse, etc.” to “show me the data” </li></ul><ul><li>Care teams, (physicians included) have a professional obligation to measure and continually improve the quality of the care they deliver </li></ul><ul><li>And, they have a professional obligation to assess and continually improve their professional development </li></ul>
    27. 28. ABP and AAP related efforts <ul><li>Primary Care: </li></ul><ul><li>Asthma, ADHD, preventive services, Medical Home </li></ul><ul><li>Subspecialty Care </li></ul><ul><li>Pediatric Inflammatory Bowel Disease – PIBDnet with NASPGHAN – research network then collaborative </li></ul><ul><li>Pediatric Cardiology </li></ul><ul><li>Efforts beginning in rheumatology, nephrology, hematology/oncology, infectious disease </li></ul><ul><li>Participation in approved VON and CPQCC projects qualifies for credit for Part 4 of MOC </li></ul><ul><li>CF, regional or local efforts </li></ul><ul><li>Blood stream infections </li></ul>
    28. 29. <ul><li>1. Patient Safety </li></ul><ul><li>NACHRI Blood Stream Infection Collaborative (IP) </li></ul><ul><li>2. Neonatology </li></ul><ul><li>National Collaborative (Vermont Oxford Network, California Perinatal Quality Care Collaborative, Pediatrix, State Coalitions) </li></ul><ul><li>3. Children with Special Needs (chronic care) </li></ul><ul><li>Tri-State Asthma Collaborative </li></ul><ul><li>Improving Performance in Practice (IPIP) (OP) </li></ul><ul><li>Other Asthma Improvement efforts </li></ul><ul><li>Cystic Fibrosis Foundation Collaborative (cross setting) </li></ul>Improve First The Action Plan for Pediatric Quality The Alliance for Pediatric Quality (AAP, ABP, NACHRI, CHCA)
    29. 30. Improving Care for Children <ul><li>Interdisciplinary teams </li></ul><ul><li>Measure performance and share data transparently </li></ul><ul><li>Work together across practice sites to improve processes of care (participate in collaboratives such as VON, NACHRI BSI, CF, CPQCC </li></ul><ul><li>Involve parents/patients </li></ul><ul><li>Use improvement science </li></ul><ul><li>Population based networks of Medical Homes </li></ul><ul><li>Commit to ongoing professional development </li></ul><ul><li>“ every child treated is a child studied” </li></ul>
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×