Many health care institutions, health centers, and individual practitioners are familiar with the Patient-Centered Medical Home Model. Many of them know first-hand the importance of taking the best practices of successful PCMH implementations, it increases patient satisfaction, lower cost, improves staff moral, and increases patient quality of care. However, there are many challenges involved in implementing the PCMH model, from financial, workforce demands, time, and others. It is important to focus on the bigger picture, which is to improve quality of care and reduce cost. For that, practices desiring or in the beginning process of PCMH implementation should see certain "challenges" as investments. For example, staff/or physicians time to discuss the desire and need to get stared with the PCMH implementation. This is a required investment from the physician and practice part as it is an investment when coordinating PCMH implementation teams. In many situations there are practices that see the PCMH model as a burden, instead of an opportunity to be humble and take the responsibility of investing in the quality of care for their patients. It is always better to breakdown big projects into manageable and doable tasks to focus on specific areas to reach success in making changes.
The following link is an evaluation study released by the Robert Wood Johnson Foundation "A new research summary based on work from the University of Michigan, in collaboration with the Aligning Forces for Quality (AF4Q) evaluation team, explores the readiness of primary care practices for implementing the Patient-Centered Medical Home (PCMH) model, and provides guidelines for assessing, and increasing readiness."
The study reinforces the challenges in the divided arena on the Patient-Centered Medical Home Model implementation to reach optimum quality of care for patients. The study was conducted using two groups of practices 1) practices with a high score of implementation and 2) practices with the lower scores of implementation. The attitude and behavior of each group were defined by the level of engagement, motivation, and capability in the PCMH Model implementation.
One thing that I want to mention is that the study should have looked at the lack of interest and collaboration between primary care practices and other agencies that can provide support toward the PCMH implementation. For instance, there are community-based organizations looking for primary care practices to collaborate in demonstration/pilot projects on quality Improvement (QI). These demonstration projects lead to the exploration of gaps in the primary practice's system of care, such as care coordination, co-management, Electronic Medical Records, and others. This can be a great leverage for practices to take advantage.
Evaluation: Assessing and Increasing Readiness for Patient-Centered Medical Home Implementation
By: Wise CG, Alexander J, Green LA, Cohen GR and Koster C
In: Research Summary No. 9
Published: March 2012
Copy and paste link to browser:
http://www.rwjf.org/qualityequality/product.jsp?id=74126&cid=XEM_A5817
Author:
Helen E. Dao is the President and CEO at her company Dao Management Consulting Services, Inc. (www.daoconsultingservices.com) Helen has been working on Quality Improvement projects, intercultural competence, and public health strategies development for 11 years. You can follow her on Twitter @ http://twitter.com/#!/daoconsulting and @ her blog http://daoconsultingservices.blogspot.com/
Dao Management Consulting Services, Inc.
Wednesday, March 28, 2012
Thursday, March 15, 2012
Dao Management Consulting Services, Inc.: Care Coordination for Patients with Chronic Condit...
Dao Management Consulting Services, Inc.: Care Coordination for Patients with Chronic Condit...: Care Coordination for Patients with Chronic Conditions White Paper Author: Helen Dao, MHA Public Health Consultant March 2012 Historic...
Care Coordination for Patients with Chronic Conditions
Care Coordination for Patients with Chronic Conditions
White Paper
Author: Helen Dao, MHA
Public Health Consultant
March 2012
Historically, public and private health organizations have tried and continue trying to improve the quality of care for patients with chronic conditions. The following statistics were published by the Center for Disease Control and Prevention:
•7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.
•In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least one chronic illness.
•Obesity has become a major health concern. 1 in every 3 adults is obese and almost 1 in 5 youth between the ages of 6 and 19 is obese (BMI ≥ 95th percentile of the CDC growth chart).
•About one-fourth of people with chronic conditions have one or more daily activity limitations.
•Arthritis is the most common cause of disability, with nearly 19 million Americans reporting activity limitations.
•Diabetes continues to be the leading cause of kidney failure, non-traumatic lower-extremity amputations, and blindness among adults, aged 20-74.
Unfortunately this statistics may not change for the better, if not, increase affecting million more Americans. A chronic condition is the state of the disease that usually will last for more than one-year without significant improvement and debilitating the individual in many different functions of his life, physically and mentally. To care for an individual with a chronic condition, it requires extensive care coordination and follow-up.
In another statics release by the Improving Chronic Illness Care, a national organization, show that more than 145 million people, or almost half of all Americans, live with a chronic condition. That number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million.
Almost half of all people with chronic illness have multiple conditions. As a result, many managed care and integrated delivery systems have taken a great interest in correcting the many deficiencies in current management of diseases such as diabetes, heart disease, depression, asthma and others.
Those deficiencies include:
•Rushed practitioners not following established practice guidelines
•Lack of care coordination
•Lack of active follow-up to ensure the best outcomes
•Patients inadequately trained to manage their illnesses
In order to address the mentioned “deficiencies” in the management of disease, care coordination takes the center as a promising evidence-based best practice in order to help address deficiencies.
Care coordination has many different definitions and functions, it depends on patients’ demographics and specific health care needs. It is also known that care coordination is not a single approach such as the primary care provider coordinating all the care and services for his/her patients, but also takes an integrated team approach.
The following is a care coordination definition that captures the meaning and functions of care coordination “the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services.” In other words, care coordination facilitates the exchange of information between providers such as primary care provider and specialist, it involves the patients and family in the process of care treatment, and decision-making, coordinates and follow-up on referrals, and facilitates the learning of disease management and independence.
In reviewing the literature in Care Coordination, we encountered this Care Coordination Model that integrates four key areas in order to achieve effective care coordination. It is important to note that all four steps should be linked to each other in order to achieve “high-level” change in the practice.
Change Package
Practices wanting to improve the coordination of their care should consider making changes to practice systems and processes consistent with four elements—accountability, relationships and agreements, patient support, and connectivity.
These four areas represent high-level “change concepts,” which the Institute for Healthcare Improvement defines as “general ideas…that can be adapted to make specific changes that lead to improvement in many processes and clinical areas”. In aggregate they describe the “change package” for better care coordination. But, to be useful, suggested changes to a practice must be more specific. The following is a breakdown of what each area in the Care Coordination Model, as they apply to each change concept, and the specific activities involved in making the key change. For more information on this model, visit ICIC at http://www.improvingchroniccare.org.
Accountability Key Changes
1. Decide as a primary care clinic to improve care coordination.
2. Develop a tracking system.
Patient Support Key Changes
3. Organize a practice team to support patients and families.
Relationships & Agreements Key Changes
4. Identify, develop, and maintain relationships with key specialist groups, hospital, and community agencies.
5. Develop agreements with these key groups, hospital, and agencies.
Connectivity Key Changes
6. Develop and implement an information transfer system.
It is important to keep all four key areas in mind when planning for improving care coordination at your practice. Each step should be planned, analyzed, strategized, and implemented with realistic obtainable goals. It is highly suggested that if it is your first time improving care coordination at your practice that you set short term goals and long term goals for measurement. You can also use another tool to track your progress in the care coordination improvement “initiative” such as Plan, Do, Study, and Act breakthrough series pioneered by the Institute for Healthcare Improvement (IHI). This tool can help out the team to document test changes, track team progress, and observe changes. It is important to set simple and short terms objectives when using the PDSA.
Once the practice has decided to improve care coordination (Accountability area), the PDSA should be used, but first an aim statement should be drafted to provide specific focus to the team.
Set short-term goals, set measureable outcomes, assign team member’s role, and identify who will keep track and document changes.
The following is a test change sample:
MODEL FOR IMPROVEMENT Cycle # 1a
PLAN DO STUDY ACT (PDSA)
Change or Idea evaluated:
Submit letter of request to Director of Health Information Management for approval.
Objective for this PDSA Cycle: To obtain an approval from the director of health information management in order to integrate care notebook tools.
What question(s) do we want to answer with this PDSA cycle? Are there any protocols processes that need to be approved before the director of health information management makes a final decision?
Plan: Plan to answer questions
Primary Investigator (PI) sent a memo to the director of health information management, requesting approval of the care book integration into the practice system of care.
Tracking (data collection)
Collect and track the number of disseminated care books to current and new patients during visits with specialist. A receipt will be enclosed the care book for the specialist and the medical home provider to sign as proof of receiving and reviewing the care book.
The second part of the test is to track the number of care books scanned into the patient’s electronic medical records.
Predictions
We predict that the approval process by the director of health information management may take up to 3 months. We also predict that clinic staff will need our guidance in implementing the tools with new patients.
Do: We predict extensive staff training in utilizing the tools with patients. We are targeting to begin transition process by the end of August.
Study: The director of health information management approve PI request within 45 days of submitting memo.
The care book was distributed the first 10 families within two months. The receipt was tracked and only 6 specialist and 4 medical home providers signed it.
Act: The receipt was removed from the care book. Practice staff will continue distributing the care book to new patients. Staff need more training in how to work with families around the care book.
In conclusion, improving care coordination at your practice is a process that should have well defined steps, staff roles, resources, goals, and a timeframe. People with chronic conditions need the quality of care, but at the same time need to gain control and manage within the best of their ability the disease. The practice team should decide which tools is the best for them to use, keeping in mind that taking small steps and testing short term changes can be efficient and simple to manage. Applying quality improvement models can help close the gap in the care of people with chronic conditions as well lower the cost of health care, minimizing the number of visits to the ER, and obtain optimum quality of care.
_________________________________________________________
References
1.Improving Chronic Illness Care (ICIC)
http://www.improvingchroniccare.org/index.php?p=Care_Coordination_Model&s=353
2.Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20:64-78.
3.Improving Chronic Illness Care (ICIC)
http://www.improvingchroniccare.org/index.php?p=Change_Package&s=354
4.Institute for Healthcare Improvement (IHI)
http://www.ihi.org/knowledge/pages/tools/plandostudyactworksheet.aspx
5.The Epilepsy Foundation of Metropolitan New York. Project Access, 2010.
White Paper
Author: Helen Dao, MHA
Public Health Consultant
March 2012
Historically, public and private health organizations have tried and continue trying to improve the quality of care for patients with chronic conditions. The following statistics were published by the Center for Disease Control and Prevention:
•7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.
•In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least one chronic illness.
•Obesity has become a major health concern. 1 in every 3 adults is obese and almost 1 in 5 youth between the ages of 6 and 19 is obese (BMI ≥ 95th percentile of the CDC growth chart).
•About one-fourth of people with chronic conditions have one or more daily activity limitations.
•Arthritis is the most common cause of disability, with nearly 19 million Americans reporting activity limitations.
•Diabetes continues to be the leading cause of kidney failure, non-traumatic lower-extremity amputations, and blindness among adults, aged 20-74.
Unfortunately this statistics may not change for the better, if not, increase affecting million more Americans. A chronic condition is the state of the disease that usually will last for more than one-year without significant improvement and debilitating the individual in many different functions of his life, physically and mentally. To care for an individual with a chronic condition, it requires extensive care coordination and follow-up.
In another statics release by the Improving Chronic Illness Care, a national organization, show that more than 145 million people, or almost half of all Americans, live with a chronic condition. That number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million.
Almost half of all people with chronic illness have multiple conditions. As a result, many managed care and integrated delivery systems have taken a great interest in correcting the many deficiencies in current management of diseases such as diabetes, heart disease, depression, asthma and others.
Those deficiencies include:
•Rushed practitioners not following established practice guidelines
•Lack of care coordination
•Lack of active follow-up to ensure the best outcomes
•Patients inadequately trained to manage their illnesses
In order to address the mentioned “deficiencies” in the management of disease, care coordination takes the center as a promising evidence-based best practice in order to help address deficiencies.
Care coordination has many different definitions and functions, it depends on patients’ demographics and specific health care needs. It is also known that care coordination is not a single approach such as the primary care provider coordinating all the care and services for his/her patients, but also takes an integrated team approach.
The following is a care coordination definition that captures the meaning and functions of care coordination “the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services.” In other words, care coordination facilitates the exchange of information between providers such as primary care provider and specialist, it involves the patients and family in the process of care treatment, and decision-making, coordinates and follow-up on referrals, and facilitates the learning of disease management and independence.
In reviewing the literature in Care Coordination, we encountered this Care Coordination Model that integrates four key areas in order to achieve effective care coordination. It is important to note that all four steps should be linked to each other in order to achieve “high-level” change in the practice.
Change Package
Practices wanting to improve the coordination of their care should consider making changes to practice systems and processes consistent with four elements—accountability, relationships and agreements, patient support, and connectivity.
These four areas represent high-level “change concepts,” which the Institute for Healthcare Improvement defines as “general ideas…that can be adapted to make specific changes that lead to improvement in many processes and clinical areas”. In aggregate they describe the “change package” for better care coordination. But, to be useful, suggested changes to a practice must be more specific. The following is a breakdown of what each area in the Care Coordination Model, as they apply to each change concept, and the specific activities involved in making the key change. For more information on this model, visit ICIC at http://www.improvingchroniccare.org.
Accountability Key Changes
1. Decide as a primary care clinic to improve care coordination.
2. Develop a tracking system.
Patient Support Key Changes
3. Organize a practice team to support patients and families.
Relationships & Agreements Key Changes
4. Identify, develop, and maintain relationships with key specialist groups, hospital, and community agencies.
5. Develop agreements with these key groups, hospital, and agencies.
Connectivity Key Changes
6. Develop and implement an information transfer system.
It is important to keep all four key areas in mind when planning for improving care coordination at your practice. Each step should be planned, analyzed, strategized, and implemented with realistic obtainable goals. It is highly suggested that if it is your first time improving care coordination at your practice that you set short term goals and long term goals for measurement. You can also use another tool to track your progress in the care coordination improvement “initiative” such as Plan, Do, Study, and Act breakthrough series pioneered by the Institute for Healthcare Improvement (IHI). This tool can help out the team to document test changes, track team progress, and observe changes. It is important to set simple and short terms objectives when using the PDSA.
Once the practice has decided to improve care coordination (Accountability area), the PDSA should be used, but first an aim statement should be drafted to provide specific focus to the team.
Set short-term goals, set measureable outcomes, assign team member’s role, and identify who will keep track and document changes.
The following is a test change sample:
MODEL FOR IMPROVEMENT Cycle # 1a
PLAN DO STUDY ACT (PDSA)
Change or Idea evaluated:
Submit letter of request to Director of Health Information Management for approval.
Objective for this PDSA Cycle: To obtain an approval from the director of health information management in order to integrate care notebook tools.
What question(s) do we want to answer with this PDSA cycle? Are there any protocols processes that need to be approved before the director of health information management makes a final decision?
Plan: Plan to answer questions
Primary Investigator (PI) sent a memo to the director of health information management, requesting approval of the care book integration into the practice system of care.
Tracking (data collection)
Collect and track the number of disseminated care books to current and new patients during visits with specialist. A receipt will be enclosed the care book for the specialist and the medical home provider to sign as proof of receiving and reviewing the care book.
The second part of the test is to track the number of care books scanned into the patient’s electronic medical records.
Predictions
We predict that the approval process by the director of health information management may take up to 3 months. We also predict that clinic staff will need our guidance in implementing the tools with new patients.
Do: We predict extensive staff training in utilizing the tools with patients. We are targeting to begin transition process by the end of August.
Study: The director of health information management approve PI request within 45 days of submitting memo.
The care book was distributed the first 10 families within two months. The receipt was tracked and only 6 specialist and 4 medical home providers signed it.
Act: The receipt was removed from the care book. Practice staff will continue distributing the care book to new patients. Staff need more training in how to work with families around the care book.
In conclusion, improving care coordination at your practice is a process that should have well defined steps, staff roles, resources, goals, and a timeframe. People with chronic conditions need the quality of care, but at the same time need to gain control and manage within the best of their ability the disease. The practice team should decide which tools is the best for them to use, keeping in mind that taking small steps and testing short term changes can be efficient and simple to manage. Applying quality improvement models can help close the gap in the care of people with chronic conditions as well lower the cost of health care, minimizing the number of visits to the ER, and obtain optimum quality of care.
_________________________________________________________
References
1.Improving Chronic Illness Care (ICIC)
http://www.improvingchroniccare.org/index.php?p=Care_Coordination_Model&s=353
2.Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20:64-78.
3.Improving Chronic Illness Care (ICIC)
http://www.improvingchroniccare.org/index.php?p=Change_Package&s=354
4.Institute for Healthcare Improvement (IHI)
http://www.ihi.org/knowledge/pages/tools/plandostudyactworksheet.aspx
5.The Epilepsy Foundation of Metropolitan New York. Project Access, 2010.
Tuesday, March 13, 2012
Dao Management Consulting Services, Inc.: A Case of Improving Quality of Care for Children w...
Dao Management Consulting Services, Inc.: A Case of Improving Quality of Care for Children w...: One of the most vulnerable populations in the US, are Children with Special Health Care Needs (CSHCN). They suffer for chronic health condi...
A Case of Improving Quality of Care for Children with Special Health Care Needs
One of the most vulnerable populations in the US, are Children with Special Health Care Needs (CSHCN). They suffer for chronic health conditions, and in many cases will deal with multiple chronic conditions effecting profoundly their quality of life.
Disparities in Care
Nearly 1 in 5 U.S. children now have a chronic condition requiring above-mentioned routine services or special health care services. These children with special health care needs are especially vulnerable to weaknesses in the health care system. Data from the most recent Maternal and Child Health Bureau National Survey of Children's Health show reveals that such children experience a wide range of disparities in health status, in accessing health care and quality of care, and in school related outcomes compared to other children.
National Statistics Including National Costs
Children with Special Health Care Needs (Data from the National Survey of Children with Special Health Care Needs) :
•10.2 million children in the United States have special health care needs; that number represents 14 % of all U.S children.
•More than a fifth of U.S households with children have at least one child with special needs.
•16 % of these children are reported to not receive all the services they need;
•More than 94 % of these children have a regular source of care when they are sick. For 78 % this is a private doctor's office; for 13 % it is a clinic or health center; and for almost 4 % it is another setting.
•12 % of families required mental health care or counseling related to the child's medical, behavioral or other health conditions; and
•24 % of families reported that a parent had to stop working or cut work hours to care for their children.
The following is a short version of a case study conducted by a Metropolitan organization serving children with epilepsy. The following abstract represents a model that now is being applied by some health centers and clinics to help children with other chronic health condition such as autism.
Building a system of care that is sustainable and replicable for children with special health care needs (CSHCN) is a multi-faceted process that requires consideration of existing health care systems, accessibility to care, provider’s availability, family’s cultural background and linguistic barriers, and community-based resources. Children with special health care needs faced many different barriers when accessing comprehensive health care services. One of the most common obstacles identified is the lack of a sustainable system of communication between their pediatrician and specialist.
The implementation of a community needs assessment and parents’ focus groups were conducted in order to identify specific gaps in the delivery and access of care for CSHCN. The project targeted four different medical institutions in a metropolitan area serving different ethnic groups. The project was divided into three years; first year focused on the Caribbean – Hispanic, the second year on the Asian-Chinese, and the third year on the Caribbean-non-Hispanic, all communities received the needs assessments the first year of the project. Four major approaches were used to address identified needs; Model of Quality Improvement and Breakthrough Series Approach, Medical Home Model Approach, Cultural and Linguistic Competence Approach, and Community Needs Assessment. We selected a random sample of 166 CSHCN, 70% of children were assigned to a medical home provider. There were significant improvements in the quality of care that children with special health care needs received from their medical home provider. It increased ongoing communication in a three-way system, family-medical provider, medical home provider-specialist, and specialist-medical home provider. It also increased family’s’ knowledge about their child’s chronic health condition and trust with their health care providers.
Some Strategies for Sustainability:
•Implemented Memorandum Of Understanding (MOU) practice between medical home providers and specialists
•Used train the trainer model
•Identify a champion
•Engaging administrators and decision makers
•Set up utilization of social media such as Twitter and Facebook
•Utilized Table Topic Model with a community partner to identify progress and continue areas of improvement
•Created a learning collaborative
•Set up monthly conference calls and in person meetings with collaborative members
•Capitalize on current financial resources
•Created a community-based services directory in Chinese and for Hispanic families.
•Used the cultural broker model
•Create and implement an organizational structure model
•Trained medical staff an service coordinators on cultural competence
•Provided technical support to community partners to start and sustain parent support groups
•Established a collaborating partnership between community partners/providers
Some Strategies for Expansion:
•Create a model that can be replicated for different or similar projects
•Create a system that will allow access to previous resources and information
•Identify specific geographical areas where the project can be implemented
•Identify organizational structure that will support the expansion
•Identify other populations that will benefit from project outcomes
•Once capability and sustainability are built within the organizational structure, prepare for expansion
•Seek for additional or new funding
•Keep a log of project activities for practical replication
The success of the project was due to the collaboration by many providers and parents that were part of the collaborative. Any quality improvement project cannot be done in a vacuum, people need to get involve and make changes. One of the well knows methods that was used to monitor and measure the different objectives of the project was the PDSA Model helping the collaborative team keep track of the progress and at times set back.
In Summary, some of the lessons learned during the project relate to, engaging providers and parents at the very early stages of the project. Explain collaborative members their roles and expectations. Reach out to existing partners to be part of the project and show them the benefit of their involvement. Predict on loosing staff along the way and plan for it. Tap into agency's internal resources such as collaborating with other departments, leverage on other similar project to help you promoting and enhancing your project. Reach out to external organization that are working on similar project for collaboration.
Author
Helen E. Dao was the Primary Investigator (PI) for this project. She is also the President and CEO at her company Dao Management Consulting Services, Inc. (www.daoconsultingservices.com) Helen has been working on Quality Improvement projects, cultural diversity, and public health strategies development for 11 years. You can follow her on Twitter @ http://twitter.com/#!/daoconsulting and @ her blog http://daoconsultingservices.blogspot.com/
Email: helen@daoconsultingservices.com
Tel. 201-448-2046/800-905-1208
Grantee, The Epilepsy Foundation of Metropolitan New York, 2010. www.efmny.org
Disparities in Care
Nearly 1 in 5 U.S. children now have a chronic condition requiring above-mentioned routine services or special health care services. These children with special health care needs are especially vulnerable to weaknesses in the health care system. Data from the most recent Maternal and Child Health Bureau National Survey of Children's Health show reveals that such children experience a wide range of disparities in health status, in accessing health care and quality of care, and in school related outcomes compared to other children.
National Statistics Including National Costs
Children with Special Health Care Needs (Data from the National Survey of Children with Special Health Care Needs) :
•10.2 million children in the United States have special health care needs; that number represents 14 % of all U.S children.
•More than a fifth of U.S households with children have at least one child with special needs.
•16 % of these children are reported to not receive all the services they need;
•More than 94 % of these children have a regular source of care when they are sick. For 78 % this is a private doctor's office; for 13 % it is a clinic or health center; and for almost 4 % it is another setting.
•12 % of families required mental health care or counseling related to the child's medical, behavioral or other health conditions; and
•24 % of families reported that a parent had to stop working or cut work hours to care for their children.
The following is a short version of a case study conducted by a Metropolitan organization serving children with epilepsy. The following abstract represents a model that now is being applied by some health centers and clinics to help children with other chronic health condition such as autism.
Building a system of care that is sustainable and replicable for children with special health care needs (CSHCN) is a multi-faceted process that requires consideration of existing health care systems, accessibility to care, provider’s availability, family’s cultural background and linguistic barriers, and community-based resources. Children with special health care needs faced many different barriers when accessing comprehensive health care services. One of the most common obstacles identified is the lack of a sustainable system of communication between their pediatrician and specialist.
The implementation of a community needs assessment and parents’ focus groups were conducted in order to identify specific gaps in the delivery and access of care for CSHCN. The project targeted four different medical institutions in a metropolitan area serving different ethnic groups. The project was divided into three years; first year focused on the Caribbean – Hispanic, the second year on the Asian-Chinese, and the third year on the Caribbean-non-Hispanic, all communities received the needs assessments the first year of the project. Four major approaches were used to address identified needs; Model of Quality Improvement and Breakthrough Series Approach, Medical Home Model Approach, Cultural and Linguistic Competence Approach, and Community Needs Assessment. We selected a random sample of 166 CSHCN, 70% of children were assigned to a medical home provider. There were significant improvements in the quality of care that children with special health care needs received from their medical home provider. It increased ongoing communication in a three-way system, family-medical provider, medical home provider-specialist, and specialist-medical home provider. It also increased family’s’ knowledge about their child’s chronic health condition and trust with their health care providers.
Some Strategies for Sustainability:
•Implemented Memorandum Of Understanding (MOU) practice between medical home providers and specialists
•Used train the trainer model
•Identify a champion
•Engaging administrators and decision makers
•Set up utilization of social media such as Twitter and Facebook
•Utilized Table Topic Model with a community partner to identify progress and continue areas of improvement
•Created a learning collaborative
•Set up monthly conference calls and in person meetings with collaborative members
•Capitalize on current financial resources
•Created a community-based services directory in Chinese and for Hispanic families.
•Used the cultural broker model
•Create and implement an organizational structure model
•Trained medical staff an service coordinators on cultural competence
•Provided technical support to community partners to start and sustain parent support groups
•Established a collaborating partnership between community partners/providers
Some Strategies for Expansion:
•Create a model that can be replicated for different or similar projects
•Create a system that will allow access to previous resources and information
•Identify specific geographical areas where the project can be implemented
•Identify organizational structure that will support the expansion
•Identify other populations that will benefit from project outcomes
•Once capability and sustainability are built within the organizational structure, prepare for expansion
•Seek for additional or new funding
•Keep a log of project activities for practical replication
The success of the project was due to the collaboration by many providers and parents that were part of the collaborative. Any quality improvement project cannot be done in a vacuum, people need to get involve and make changes. One of the well knows methods that was used to monitor and measure the different objectives of the project was the PDSA Model helping the collaborative team keep track of the progress and at times set back.
In Summary, some of the lessons learned during the project relate to, engaging providers and parents at the very early stages of the project. Explain collaborative members their roles and expectations. Reach out to existing partners to be part of the project and show them the benefit of their involvement. Predict on loosing staff along the way and plan for it. Tap into agency's internal resources such as collaborating with other departments, leverage on other similar project to help you promoting and enhancing your project. Reach out to external organization that are working on similar project for collaboration.
Author
Helen E. Dao was the Primary Investigator (PI) for this project. She is also the President and CEO at her company Dao Management Consulting Services, Inc. (www.daoconsultingservices.com) Helen has been working on Quality Improvement projects, cultural diversity, and public health strategies development for 11 years. You can follow her on Twitter @ http://twitter.com/#!/daoconsulting and @ her blog http://daoconsultingservices.blogspot.com/
Email: helen@daoconsultingservices.com
Tel. 201-448-2046/800-905-1208
Grantee, The Epilepsy Foundation of Metropolitan New York, 2010. www.efmny.org
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