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

The Medical Home1967 – AAP was the first to introduce the concept;

initially referred to a central location for archiving a child’s medical record

Medical care 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 and

family, and is able to develop a partnership of mutual responsibility and trust

AAP POLICY STATEMENT (initially published: PEDIATRICS Vol. 110 No. 1 July 2002, pp. 184-186; reaffirmed August 1, 2008)

Theoretical basisCSHCN 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

Paired Correctly

NOT paired correctly

Total Visits Percent Paired Correctly

Resident 40 36 76 53%Attending 62 32 94 66%Total 102 68 170 60%

Background Data

Background SurveyLow 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

How a Clinic Appointment is Made?

PFA

Call Center

ER

PDSA

P: Increase correct PMD-Patient visits by identifying PMD in Eclypsis

D: Designate PMD in Eclypsis

Study

Total Patients Seen

PMD Designated

Mid-Block 26 3 (12%)

End-Block 56 10 (18%)

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

Act Abort Eclypsis PMD designation

PMDs only sporadically self-identifying in EclypsisNeither PFA nor call center utilized this

information when making appointment

 Future Plans:Devise other methods of identifying PMD

How to Identify PMD?Business Card?

The Face sheet?

The Welcome sheet!

PDSA P: Increase PMD awareness by distributing Welcome

Sheet at each visitD: Survey residents as to how often Welcome Sheets

are provided by PFAS: 1 handout in 24 patient encountersA: How to improve Welcome Sheet Distribution?

Welcome Sheets placed in clinic rooms Increase family awareness of providers in other

ways Survey Families

PMD Photos

Family Survey10 families questioned in waiting room after visit0 received Welcome sheets 5 could name PMD immediately after visitAll relied on call center to identify PMD when making an appointment. 7 said they would take appointment with first available provider if more convenient

 

• 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

Final Results

Final Results

Paired Correctly

Not paired correctly

Total Visits Percent Paired Correctly

Resident 41 23 64 64%Attending 65 18 83 78%Total 105 43 147 71%

Future DirectionsContinue to distribute Welcome SheetsCall center?

Challenges• Multiple systems that do not communicate Patient literacyFurther limitations on resident availability

UpdatePost partum depressionAIM 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 to Audubon PFAs, MAs, RNs, Residents, Fellows and Attendings

Special Thanks to Connie Kostacos, Mariellen Lane and all the other ACN Clinics

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.