Transformation in Primary Care - Indiana’s Successes with Medical Home
By Mary Jo Paladino
IN CISS Project Facilitator at the Indiana University School of Medicine
As we quickly move past the first decade of the twenty-first century, health care reform and the need to transform primary care practice has never been more urgent. The health care reform bill contains Medical Home as the model of primary care needed to improve patient care and stop spiraling costs. The Institute of Medicine and others have stated that system change is needed to make this transformation. System change within a practice is best done through quality improvement processes. Experiences by members of the American Academy of Pediatrics (AAP) have demonstrated that "learning collaboratives" help start and maintain this process.
Indiana’s Medical Home Learning Collaborative (MHLC) is a three-year joint project between the Indiana University School of Medicine and Indiana State Department of Health through a State Implementation Grant for Integrated Community Systems for CSHCN. The MHLC has been working to improve Medical Home concepts in primary care practices since the fall of 2009. The MHLC includes 18 primary care practices and run by a MHLC Resource Team. Our learning collaborative is unique in that it includes both pediatric and family medicine. The Collaborative meets biweekly on conference calls to share successes, challenges and updates regarding quality improvement projects and issues involving Medical Home. Two conferences are also held to present specific topics relating to Medical Home. The MHLC Resource Team makes site visits to the practices to provide consulting, support and community resources.
Practice QI teams include physicians, nursing staff, practice staff and family leaders, an important part of the practice QI teams. One of the accomplishments is the increase of family involvement in the MHLC. The family/parent partner is invited to these QI meeting to share their input and perspective. Feedback is given in less formal ways through the telephone or e-mail. Another success has been to explore different ways for family partners to engage in QI team activity. In an effort to sustain the child health improvement work of the MHLC our core partners have elected to adopt a child health improvement model. For more information, contact the MHLC Resource Team: firstname.lastname@example.org or email@example.com.
Maryland’s State Implementation Grant
By Josie Thomas
Director of the Parent's Place of Maryland
The Parents' Place of Maryland, in partnership with the Office for Genetics and Children with Special Health Care Needs (OGCSHCN, Maryland’s Title V program for CYSHCN at the Maryland Department of Health and Mental Hygiene) was awarded a State Implementation Grant for Integrated Community Systems for Children and Youth with Special Health Care Needs (CYSHCN) from the federal Maternal and Child Health Bureau in 2008. Other major collaborators included the Maryland AAP and the Johns Hopkins School of Public Health.
The backbone of the project is the development of the Maryland Community of Care Consortium for Children with Special Health Care Needs (COC) — a working group of diverse stakeholders, including families, providers, advocates, consumers, administrators, and professionals from the public and private service systems. The quarterly meetings brings together over 50 stakeholders and offers a forum for information exchange, problem solving, consensus building, and collaborative action to address gaps and barriers in services for CYSHCN and their families. During the past year, the accomplishments of the COC, including the provision of guidance and input on Maryland’s Title V Needs Assessment and the 2010 Maryland Parent Survey, were the driving force behind a restructuring of OGCSHCN, and a thriving mini-grant program. The COC serves as a model for developing respectful and respected family-professional partnerships at every level and as a model for an ongoing successful public, nonprofit, family and private collaborative.
Another key aspect of the project is the planned statewide implementation of a Baltimore City based developmental screening improvement pilot program at the pediatric practice level, conducted by project partners Dr. Tracy King (Johns Hopkins University), Baltimore City Reach Out and Read, and the Maryland AAP. In addition to large-group and on-site trainings, certain practices were offered multi-tiered, ongoing, in-office support. Dr. King published an article discussing her work in Pediatrics. Both the COC and the developmental screening implementation project will be sustained through Maryland’s Title V Block Grant.