Transcript National Center for Medical Home Implementation

Fostering Partnerships and Teamwork
in the Pediatric Medical Home:
A “HOW TO” Webinar Series
brought to you by the National Center for Medical Home Implementation
Enhancing Care Partnership Support
March 27, 2014
1 – 2 pm Central
Fostering Partnerships and Teamwork
in the Pediatric Medical Home:
A “HOW TO” Webinar Series
brought to you by the National Center for Medical Home Implementation
Moderator:
William Schwab, MD
University of Wisconsin
Department of Family Medicine, WI
Fostering Partnerships and Teamwork
in the Pediatric Medical Home:
A “HOW TO” Webinar Series
brought to you by the National Center for Medical Home Implementation
Faculty:
R.J. Gillespie, MD, MHPE
The Children’s Clinic
Portland, OR
Fostering Partnerships and Teamwork
in the Pediatric Medical Home:
A “HOW TO” Webinar Series
brought to you by the National Center for Medical Home Implementation
Faculty:
Cortnee Whitlock
The Children’s Clinic
Portland, OR
Fostering Partnerships and Teamwork
in the Pediatric Medical Home:
A “HOW TO” Webinar Series
brought to you by the National Center for Medical Home Implementation
Faculty:
Jill Rinehart, MD, FAAP
Hagan, Rinehart, & Connolly Pediatrics,
Burlington, VT
Fostering Partnerships and Teamwork
in the Pediatric Medical Home:
A “HOW TO” Webinar Series
brought to you by the National Center for Medical Home Implementation
Faculty:
Kristy Trask, BSN, RN
Hagan, Rinehart, & Connolly Pediatrics,
Burlington, VT
Disclosures
We have no relevant financial relationships with the
manufacturers(s) of any commercial products(s) and/or
provider of commercial services discussed in this
activity.
I do not intend to discuss an unapproved/investigative
use of a commercial product/device in my presentation.
Webinar Objectives
 Define the term “care partnership support” and explain its
effectiveness as part of an approach to providing family- and
patient-centered care.
 Describe strategies for implementing successful care
partnership support within a pediatric practice.
 Provide examples of how care partnership support can be
exemplified in pediatric practices.
Pediatric Medical Home
 Team-based approach
 Families are essential team members
 Care partnership support is a strategy which helps to ensure
families are essential team members within the medical home
Defining Care Partnership Support
 A meaningful collaboration between families and the
pediatric care team to ensure effective and quality care for the
patient.
 Addresses:


Family and patient access to quality care
Effective communication
Benefits of Enhanced Care Partnership Support
 Health care plan is specific to each family’s individual
circumstances
 Empowers families and caregivers
 Increased patient follow through, understanding, and
compliance
Benefits of Enhanced Care Partnership Support
 Increases access to



support services
specialty care
educational resources
 Improved health outcomes
 Meets the challenges faced by vulnerable populations
Implementation of Care Partnership Support
 Create and articulate a policy of care partnership support
 Market/communicate your policy
 Encourage patient and family involvement in the health care
plan
Best Practice
R.J. Gillespie, MD, MHPE
Cortnee Whitlock
The Children’s Clinic
Portland, OR
The Children’s Clinic, OR
Parent Provider Partnership
Partnership is a collaborative relationship
between two or more parties based on
trust, equality, and mutual understanding
for the achievement of a specified goal.
World Health Organization, 2009
The Children’s Clinic, OR
The Value of Partnership
 In the beginning, parents
often feel very lost
 Establishing a trusting
relationship with the medical
specialists and team members
decreases a large percentage
of parental stress regarding
care
 Access to support and
continuing education
 All in it together
The Children’s Clinic, OR
Parent Partner Impact:
 Vital team member
 Coordinated team care that is centralized around the child
 Provider, parent, and child team development
 Role in improving and making a difference in the health care
system
The Children’s Clinic, OR
Maxims of Patient-Centered Care:
“The needs of the patient come first
Nothing about me without me
Every patient is the only patient.”
From: D. Berwick. What ‘Patient-Centered’ Should Mean: Confessions of an Extremist. Health Affairs, 28, no.4 (2009): w555-565.
The Children’s Clinic, OR
Environmental Context
Policy
Macro-system
Health Plan
Delivery System
Micro-system
Clinic
Hospital
Patient-Provider Encounter
Provider
Patient
From: D. Berwick. What ‘Patient-Centered’ Should Mean: Confessions of an Extremist. Health Affairs, 28, no.4 (2009): w555-565.
The Children’s Clinic, OR
Steps for Adding Parents To Your Team:
1.
2.
3.
4.
5.
Embracing the idea of a parent partner
Discussing characteristics, traits, and qualities
Successfully selecting a parent partner
Inviting and compensating a parent partner
Replacing a parent partner (when necessary)
The Children’s Clinic, OR
What We Hoped To Get:
 Genuine interest in improving care for families
 Our state’s medical home standards include patient and
family involvement
 We thought we had a good idea of what parents wanted/
needed, but felt it would be important to ask

Goes beyond “clearing ideas” with a parent partner and involves meaningfully
listening to their perspective and experience
 We have specific questions about access, shared care plans,
and other medical home principles
The Children’s Clinic, OR
Embracing the Idea:
 Discuss the concept in depth



Include all stakeholders on current team
Be sure to include key thought leaders and decision makers at your practice
It is best not to debate the concept AFTER bringing a parent into the mix
 Start this journey committed to the concept

There may be barriers experienced and refinements needed- committing to
work through this experience is key to achieving success and realizing the value
The Children’s Clinic, OR
Discussing Traits and Qualities:
 Determine what collection of characteristics meets your
needs
 Key traits include:




Has the time to commit (access to childcare, etc.)
Confident, able to speak up in group settings
Fits in with group dynamic -- humor!
Experience with local resources and multiple specialists
The Children’s Clinic, OR
Discussing Traits and Qualities (Continued):
 Parents of children and youth with special health care
needs have an extremely valuable perspective when it
comes to medical homes for children
 Multiple parent partners with different experiences
provide for an even richer parent perspective
The Children’s Clinic, OR
What We Got:
 A parent who is dedicated to the improvement of her own
medical home, in the interest of her children
 A perspective that cannot be achieved any other way
 Important insights:


What aspects of the care we provide are going well
Where we needed to improve (some of which we didn’t know)
The Children’s Clinic
What’s Next?
 Having a parent on a quality improvement (QI) team is one of
many ways that parent perspectives can be heard
 We have also conducted parent surveys (CAHPS CG PCMH)
which gave vital information about our practice


Designed QI project based on the findings
Re-fielding the survey in summer/fall 2014
 Now in the planning phases for a parent advisory group


Broader parent perspective
Less time commitment for parents (quarterly instead of 1-2 meetings a month)
Best Practice
Jill Rinehart, MD, FAAP
Kristy Trask, BSN, RN
Hagan, Rinehart, and Connolly Pediatrics, PLLC
Burlington, VT
Hagan, Rinehart, and Connolly Pediatrics, VT
 Effective Care Coordination
 Care Planning
 Care Plans
 Care Conferences
Hagan, Rinehart, and Connolly Pediatrics, VT
5 Key Elements of Highly Effective Care Coordination
The Concept:
1. Needs assessment for care
coordination
2. Care planning and
communication
3. Facilitating care transitions
4. Connecting with community
resources
5. Transitions
The Person:
Antonelli, McAllister, Popp. Making Care Coordination a Critical Component of the Pediatric Health System: A Multidisciplinary Framework.
The Commonwealth Fund, May 2009
Hagan, Rinehart, and Connolly Pediatrics, VT
A Framework for Highly Performing Pediatric Care
Coordination
Care Coordination Competencies
Care Coordination Functions
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
1)
2)
3)
4)
5)
6)
7)
8)
9)
Develops partnerships
Proficient communicator
Uses assessments for intervention
Facile in care planning skills
Integrates all resource knowledge
Possesses goal/outcomes orientation
Approach is adaptable & flexible
Desires continuous learning
Applies solid team building skills
Adept with information technology
Provide separate visits & interactions
Manage continuous communications
Uses assessments for intervention
Develop Care Plans (with families)
Integrate critical care information
Coach patient/family skills learning
Support/facilitate all care transitions
Facilitate care conferences
Use health information technology for
care coordination
Antonelli, McAllister, Popp. Making Care Coordination a Critical Component of the Pediatric Health System: A Multidisciplinary Framework.
The Commonwealth Fund, May 2009.
Hagan, Rinehart, and Connolly Pediatrics, VT
Partnership Care Planning Model
Hagan, Rinehart, and Connolly Pediatrics, VT
ECOMAP
Medical
Specialists
Financial
Supports
Family
School
Medical Home
Primary Care Provider
Care Coordinator
Childcare
Community and
State Services
Informal Supports
Hagan, Rinehart, and Connolly Pediatrics, VT
Community Alliance Church in
Hinesburg
Hagan, Rinehart and
Connolly
Pediatricians
Dr. HastingsPeds-Ophthalmology
Medical Store
Dr. Benjamin- physiatrist
Dr. BauerPeds Neurosurgeon at
Dartmouth
Dr. FilianoNeurologist at Dartmouth
Children's Ministry
Dr. D'AmicoGastroenterologist
CSHN Social Worker
Outings- Sugar House, Echo,
Lowes, town activities,
swimming etc.
Dr. TranmerNeurosurgeon
3 Squares Vermont
Biomedic Appliances
Shelburne Community
School
Champlain CollegeHealthcare Technology
PCA
VG
Section 8 Housing
SSA
4 yo CG
5 yo
Child Only Reach Up Grant
SSI
PSE
Wheels for Johnny-Fundraiser
for handicap accessible vehicle
DebbiePara-professional
Swimming at
YMCA
S.&J., MGM
friends
Petsmart
Therapy Dogs of
Vermont
Medical
Family
State/Education/
Community
Howard
Center
DelanaBRIDGE
CSHN Registered Dietitian
7 yo
(service dogs in training)
Shelburne
Nursery School
Keen Medical
Apria
Deborah Keel- Flexible Family
Funding
School Physical
Therapist
Shelburne
Community
Rue Kendrickclassroom
teacher
Occupational
Therapist
School
Special Educator
Speech Language
Pathologist
Garrison, Victoria . Interview by Marley Donaldson. Personal interview. 26 Mar. 2013.
Hagan, Rinehart, and Connolly Pediatrics, VT
Tools: Care Conferences
 Introductions
 Set Agenda
 Set Roles
 Review Youth & Family Strengths
 Discussion
 Minutes
 Update Care Plan with “Goals”
 Create Next Steps
 Set Next Conference Date
 Share Care Plan
Hagan, Rinehart, and Connolly Pediatrics, VT
Care Study 1: Matt
 13 year old boy with autism, non-verbal, self injury,




polydipsia
Parents struggling with bolting, overall safety
Middle school unable to educate or keep safe
Medical issues of skin infections, enuresis, sleep dysfunction
Family has gone above and beyond capacity of most families
to deal with this at home
Hagan, Rinehart, and Connolly Pediatrics, VT
Care Planning 1:
Patient/Family/Team Goals
CICP Negotiated Actions
Process and Outcome Measures
Less Self Injury
Psychiatry Assessment, comanagement from psychiatry,
medical home and subspecialists
Keeping family together
Less need for police, mental
health crisis support
In-home behaviorists
Improve school attendance
Improve education supports
Repetitive behaviors
Same behavior plan across
settings
Clear communication between
home/school/providers
Explore alternative school
placement
Alternative program found
Improved psych pharm
Improved wrap around services
Improved behavior plans
Innovation: across silos of
mental health, developmental
disabilities, children with special
health care needs, and school
Hagan, Rinehart, and Connolly Pediatrics, VT
Care Study 2: Mary
 4 year old with tuberous sclerosis




self-injurious behaviors
tantrums
sleep dysfunction
heading toward inpatient psychiatry hospitalization
 Despite having a VT developmental services waiver, respite
care and a team of multidisciplinary medical experts at
Massachusetts General Hospital
Hagan, Rinehart, and Connolly Pediatrics, VT
Care Study 2: Mary (Cont)
 Intractable seizures seemed the least of her concerns in
comparison to behaviors
 Strengths:




strong parent involvement and expertise
loving respite family
Mary engaging
verbal with cognitive strength (can anticipate seizures)
Hagan, Rinehart, and Connolly Pediatrics, VT
Care Planning 2:
Patient/Family/Team Goals
CICP Negotiated Actions
Process and Outcome Measures
Less need for “crisis”
intervention
Co-management from psychiatry,
medical home and subspecialists
Less need for police, mental
health crisis support
In-home behaviorists
Improve Sleep
Same behavior plan across
settings
Less communication errors
about medications
Improved work attendance
Increase Home Safety-of Mary
and family
Mary to attend school
Improve social relationships
Improved psych pharm
CSHN SW: Waiver allowed for
enhanced access to in-home
behaviorists
Innovation: region contracted
with vendor outside of network
Communication opened between
school, behavioral plans, family,
medical home
Making academic gains
Attendance improved
Cannot pick her out from peers
Less Crisis Need
Hagan, Rinehart, and Connolly Pediatrics, VT
Principles for Successful Use of Shared Plan of Care
 Active engagement in care
 Clear, frequent, and timely communication
 Patient and family assessment based on full understanding of
needs
 Strong family/professional relationship characterized by
mutual trust and respect.
 Family-centered care teams can access the information they
need to make shared, informed decisions.
McAllister, J., et al., Achieving a Shared Plan of Care for Children and Youth with Special Health Care Needs: 2014 (in press), Lucille Packard Foundation for Children's
Healthcare
Hagan, Rinehart, and Connolly Pediatrics, VT
Principles for Successful Use of Shared Plan of Care (Cont.)
 Shared goals and negotiated actions; mutual understanding




on behalf of all partners
Monitoring, feedback, adjustment
Anticipate, prepare and plan for all transitions
Common, shared document; used consistently by all
providers
Care is well coordinated across all involved
organizations/systems
McAllister, J., et al., Achieving a Shared Plan of Care for Children and Youth with Special Health Care Needs: 2014 (in press), Lucille Packard Foundation for Children's
Healthcare
Hagan, Rinehart, and Connolly Pediatrics, VT
Why is a Family- Centered Medical Home Important to
family?
• Opportunity for the family to build a
trusting and collaborative relationship
with the pediatrician and office staff
• Care coordination provides smooth
facilitation among all members of the
child’s care team including family,
specialists, pharmacy staff, community
and school services
• Comprehensive source of complete
patient medical history
Victoria Garrison, “Innovations in Medical Home,” VFN annual conference, April 2013
Conclusions
 Care partnership support helps to ensure family, caregiver,
and patient involvement within the pediatric medical home.
 Implementation of care partnership support results in
improved health of the child and improves future care goals.
Resources
 National Center for Medical Home Implementation (NCMHI):




Care Partnership Support
NCMHI: Positioning the Family and Patient at the Center,
Resources and Tools
Family Voices: Family Centered Care
National Initiative for Children’s Healthcare Quality: Powerful
Partnerships
Region 4 Genetics Collaborative: Partnering With Your Doctor,
the Medical Home Approach
NCMHI Educational Video Series
 Don’t forget to view the National Center for Medical Home
Implementation (NCMHI) Video Series. Topics Include:
 Team Huddles
 Care Partnership Support
 Family Advisory Groups
Save the Date
Fostering Partnerships and Teamwork in the Pediatric
Medical Home:
A “HOW TO” Webinar Series
Starting and Supporting Family Advisory Groups
April 24, 2014
11 am – Noon (Central)
REGISTER NOW!
We’re Here to Help You!
Have a question about medical home?
Contact us!
[email protected]
800/433-9016 ext 7605
Subscribe to our Listserv!
Questions?
Save the Date
Fostering Partnerships and Teamwork in the Pediatric
Medical Home:
A “HOW TO” Webinar Series
Starting and Supporting Family Advisory Groups
April 24, 2014
11 am – Noon (Central)
REGISTER NOW!