Putting Bright Futures into Practice by Engaging Parents

1. Putting Bright Futures into Practice by Engaging Parents Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative, Portland, OR, Kasey McCracken, MPH Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative, Portland, OR, Colleen Reuland, MS, Pediatrics, OHSU, Oregon Pediatric Improvement Partnership, Portland, OR

2. Agenda for Call Brief overview of CAHMI Engaging Patients – Why is it needed? Operationalizing Bright Futures – Harnessing the Power in Patient Engagement Overview of patient engagement tools current in use

3. About the CAHMI Who We Are: The Child and Adolescent Health Measurement Initiative (CAHMI) is a national, not-for-profit initiative based out of Oregon Health and Science University in the Department of Pediatrics in Portland, OR. Originally housed at FACCT - Foundation for Accountability, the CAHMI was established in 1997. Our Evolving Mission: “To ensure that children, youth and families are at the center of quality measurement and improvement efforts in order to advance high quality consumer-centered health care.” “Providing data and inspiring partnerships toimprove health care promote lifelong health for children, youth and families.”

4. Key Topics Addressed by CAHMI Tools Coverage and Access Insurance coverage, gaps in coverage and impact of uninsurance and type of coverage Adequacy of insurance Timely access to covered/needed care Quality & Equity Medical home for all children and children and youth with special health care needs Mental, emotional and behavioral health Health disparities for vulnerable populations (minorities, low income, by health status/CSHCN) Prevention and Healthy Development Childhood obesity (BMI, Activities, TV watching, etc) Early childhood development Transition to adulthood

5. CAHMI Measures Endorsed by the National Quality Forum Application of Measures NQF Ratified/Endorsed: CAHMI Promoting Healthy Development Survey (PHDS) CAHMI Young Adult Health Care Survey (YAHCS) Developmental Screening –CAHMI Steward with NCQA CAHPS-CCC (CAHMI led initial development of prior to NCQA endorsement) 21 Measures from the National Survey of Children’s Health (NSCH) and National Survey of CSHCN, including Medical Home Insurance Adequacy Gaps in Insurance (Duration) Care Coordination Developmental Screening Transition to Adulthood for CSHCN School and Community Measures Health Risks (BMI; Smoking in Home; Dental Carries/Decay) and Behaviors (Physical Activity)

6. Data In Action Focus

7. Patient-Centered • Quality Measurement & Improvement: • Why is it needed? The Good News! • Patient-centered care, engagement and choice are included as strategic pillars of prominent policy and improvement efforts • We have moved beyond the “feel good” interpretation of patient-centered care and “us vs. them” interpretation of engagement and choice. • Growing consensus that good quality care and health outcomes is substantially related to whether consumers and patients are able to play a significant role in selecting, managing and evaluating their own care.

8. Why are Patient-Centered Measurement Tools Needed To Improve in Well-Child Care ? • Efforts are needed to improve well-child care • Assessments of quality for well visits show 9 out of 10 children receiving well visits miss one or more of basic aspects of recommended care. Parents report they wish they had received this care. • Sig. variation in quality of care by : Child and family characteristics; Provider; Office System • Within provider variation is as large as across providers • Well-child care is primarily about educating and empowering the parent/family to promote child’s development Parent-based data needed about whether informational needs are met and status of child and family health • Yet, the parent/patient voice is often missing in efforts to assess and improve quality--despite the fact that • patients are often the most valid source for quality measurement and • are essential partners in improvement

9. Operationalizing Bright Futures The New Challenge of the Revised Guidelines • The revised guidelines call for the provider to “attend to the concerns of the parents” as a first priority for the visit. • How can pre-visit tools support providers to address parents’ priorities?

10. Overview of HRSA/MCHB R40 Funded CAHMI/OHSU Patient-Centered Quality Measurement and Improvement Project (2/08-2/12)

11. “Enhanced Encounter” Well Child Care Model Using the CAHMI Promoting Healthy Development Survey (PHDS) Using the Provider and Clinic Specific “Provider Feedback Reports” from the Promoting Healthy Development Survey (PHDS) Using the CAHMI Parent PlanYourChildsWellVisit (PCW) Online Tool and Parent Information Integrated into the EHR

12. Baseline Quality Measurement Homepage for Online PHDS (www.childrensclinicsurvey.com)

13. Provider Feedback Report on the PHDS

14. Parent-Centered Quality Improvement Tool:Plan My Child’s Well Visit Tool (Paper-based Tool)

15. Bright Futures Recommendation: • Where it is in the Online PCW Tool • Part 1: Open-ended questions • Share with me one thing that your child is able to do that you're excited about: • Are there any specific concerns you would want to discuss at your child’s • upcoming well-visit? • Have there been any MAJOR changes in your family lately? Check all that apply. • Do you have concerns about your child’s learning, development or behavior? • Part of developmental surveillance

16. Shared Encounter Form: Example • Related Bright Futures Recommendation • Anticipatory Guidance & Parental Education

17. Page 1: SHARED ENCOUNTER FORM (SEF) • Related Bright Futures Recommendation • 3.Child & Family Health Screening

18. Page 1: SHARED ENCOUNTER FORM (SEF) • Related Bright Futures Recommendation • 4. Developmental Surveillance

19. SEF FRAMEWORK FOR FORMATTING: • DESIGNED FOR EASY USE/SCORING • Developmental Surveillance • Bold are milestones 90% children do (rec. screening) • Non-bold – give ASQ Learning Activity

20. Page 1: SHARED ENCOUNTER FORM (SEF) • Related Bright Futures Recommendation • 3.Child & Family Health Screening

21. SHARED ENCOUNTER FORM (SEF): • PAGE 2 (Copy Goes to Parent)

22. Parent-Centered Quality Improvement Tool:Plan My Child’s Well Visit Tool: Demonstration http://www.youtube.com/watch?v=KQMtCoFcWlA

23. Online PCW Tool – Content • Part 1: Child & Family Health Screeners • 1A : Open-ended questions about strengths, questions or concerns, changes in • the home • 1B. General Child Health Screening Questions • Included The Children’s Clinic’s Lead and TB Screeners • 1C: Developmental Surveillance, and, where applicable, a PDF of the ASQ. • 1D: Screeners Assessing for Issues in the Family that Impact the Child • Part 2: Anticipatory Guidance & Parental Education • 2A. Parent picks their top three priorities • 2B. Education about recommended topics: • -- Can be assessed before OR after the visit. • -- So it can be referenced by provider during visit.

24. Additional PCW Features: Developmental Screening 9, 18, & 24 Month Visits

25. Extending the Well Child Care Visit: Online Educational Materials Via the PCW

26. Extending the Well Child Care Visit: Parent Visit Guide

27. Getting the Parent’s Voice into the EHR: Mapping to the Existing EHR Forms EHR Forms Updated to Align to Bright Futures through this process

28. Examples of the EHR Feed: Open Ended items [Parent report: Should she be interested in toilet training?] [Parent report: She can say so much lately. It is fun to hear the new ]

29. Examples of the EHR Feed: General Child Screeners

30. Findings Sneak Peak!PCW Usage Summary: June, 2010-Sept, 2011 • 2076 Completed tools (2139 started tool) • 43.2% response rate as of September, 2011 • varies by age of child, up to 52.2% for 6 month old visits • Median Completion Time: 9 min

31. What Parents Think: Some Early Findings Interim Results from Follow-up Survey (N=154) Overall Value • 91.7% of parents reported that they would recommend the PCW to other parents • 85.2% of parents reported that the tool helps to prioritize topics to discuss with the health care provider Acceptability • 91.2% of parents reported that they were comfortable with the amount of time that it took to complete the tool

32. PCW Usage Summary: June, 2010-Sept, 2011 Top 5 Priorities Picked (Across all Ages)

33. What Parents Think: Some Early Findings Usefulness of PCW Features: Percentage of Parents Reporting Feature as “Extremely” or “Very Useful”

34. What Parents Think: Some Early Findings Parent Report of Whether the PCW Section Helped them to Identify Topics to Discuss with Their Child’s Doctor or Healthcare Provider

35. What we hear! Parents: “I didn’t get my email!” Providers: “I can’t live without my CAHMI visits”

36. Next Steps Analyzing Evaluative Data Parent report – using the PHDS Provider surveys and focus groups Exploring funding and partners for next step Beta test of existing tool focused on well-child care for young children Development of tools for other populations/needs Example: Children with special health care needs

37. Thank You For additional information about the PCW, contact cahmi@ohsu.edu Christina Bethell, PhD, MBA, MPH Director, The Child and Adolescent Health Measurement Initiative bethellc@ohsu.edu Kasey McCracken, MPH mccrackk@ohsu.edu Colleen Reuland, MS Executive Director: Oregon Pediatric Improvement Partnership reulandc@ohsu.edu