Community Care of North Carolina (CCNC) (Text Version)
Community Care of North Carolina (CCNC)
CHIPRA [The Children's Health Insurance Program Reauthorization Act)]: A Quality Demonstration Grant
CHIPRA Team: *Marian Earls, MD, *James Green, Data Analyst, *Stacy Warren, Project Director, *Kern Eason, Central PEHR Consultant, *Janie Shivar, Category A Clinical Consultant, Maria Dover, Connect Clinical Consultant, *Marla Satterfield, Connect Clinical Consultant
Key Partners: NC Chapter of the AAP, American Academy of Family Physicians, Center of Excellence for Integrated Care, & the Oral Health Division of DMA
- A—Experiment with and evaluate the use of new and existing measures of quality for children.
- B—Promote the use of health information technology (Health IT) for the delivery of care for children.
- C—Evaluate provider-based models to improve the delivery of care.
- D—Demonstrate the impact of model pediatric EHRs (electronic health records).
- E—Creating targeted models to demonstrate their impact on health, quality and cost.
Community Care of North Carolina (CCNC): Why is it Unique?
- CCNC is made up of 14 Networks which represent all 100 NC counties.
- CCNC has created an infrastructure that is data driven.
- Over 90% of NC's primary care providers belong to a CCNC network.
- CCNC believes in doctors working with other doctors to improve quality and decrease costs of healthcare.
Image: The CCNC Network map is shown.
Categories A, C & D: The Quality Improvement Cycle
Image: A graphic of categories A, C, & D is shown. PDSA (Plan * Do * Study * Act) Ramps are depicted, on which PDSA circles roll up the ramp from theories, hunches, and best practices at the bottom toward breakthrough results at the top by way of evidence and data, and learning and improvement.
Category A—Core Quality Indicators
24 Quality Indicators:
- By the end of 2011 NC projects we will be able to report on 12 of the 24 measures.
- By the end of 2012, NC projects we will be able to report on all of the 24 measures.
- All 24 Quality Indicators will be reported to the Centers for Medicare & Medicaid Services (CMS) annually.
- Some of the 24 measures will be reported to the Networks and Practices quarterly in order to promote quality improvement initiatives.
NC Unique Indicators:
NC Unique measures to be reported on Quarterly.
- EPSDT Report Card.
- Dental Varnishing.
- Developmental & Behavioral Screening—all ages.
- Foster kids linked to Medical Home.
- ADHD quarterly measure—TBD.
CCNC believes that in order to ‘move the needle’ on improving healthcare, real time data needs to be given to practices consistently and timely so this information is meaningful and actionable.
CHIPRA C or CHIPRA 'Connect'
- Promoting Medical Homeness.
- Implement Mental Health competencies in primary care by using the American Academy of Pediatrics (AAP) Mental Health Toolkit.
- Promoting Routine Screens for children of all ages with special emphasis on:
- Maternal Depression Screens.
- Autism Screens.
- School Age screens.
- Adolescent screens.
- Promoting primary care providers and community service providers ability to:
- Build strong relationships.
- Communicate effectively.
- Collaborate to promote family centered care.
MoC-IV available to pediatricians and family physicians for QI projects including: Adolescent Screening, Maternal Depression Screening & Oral Health Screening.
Connect—Chart Extraction and Evaluation
Monthly Chart audits are completed by QI specialists and auto populated into the chart extraction tool.
Run chart data is analyzed and reported monthly. QI specialists amend PDSA projects according to data trends.
Images of two different charts are also shown.
Category D—Project Overview The Pediatric EHR Format
Existing EHR systems often do not optimally support the provision of health care to children. The goal is to develop a model EHR Format for children, demonstrate that it can be readily used, and package it in a way that facilitates broad incorporation into EHR systems.
The elements of the EHR to be tested will be developed with practices input during the planning and infrastructure development phase.
It is anticipated that the model will influence the criteria for future EHR product certification.
NC PEHR Survey of Gaps
A March 2011 survey of NC pediatric practices identified the following gaps in current EHRs.
Image of a bar chart showing the survey results.
Working with Westat and the AAP to identify additional gaps and to develop a model EHR, optimized for child health.
Asthma Severity Scoring. The system shall support Asthma Severity Scoring.
Documentation of pertinent family history. The system should incorporate documentation of pertinent family history to screen children at risk for common chronic conditions such as asthma and diabetes (Trotter & Martin, 2007).
Capture/calculate coded individualized disease measure goals and thresholds. The system should capture/calculate coded individualized disease measure goals and thresholds for modifying care (e.g. peak flow, FEV1, HgA1c, or behavioral goals used in self-care and inpatient treatment plans).
In North Carolina.....
- All 14 Networks will work with providers/medical homes interested in implementing the model EHR.
- We will be collaborating with the NC REC throughout this project.
- Identify Vendors.
- Identify Practices.
- Evaluation Design.
Children present a prime opportunity to prevent health issues from becoming chronic adult concerns.
Currently we are identifying vendors who wish to incorporate the model in their product offerings and are eager to help their clients/customers improve evidence-based care of children.
Our longer-term evaluation plan will engage individual practices in measuring the effect of the Pediatric EHR model in changing the way care is delivered and received.
Claims—Population level data but the scope is limited to billable items.
Chart Extraction—Is able to gather more robust quality measures but scope is limited because it is only a small sample of the population.
With EHR adoption.
Data can be gathered on the broad population and provide information on how care was delivered.
Breadth and Depth
Image: A Breadth and Depth Venn diagram is shown.
Integration of Categories A, C, and D
Each strategy will propel quality improvement both independently and in concert with the other strategies.
Measures enable ongoing, flexible tracking of Medical Home Impact.
Medical Homes provide data on feasibility, cost and value of measures.
A. Quality Measures.
C. Medical Home.
D. Pediatric Electronic Health Record.