AAP Medical Home Chapter Champions Program on Asthma

Report
AAP Medical Home
Chapter Champions
Program on Asthma
[insert name]
[insert title]
AAP [insert state] Chapter Champion
AAP Comprehensive Asthma Program
• Funded by the Merck Childhood Asthma
Network (MCAN) through March 2012
• Components:
▫ Chapter Quality Network (CQN) Asthma Project — a
quality improvement project implemented through
AAP chapters and supported by the national AAP
office
▫ Medical Home Chapter Champions Program on Asthma
(MHCCPA)
AAP Accelerating Improved Care for
Children with Asthma Program
• Funded by The JPB Foundation
• Components:
▫ Chapter Quality Network (CQN) Asthma Project — a
quality improvement project implemented through
AAP chapters and supported by the national AAP
office
▫ Medical Home Chapter Champions Program on Asthma
(MHCCPA)
Program Overview: Overarching Goal
To facilitate dissemination of best
practices and advocacy related to
asthma care within a medical home
Program Overview: Program Goals
• Increase access to a medical home for all
children and youth, with a specific focus on
reducing health disparities
• Facilitate pediatric practices’ adoption and
implementation of NHLBI asthma guidelines
within the context of a medical home
• Increase advocacy efforts for implementation
of asthma care within medical homes at
chapter/state level(s)
Imagine
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Staff recognizing a parent when appointment is made
Adequate time scheduled for that child
Prior asthma care plan in chart
Specialist’s record in your hands prior to the visit with
lab, allergy testing, spirometry, X-ray results
Parent concerns identified before the visit; multiple
tasks completed at the visit
Lab slips ready and EMLA cream on child prior to visit
Help by your staff for families with referrals,
resources, equipment, forms
Follow-up to assure completion of tasks
What is a Medical Home?
“The Medical Home is the model for 21st
century primary care, with the goal of
addressing and integrating high quality health
promotion, acute care and chronic condition
management in a planned, coordinated and
family-centered manner.”
-American Academy of Pediatrics
Joint Principles of Medical Home
AAP, AAFP, ACP, AOA, 2007
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Personal physician
Physician-directed practice
Whole-person orientation
Coordinated care
Quality and safety
Enhanced access
Appropriate payment
Essential Components of a
Medical Home: The 6 R’s
1.
2.
3.
4.
5.
6.
Ready Access
Relationships/Respect
Registry and Records
Resources
Reimbursement
Recruitment
NIH Asthma Guidelines
NHLBI NAEPP, 2007
Expert Panel Report 3: Guidelines for the
Diagnosis and Management of Asthma
Principle 1: Personal Physician
• Provide continuity of care in a partnership
• Schedule routine follow-up care
• Monitor use of beta2-agonist medications
Relationships/Respect
Patient and Family
MH Staff
Specialists
• Enhanced appointment and medication
compliance
• Help with asthma teaching, spirometry, flu shots
• Support for difficult cases, education
Schools
• Asthma care for when parents not present
Insurers
• Payment
• Surveillance for med overuse, noncompliance
Community Providers
• Medicaid managers, social workers, summer
camps, smoking cessation
Principle 2: Physician-Directed Medical
Practice
Coordinate services for children with asthma that are:
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Family-centered
High quality
Accessible
Affordable
Principle 3: Holistic Orientation
• Control of environmental triggers
▫ Allergens
▫ Irritants, especially tobacco smoke
• Treat and prevent co-morbid conditions
• Promote physical fitness and nutrition for
children with asthma
• Help address socioeconomic barriers to wellbeing
Principle 4: Coordinated Care
• Integrate care across the community
• Use information technology
▫ Asthma registry
▫ Electronic health record
 Performance and outcomes measures
 Accountability
• Refer to specialist, if needed
• Transition teens to adult care
Care Coordination: Key Components
• Visit planning, referral services, follow-up
• Assists with equipment needs (eg, local suppliers for
environmental controls, spacers, nebulizers, oximeters)
• Collaborates with other providers (eg, specialists,
school nurse, etc)
• Maintains a centralized database (paper or electronic)
of local resources
• Connects families to support networks
▫ Family-to-family health information centers (F2F HICs)
▫ Community asthma education
▫ Smoking cessation programs (patient, family)
Care Coordination:
Collaboration/Co-management
with Specialists
• Bridges to service
▫ Between primary care and specialist
▫ Between multiple specialists and medical home
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Ensure referral data sent and visit accomplished
Access to specialist records (letter, fax, electronic)
Regular phone/e-mail dialogue regarding patient care
Specialty follow-up (hospital/ED follow-up, labs, etc)
Registry and Records:
Knowing Who Needs Care
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Registry can be paper or electronic
Notebooks  Excel  Access  EMR
Alerts schedulers to need for more time for visit
Assures key data to specialist for consult
Tracks referrals and specialist reports
Prompts pre-visit contacts
Data management for flu shots, ACP on chart
Data recall for self-assessment of care quality
Electronic Records Make Asthma
Care Easier
• Chart is never “lost”
• Permits “tracking” of asthma visits, both acute
and planned
• Medication doses, strengths, refill dates are
recorded
• Specialty consults are easily accessed
• Asthma plan, allergies are on chart
• Asthma education printouts available
Principle 5: Quality and Safety
• Patient-centered, evidence-based care
• Establish the asthma diagnosis
• Provide asthma education for patient selfmanagement
• Prescribe and adjust medications
▫ Inhaled corticosteroids are preferred for
persistent symptoms
▫ Stepwise treatment based on age
• Develop a written asthma management plan
AAP Quality and Safety Resources
• Chapter Alliance for Quality Improvement (CAQI)
www.aap.org/member/chapters/caqi/
• Education in Quality Improvement for Pediatric Practice
(EQIPP)
http://eqipp.aap.org/
 Medical Home for Pediatric Primary Care
 Asthma — Diagnosing and Managing in Pediatrics
 CME offered, MOC Part 4 available
• Medical Home Chapter Champions Program on Asthma
www.medicalhomeinfo.org/national/mhccpa.aspx
Principle 6: Enhanced Access
• Pediatrician availability to assess, classify, and
monitor asthma severity and control
• Reduce disparities in processes and outcomes in
asthma care
▫ Socioeconomic
▫ Racial/ethnic
▫ Geographical
Ready Access
• Accept Medicaid, many insurers
• Evening, weekend, and holiday office hours for
asthma flares
• 24-hour advice nurses (to the ED or not?)
• Translation phone
• Privacy protection for teens (cigarettes, THC)
• ADA accessible physical plant and parking area
• Policy on transition to adult care (age, process,
list of adult providers)
Principle 7: Appropriate Payment
• Added value provided to patients with asthma
who receive care in a medical home
• Adequate fees
• Bundled payments
• Accountable care organizations
Reimbursement for Asthma Management
Bill for what you do
Chronic care management
visits (schedule in advance)
Know the codes
Stay current on proper coding
for care of CSHCN
Spirometry
(if available and trained)
Education time
(eg, MDI, asthma education,
oximetry, nebulizations)
After-hours visits
Payer contract
negotiations
Know what they pay for and
address the things they don’t
Know what your rates are for
each payer on the activities
you do the most
Refer to AAP Financing and
Payment Resources
Have the data that shows your
effectiveness (eg, low ED or
hospitalization rates)
Recruitment—Yes, YOU!
• One family in five has a CSHCN
• Asthma is one of most common chronic
condition in pediatrics
• Parents, insurers, government are demanding
quality improvement in care systems
• Planned, supported care is more fun to deliver!
• Where do you want to start?
MHCCPA Project Advisory Committee
Members
• Chuck Norlin, MD, FAAP,
Chairperson
• Julie Katkin, MD, FAAP
• Jennifer Lail, MD, FAAP
• John Meurer, MD, MBA, FAAP
• Matthew Sadof, MD, FAAP
• Jim Stout, MD, FAAP
Parent Representative
• Karen VanLandeghem, MPH
Liaisons
• Rhonda Hertwig, CPNP
• Marie Mann, MD, FAAP
Chapter Champion Regional “Networks”
Districts I & II:
Dr Sadof
(CT, MA, ME, NH, NY1, NY2,
NY3, RI, USE, VT)
Districts VII & X
Dr Katkin
(AL, AR, FL, GA, LA, MS, OK,
PR, TX)
Districts III & IV
Dr Lail
(DE, DC, KY, MD, NC, NJ, PA,
SC, TN, VA, WV)
Districts V & VI
Dr Meurer
(IA, IL, IN, KS, MI, MN, MO,
ND, NE, OH, SD, WI)
District VIII
Dr Stout
(AK, AZ, CO, HI, ID, MT, NM,
NV, OR, USW, UT, WA, WY)
District IX
Dr Norlin
(CA 1, CA 2, CA3, CA 4)
MHCCPA Web Page
http://medicalhomeinfo.org/national/mhccpa.aspx
Thank You!
Questions?
Program Contact:
Chelsea Rajagopalan
Program Manager
AAP Division of Children with Special Needs
800/433-9016, ext 4311
[email protected]

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