illinois medical home project presented by kathy sanabria, mba, pmp project director
TRANSCRIPT
Illinois Medical Home Illinois Medical Home ProjectProject
Illinois Medical Home Illinois Medical Home ProjectProject
Presented by Kathy Sanabria, MBA, Presented by Kathy Sanabria, MBA, PMP Project DirectorPMP Project Director
Illinois Medical Home Project (IMHP) Evaluation Status
American Public Health Association 134th Annual Meeting and Exposition
November 7th, 2006Boston, MA
Principle Investigator: Charles Onufer, MDProject Director: Kathy Sanabria, MBA, PMP
Administering Organization: Illinois Chapter, American Academy of Pediatrics (ICAAP)
Evaluators: CADE Research Data Management Group University of Illinois Chicago (UIC) School of Public Health:
Kristin Rankin, MSPH (PhD Candidate)Andrew Cooper, MPH
Wendy Guo, BS
There’s No Place Like a “Medical Home”
A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.
Illinois Medical Home Project
In July 2004, the ICAAP was awarded a four-year $1,000,000 federal grant through the Division of Services for Children with Special Health Care Needs, Maternal and Child Health Bureau, to spread the medical home concept to primary care providers throughout Illinois. This presentation provides evaluation results for Phase I of the project, which occurred July 2004 through June 2006, and outlines Phase II of the project. The project is being administered by the Illinois Chapter of the AAP in collaboration with the Division of Specialized Care for Children (DSCC), Title V Program, University of Illinois.
IMHP Evaluation Subcommittee
• Charles Onufer, MD, Chair, Principle Investigator• Helen Binns, MD, MPH• Jenifer Cartland, PhD• Andrew Cooper, MPH • Colleen Monahan, DC, MPH• Kristin Rankin, MSPH• Kathy Sanabria, MBA
This project has received Institutional Review Board (IRB) approval through the University of Illinois at Chicago School of Public Health.
OUTLINE
• Phase I Evaluation Results
• Phase II Evaluation Plan
• Phase II Evaluation Baseline Results
Participating SitesDuring Phase I of the project, 6 core pediatric
primary care practices participated and received the following:
• Modest annual mini-grant stipends for 2 years• Quality Improvement (QI) teams at each site
participated in 3 Learning Sessions• Medical home resources from the AAP, NICHQ,
CMHI, ICAAP and DSCC• Access to trained facilitators to help organize
and guide the QI teams and hold monthly meetings
Phase I Evaluation Results
• Practice Assessment Checklist• Medical Home Index (MHI)• QI Team Evaluations• Family Surveys
Practice Assessment Checklist
• Developed for IMHP and piloted in Phase I• Administered on-site at baseline and 18 months
later at follow-up as an outcome measure (sites did not have access to the instrument or baseline results throughout the project)
• Inventories practice environment, resources, and characteristics of a medical home
• Will be useful to control for potential confounding factors affecting changes over time observed with other instruments
Phase I Evaluation Results
Practice Assessment Checklist
• All 6 Phase I sites (pediatric practices) completed baseline survey
• To date, 5 sites have completed follow up survey
Phase I Evaluation Results
Mean for All Phase I Practices, by Domain
0.0
0.2
0.4
0.6
0.8
1.0
AC
CE
SS
.
FA
MIL
Y.
CO
NT
IN.
CO
MP
R.
CO
OR
D.
CO
MP
AS
S.
CU
LTU
R.
QI
PH
YS
.
EN
VIR
ON
.
Sco
re
Baselinen=6 (2/2005-4/2005)
Followupn=5 (7/2006-9/2006)
Patient Care Other
Practice Assessment Checklist
Phase I Evaluation Results
Medical Home Index
• Completed by lead physician jointly with practice/clinic staff
• Defines and quantifies organization and delivery of primary care in 6 practice domains
Phase I Evaluation Results
Medical Home Index
Questions are grouped into 6 domains• Domain 1: Organizational Capacity • Domain 2: Chronic Condition
Management• Domain 3: Care Coordination• Domain 4: Community Outreach• Domain 5: Data Management• Domain 6: Quality Improvement/Change
Phase I Evaluation Results
Medical Home Index (Phase I)
Mean Score for All Practices, by Domain
1 .0
3 .0
5 .0
7 .0
OR
GA
NIZ
.
CO
ND
ITIO
NM
GM
T.
CA
RE
CO
OR
D.
CO
MM
.O
UT
RE
AC
H
DA
TA
MG
MT
.
QI
Le
ve
l
Baselinen=6 (2/2005-4/2005)
Follow-upn=6 (7/2006-9/2006)
Partial
Complete
Partial
Complete
Partial
Complete
Partial
Complete
4
3
2
1
Phase I Evaluation Results
Medical Home Index (Phase I)Distribution of Scores
For All Sites, Across All Domains21
%
21%
13% 18
%
10%
6%
12%
0%1% 2%
16%
16%
17%
17% 22
%
9%
0%
5%
10%
15%
20%
25%
30%
35%Pa
rtial
Com
plet
e
Parti
al
Com
plet
e
Parti
al
Com
plet
e
Parti
al
Com
plet
e
Per
cen
tag
e
Baseline (2/5-4/05) Follow Up (7/06-9/06)
Level 1 Level 2 Level 3 Level 4
Phase I Evaluation Results
Medical Home Index (Phase I)
Practice B
1
2
3
4
5
6
7
8
Question #
Lev
el
Baseline(3/2005)
Follow-Up(7/2006)
Partial
Complete
Partial
Complete
Partial
Complete
Partial
Complete
4
3
2
1
Phase I Evaluation Results
QI Team Evaluation
• QI Team members are surveyed• Elicit feedback on effectiveness of QI
Team meetings, facilitators, and success of QI Teams of achieving goals
• Administered twice for Phase I– At 6 months (February 2005)– At end of study (July/August 2006)
Phase I Evaluation Results
QI Team EvaluationNumber of QI Team Member Responses By Site
0
1
2
3
4
5
6
7
8
Site A Site B Site C Site D Site E Site F
Re
sp
on
se
s Baseline11/05
Followup7/06-9/06
For all sites, Baseline n=32 Follow-up n=25
Phase I Evaluation Results
QI Team Evaluation (Phase I)Sample Question: “I have a good understanding of the team’s goals and what next steps are needed to achieve them.”
Aggregated Response for All Respondents at All Sites
0%
10%
20%
30%
40%
50%
60%
Baseline 11/05 Follow-up 7/06-9/06
Pe
rce
nta
ge
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Phase I Evaluation Results
Family Surveys (Phase I)
• Medical Home Family Index (MHFI)
• Family/Caregiver Survey
Phase I Evaluation Results
Results pending completion of more follow up surveys.
Phase II Evaluation Plan Includes a Control Component
Updated Instruments• Practice Assessment Checklist• Medical Home Index (MHI)• QI Team Evaluations• Family Surveys Enrolled 10 demographically paired sites including pediatric
practices, family practices, and public health clinics: 5 sites will receive assigned “facilitators” and 5 sites will receive “technical assistance” to organize and implement their QI efforts. All sites will receive small mini-grants, three training sessions, and resources. The study attempts to determine what effect facilitators vs technical assistance brings to the process and outcomes.
Practice Assessment Checklist (Phase II)
• Updated slightly from version used in Phase I
• Checklist and baseline results are shared with Phase II sites to be used as a tool for them to select activities to work on to increase their level of “medical homeness”
• Fielded summer 2006
Phase II Evaluation Plan
Medical Home Index (Phase II)
• Same instrument as was used in Phase I
• Fielded summer 2006
Phase II Evaluation Plan
Family Surveys (Phase II)
• Modified instrument for Phase II– Combines two separate Family Surveys
used in Phase I• Medical Home Family Index (MHFI)• Family/Caregiver Survey
– Modified slightly to improve data quality– Updated for improved readability
• Letters distributed to sites September/October 2006, to be mailed same month (pending IRB approval for some sites)
Phase II Evaluation Plan
Future ActivitiesQI Team evaluations• Will be fielded to QI Teams twice• First round of evaluations will take place around April
2007
2-year follow up at conclusion of Phase II (June 2008)
• Practice Assessment Checklist• Medical Home Index (MHI)• Family Surveys
Phase II Evaluation Plan
Phase II Baseline Results• 9 of 10 sites have completed medical
home Practice Assessment Checklist baseline survey
• 9 of 10 sites have completed Medical Home Index (MHI) baseline survey
• Sites are in the process of mailing out family surveys (or receiving IRB approval to do so)
Mean for All Phase II Sites, by Domain
0.00.10.20.30.40.50.60.70.80.91.0
AC
CE
SS
.
FA
MIL
Y.
CO
NT
IN.
CO
MP
R.
CO
OR
D.
CU
LTU
R.
QI
PH
YS
.
EN
VIR
ON
.
Sco
re
Baselinen=9 (7/06-9/06)
Patient Care Other
Practice Assessment Checklist (Phase II Baseline)
Phase II Baseline Results
Medical Home Index (Phase II Baseline)
Mean Score for All Sites, by Domain
1 .0
3 .0
5 .0
7 .0
OR
GA
NIZ
.
CO
ND
ITIO
NM
GM
T.
CA
RE
CO
OR
D.
CO
MM
.O
UTR
EA
CH
DA
TAM
GM
T. QI
Lev
el Baselinen=9 (7/06-9/06)
Partial
Complete
PartialComplete
PartialComplete
PartialComplete
4
3
2
1
Phase II Baseline Results
Family Survey (Phase II Baseline)
Baseline results pending completion of more surveys
• Online responses have begun to come through
• Paper responses expected in coming weeks
Phase II Baseline Results
Illinois Medical Home Project
For more information about the project, please contact:
Kathy Sanabria, MBA, PMP, Project Director1358 West Randolph Street, Suite 2 EastChicago, IL 60607Phone: 312-733-1026, ext [email protected]
Thank you for your interest!