Family Engagement Quality Improvement Project (Family-Centered Care Quality Improvement Project, Round Two) By January 2017, 10 pediatric primary care practice teams will work individually and collaboratively to test, implement, disseminate, and plan to sustain strategies that lead to improved family engagement in clinical practice through enhanced shared decision-making and connection of families to appropriate supports and services. Participating pediatric primary care practice teams will make improvements so that: 1. 80% or more patients have documentation in their medical record that patient/family concerns were elicited at the most recent health supervision visit. 2. 80% or more patients have documentation in their medical record that patient/family concerns were addressed at the most recent health supervision visit or a plan to address the concerns was made. 3. 80% or more patients have documentation in their medical record that family strengths were identified and discussed at the most recent health supervision visit. 4. 80% or more patients have documentation in their medical record that a post-visit medical summary or a comprehensive care plan was created or updated/maintained at a most recent health supervision visit. 5. 80% or more patients have documentation in their medical record that a current copy of their post-visit medical summary or comprehensive care plan was reviewed through an active form of family engagement and offered to patient/families at a most recent health supervision visit. 6. 80% or more of patients have documentation in their medical record that families received a follow-up discussion of age-appropriate screening results on the same day as the screening. 7. 80% of parents/families will indicate that their practice honored or respected parent/family values and beliefs, as measured through a post-visit family survey. 8. 80% of parents/families will indicate that information about their child’s health was explained in an easy to understand manner, as measured through a post-visit family survey. 9. 80% of parents/families will indicate that individuals providing care to their child showed respect for the family, as measured through a post-visit family survey. 10. 80% of parents/families will indicate that practice staff treated them with dignity and respect, as measured through a post-visit family survey. 11. 80% parents/families will indicate that individuals providing medical care to their child involved families in decisions about their child health, as measured through a post-visit family survey. Balancing Measures: 1. Think about the changes your team has implemented as part of the “Family Engagement Quality Improvement Project.” Because of this project, the amount of time it takes staff and pediatricians to communicate with patients and families has taken: Much less time No change Much more time 5 4 3 2 1
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Family Engagement Quality Improvement Project
(Family-Centered Care Quality Improvement Project, Round Two)
By January 2017, 10 pediatric primary care practice teams will work individually and collaboratively to
test, implement, disseminate, and plan to sustain strategies that lead to improved family engagement in
clinical practice through enhanced shared decision-making and connection of families to appropriate
supports and services.
Participating pediatric primary care practice teams will make improvements so that:
1. 80% or more patients have documentation in their medical record that patient/family concerns
were elicited at the most recent health supervision visit.
2. 80% or more patients have documentation in their medical record that patient/family concerns
were addressed at the most recent health supervision visit or a plan to address the concerns
was made.
3. 80% or more patients have documentation in their medical record that family strengths were
identified and discussed at the most recent health supervision visit.
4. 80% or more patients have documentation in their medical record that a post-visit medical
summary or a comprehensive care plan was created or updated/maintained at a most recent
health supervision visit.
5. 80% or more patients have documentation in their medical record that a current copy of their
post-visit medical summary or comprehensive care plan was reviewed through an active form of
family engagement and offered to patient/families at a most recent health supervision visit.
6. 80% or more of patients have documentation in their medical record that families received a
follow-up discussion of age-appropriate screening results on the same day as the screening.
7. 80% of parents/families will indicate that their practice honored or respected parent/family
values and beliefs, as measured through a post-visit family survey.
8. 80% of parents/families will indicate that information about their child’s health was explained in
an easy to understand manner, as measured through a post-visit family survey.
9. 80% of parents/families will indicate that individuals providing care to their child showed
respect for the family, as measured through a post-visit family survey.
10. 80% of parents/families will indicate that practice staff treated them with dignity and respect, as
measured through a post-visit family survey.
11. 80% parents/families will indicate that individuals providing medical care to their child involved
families in decisions about their child health, as measured through a post-visit family survey.
Balancing Measures:
1. Think about the changes your team has implemented as part of the “Family Engagement Quality
Improvement Project.” Because of this project, the amount of time it takes staff and
pediatricians to communicate with patients and families has taken:
Much less time No change Much more time
5 4 3 2 1
2. Think about the changes your team has implemented as part of the “Family Engagement Quality
Improvement Project.” Because of this project, the care team’s confidence about engaging
families in shared decision-making has become:
Much more confident No change Much less confident
5 4 3 2 1
A project of the National Center for Medical Home Implementation (NCMHI) in the AmericanAcademy of Pediatrics (AAP). The NCMHI is a cooperative agreement between the AAP and theMaternal and Child Health Bureau of the Health Resources and Services Administration. This 10-month quality improvement project will provide participating pediatric practices with toolsand strategies to improve family engagement in practice through enhanced shared decision-makingand connection of families to appropriate supports and services. Background:
The NCMHI plans to engage primary care practices who care for pediatric patients 0-18 years of ageand have diverse backgrounds and experiences. Specifically, 10 practice teams are being recruitedwith four core members per team. Team members will include a pediatrician team leader,nursing/non-pediatrician clinial staff, administrative/front desk staff, and a parent/caregiver. Theanswers you provide in this application will help the NCMHI select a diverse group of pediatricpractices to be involved in this quality improvement project.
One person from each team will need to complete the application; however, you are required to listother participants on your team in the application for a firm commitment from those involved(family/caregiver partners can be identified after submission of this application).
Project Implementation will occur May 2016 – February 2017. Each practice team is required to:
Participate in a 60-minute orientation webinar on April 27, 2016 at Noon Eastern or April 28,2016, at Noon Eastern, and complete associated pre-work.Complete a web-based pre-implementation surveyParticipate in an in-person Learning Session June 3-4, 2016, at or near the AAP Headquartersin Elk Grove Village, IL (travel expenses will be covered)Regularly collect data by reviewing medical records (20 at baseline, 10 throughout the projectaction period, per practice)Distribute post-visit family surveys (10 surveys at baseline and per action period, per practice)Test changes and improvements in practices related to family engagementSubmit findings and progress through monthly progress reports (six reports in total)Engage in education on family engagement via participation on one-hour monthly educationalconference calls/webinarsParticipate on two one-hour quality improvement coaching calls with the project’s qualityimprovement advisorComplete a post-implementation surveyParticipate in team telephone interview describing your experience participating in the project(optional)Share progress and results of this project with practice staff and leadership
Family Engagement Quality Improvement Project
It will take you approximately 15 minutes to complete this application. This application contains atotal of 16 questions separated into the following 4 sections:
Part One: Practice and Team CompositionPart Two: Practice DemographicsPart Three: Family EngagementPart Four: Additional Information
In order to progress through this application, please use the following navigation buttons:
Click the NEXT button to continue to the next page.Click the PREVIOUS button to return to the previous page.Click the DONE button to submit your application.
If you have any questions, please contact:
Alex Kuznetsov, RDProgram ManagerNational Center for Medical home ImplementationAmerican Academy of [email protected]/434-7087
Each practice team is required to have four core team members participate in this project. These team members include the following:
A primary care pediatrician (team leader)Nursing/Non-pediatrician clinical staffAdministrative/Front desk staffParent/Caregiver partner*
*Please note: All participating practices are required to identify a parent/caregiver partner as amember of the core improvement team. If you are unable to identify a parent/caregiver partner atthe time of application, you may still submit an application, however you will be required to identifyand bring a parent/caregiver partner to the project’s in-person Learning Session June 3-4, 2016.
Part One: Practice and Team Composition
1. Practice Name*
2. Practice Address*
Please identify the name and profession of each team member below.
First Name
Last Name
Title
Email Address
Phone Number
3. Primary Care Pediatrician/Team Leader*
First Name
Last Name
Title
Email Address
Phone Number
4. Nursing/Non-pediatrician clinical staff*
First Name
Last Name
Title
Email Address
Phone Number
5. Administrative/Front Desk Staff*
First Name
Last Name
Title
Email Address
Phone Number
6. Parent/Caregiver Partner
7. Who is completing this application?*
Pediatrician
Nursing/Non-pediatrician Clinical Staff
Administrative/Front Desk Staff
Parent/Caregiver Partner
Other (please specify)
Part Two: Practice Demographics
8. What is the geographic location of your practice?*
Urban
Rural
Suburban
9. What is your practice size (by # of physicians)*
Small (1-3 physicians)
Medium (4-6 physicians)
Large (more than 7 physicians)
10. What is your practice type?
Independent Practice
Hospital-Affiliated Practice
Affiliated with a University/Medical School
County Public Health Department
Federally Qualified Health Center
Other (please specify)
11. What is the total number of patients in your practice?*
Less than 5% 5 - 25% 26 - 50% 52 - 75% 76 - 100%
White
Black or AfricanAmerican
Asian
Native American orOther Pacific Islander
Hispanic
More than one race
12. Please estimate the percentage of children you care for with the following racial backgrounds:*
Less than 5% 5 - 25% 26 - 50% 51 - 75% 76 - 100%
English is NOT theirprimary language
English is their primarylanguage
13. Please estimate the percentage of children in your care for whom:*
Part Three: Family Engagement
14. Why is your practice interested in participating in this quality improvement project?*
15. Have you shared your intention to participate in this project with your practice leadership (such as theclinic's Chief Executive Officer, Executive Director, among other leadership)?*
Yes
No
N/A (Applicant is/represents senior leadership from the practice)
16. How familiar/knowledgeable is your practice with the concept of family engagement?*
Not familiar/Not Knowledgeable
Somewhat familiar/Somewhat Knowledgeable
Very familiar/Very Knowledgeable
Part Four: Additional Information
17. If selected, practice teams are required to participate in one of the project's orientation webinars.Please indicate what date/time your practice team will be able to attend the orientation webinar.*
April 27, 2016, Noon - 1 pm Eastern
April 28, 2016, Noon - 1 pm Eastern
18. If selected, all members of each practice team are required to participate in the Learning Session heldat or near the American Academy of Pediatrics Headquarters in Elk Grove Village, IL, from Friday June 3,2016 (late afternoon) - Saturday, June 4, 2016 (morning and early afternoon). All travel expenses will bereimbursed.
*
Yes, all members of my practice team will be able to participate in the learning session
No, all members will not be able to participate in the learning session, however some members will be able to attend
19. Will your team be required to obtain separate approval from your organization's Institutional ReviewBoard (IRB) in order to participate in this project?*
Yes
No
I am not sure
Family Engagement Quality Improvement Project
A project of the National Center for Medical Home Implementation in the American Academy of Pediatrics Funded by a cooperative agreement from the Maternal and Child Health Bureau,
Health Resources and Services Administration
The National Center for Medical Home Implementation (NCMHI) in the American Academy of Pediatrics is recruiting 10 primary care pediatric teams to participate in a quality improvement project focused on family engagement in practice. The quality improvement project involves the following components: 1) collecting data using medical record reviews and post-visit family surveys; 2) participating in a series of facilitated discussions related to family engagement, including in-person learning sessions; and 3) conducting a series of activities designed to elicit measureable changes related to family engagement over the project period.
Practice teams of 4 members each are being recruited. Each team must include the following team members: a pediatrician, nursing/non-
This project has received approval from the American Academy of Pediatrics (AAP) Institutional Review Board (IRB). No identifiable protected health information is being collected for this project; therefore, HIPAA authorization will not be needed from patients in order for you to participate.
Project implementation will occur from May 2016 – February 2017. Practice teams selected to participate will:
Participate in a 60-minute orientation webinar on April 27, 2016 or April 28, 2016 at Noon Eastern Time
Complete a web-based pre-implementation survey
Participate in an in-person Learning Session June 3-4, 2016, at or near the AAP Headquarters in
Elk Grove Village, IL (travel expenses will be covered)
Regularly collect data by reviewing medical records (20 at baseline, 10 throughout each Action Period)
Regularly collect data by distributing post-visit family surveys (10 surveys at baseline and during each action period)
Test changes and improvements in practice related to family engagement
Submit findings and progress through monthly progress reports
Engage in education on family engagement via participation on one-hour monthly educational conference
calls/webinars
Participate on two one-hour quality improvement coaching calls with the project’s quality improvement advisor
Complete a web-based post-implementation survey
Participate in team telephone interview describing your experience participating in the project (optional)
Share progress and results of this project with practice staff and leadership
Please indicate your interest in participating by completing the application located at: https://www.surveymonkey.com/r/familyengagementqiproject
* If a parent/caregiver is not identified at the time of application, teams can still complete the application. All teams must identify a parent/caregiver partner by the in-person Learning Session June 3-4, 2016.
Applications are due from project teams by April 15, 2016. Only one application per practice-based project team is required.
Applications will be reviewed by members of a project oversight work group.
Applicants will be notified of their acceptance status by April 22, 2016
3. How would you rate each of the following sessions in terms of usefulness in your practice?
Very Useful
(5)
(4)
Somewhat Useful
(3)
(2)
Not Useful (1)
Family Engagement Overview (Hunting)
Quality Improvement in the Real World (Gubernick)
Storyboard Presentations
Topical Session 1
Topical Session 2
Report on Baseline Data and Pre-Implementation Survey (Gubernick)
Parent/Caregiver only: Break-out session(s)
4. What part(s) of the Learning Session did you find most valuable?
5. Please suggest any topics you think we should cover during the QI project via email and/or during monthly calls.
6. Share any additional comments or feedback on the Learning Session.
Monthly Progress Report Template (Will be input into SurveyMonkey)
Date Due:
The Monthly Progress Report (MPR) details the tests of change related to family engagement practice
teams undertook during the action period and any success stories or challenges they encountered.
Practice Name:
Month of Report:
Project Aim Statement: By January 2017, 10 pediatric primary care practices will work individually and
collaboratively to test, implement, disseminate, and plan to sustain strategies that lead to improved
family engagement in clinical practice through enhanced shared decision-making and connection of
families to appropriate supports and services.
The purpose of this report is to obtain the following information from practice teams:
1. Describe tests of change and identify resources and tools utilized to test changes.
2. Identify successes and barriers in implementing tests of change.
3. Share what you learned this month.
4. Rate the impact of the project on patient/family communication and health care team
experience in caring for patients and families.
TESTS OF CHANGE AND TOOLS
Please identify the changes you have tested within the past month. For each, describe changes, the
impact/learning from this change you have made, and/or the tools you have tested.
1. Has your practice developed and/or modified one or more decision aid(s) in practice (modification
could include adding a practice name or logo to a decision aid)? (yes/no)
o If yes, please specify what decision aid was developed and/or modified in practice.
Example 1 (from change package)
Example 2 (from change package)
Example 3 (from change package)
Other
o Please describe how you developed/modified the decision aid in practice.
2. Has your practice implemented one or more decision aid(s) in practice? (yes/no)
o If yes, please specify what decision aid your practice implemented.
o Please describe how you implemented the decision aid(s) in your practice.
4. Does your practices have a system in place for tracking and following up on referrals to appropriate
supports and services for patients/families/caregivers? (yes/no)
o If yes, please specify the system you have in place for tracking and following up on referrals to
appropriate supports and services for patients/families/caregivers:
o Checkbox in patient medical record
o Referral fax back form
o Requests for patient summary
o Follow-up phone calls
o Patient registry
o Other
o Please describe how you implemented the system for tracking and following up on referrals to
appropriate supports and services for patients/families/caregivers.
5. Does your practice have an engaged parent/caregiver partner that is a core member of the
improvement team? (yes/no)
o If yes, please provide one or more example(s) of how the parent/caregiver partner was
engaged in improvement team activities throughout this Action Period.
6. Does your practice have a system in place for obtaining feedback from families on patient/family
experience? (yes/no)
o If yes, please select an example of what this system is:
Family advisory group/council
Post-visit family experience survey
Parent/family focus groups
Ask families for informal feedback at visits
Suggestion boxes
Other (please describe)
o Please describe how you implemented the system(s) for obtaining feedback from
families on patient/family experiences.
7. Did your practice host a “lunch and learn” with a community-based organization that included
practice staff and/or family members? (yes/no)
o If yes, please describe what you learned at the “lunch and learn” and any changes you plan to
implement based on what you learned.
o Please select the focus of the community-based organization
Child-Care
Housing Assistance
WIC
Nutrition
Title V
Local Family to Family Health Information Center (F2F HIC)
Other (please describe)
8. Did your improvement team share project results and progress with the rest of the practice/clinic
staff (this can also include parents/caregivers)? (yes/no)
o If yes, please identify how results/progress were shared.
Discussing run charts during monthly team meetings
Sharing challenges and success during team huddles
Highlighting project results in practice newsletter
Showcasing project results on practice bulletin board
Other (please describe)
9. What other tests of change did your practice test/implement related to shared-decision making?
Shared decision making is a collaborative process that allows patients and their health care providers to
make health care decisions together, taking into account the best scientific evidence available, as well as
the patient’s values and preferences.
A model for shared decision making includes: 1) Introducing choice; 2) describing options; 3) helping
patients explore preferences and make decisions.
10. What other tests of change did your practice test/implement related to connecting families to
appropriate supports and services?
OVERALL ASSESSMENT AND FUTURE TOPICS
11. Share something important, surprising, or successful your team learned/implemented this month.
12. What was the biggest barrier/challenge your team encountered this month? Were you able to
overcome it? If so, how?
13. Think about the changes your team has implemented as part of the “Family Engagement Quality
Improvement Project.” Because of this project, the amount of time it takes staff and physicians to
communicate with patients and families has taken:
Much less time No change Much more time
5 4 3 2 1
14. Think about the changes your team has implemented as part of the “Family Engagement Quality
Improvement Project.” Because of this project, the care team’s confidence about engaging families in
shared decision-making has become:
Much more confident No change Much less confident
5 4 3 2 1
15. What issues or topics would you like to discuss on a monthly project team call or through the project
email list?
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
Thank you for attending the call, "Patient Advisory Panels"
Please help us assess our family-centered care project by completing this brief evaluation form. It should take no more than 10minutes of your time. You will need the unique identification number provided to you in your orientation materials.
Your responses will be kept strictly confidential. We will never link your responses to your name in reports or anywhere else. Thesurvey is voluntary and you may choose to end it at any time or not answer a question, for whatever reason.
If you have any questions please contact Pam Kelley, PhD at Kelley Analytics, (732) 742-8908 or [email protected].
In order to progress through this survey, please use the following navigation buttons:
- Click the Next button to continue to the next page.- Click the Previous button to return to the previous page.- Click the Done button to submit your survey.
1
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
1. Please enter your unique identification number:
2
Part One: Reactions to the Call
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
Stronglydisagree Disagree
Neitheragree nordisagree Agree
Stronglyagree
This call changed the way I think aboutpatient advisory panels.
I feel I have learned a great deal fromparticipating in this call.
Most or all of the content was a review orrefresher for me.
2. Please tell us how much you agree with the following statements about the call youjust attended:
3
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
3. If you feel the call changed the way you think, please tell us how:
4
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
I felt this:
Energized
Curious
Bored
Inspired
Annoyed
Overwhelmed
Motivated
Skeptical
Amused
Surprised
Engaged
Tired
Frustrated
In agreement withthe facilitators
In disagreementwith thefacilitators
Other (please specify)
4. During the call I felt: (Select all that apply)
5. Briefly explain why you selected the choices you did.
5
Part Two: Learning Objectives
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
Instructions: For each item below, compare how you feel NOW that the call has ended with how you felt BEFORE the call by circling anumber on each scale, where 0 is the lowest and 10 is the highest. (If you think your knowledge did not change, circle the samenumber for both.)
6. NOW that the call has ended, how would you rate your level of knowledge about patient advisorypanels?
0 (no knowledge)
1
2
3
4
5
6
7
8
9
10 (a great deal of knowledge)
6
7. Think back to how you felt BEFORE the call and rate your level of knowledge about patient advisorypanels.
0 (no knowledge)
1
2
3
4
5
6
7
8
9
10 (a great deal of knowledge)
If you feel your knowledge level did not change, select the same number from above.
7
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
StronglyDisagree Disagree Neutral Agree
StronglyAgree
I can define patient advisorypanels.
I can describe the benefits ofpatient advisory panels.
I can provide examples ofhow patient advisory panelscan be used in pediatricpractices
8. Please rate the extent to which you feel you can do the following as a result of thiscall:
8
Part Three: Content and Faculty Evaluation
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
StronglyDisagree Disagree Neutral Agree
StronglyAgree
Information presented wasapplicable and practical.
Format of call enhanced theaccomplishment of learningobjectives.
Presentation materials helpedto meet my learning needs.
Content provided via the callwill assist me in improving myprofessional effectiveness.
Instructions for how to accessthe call were clear andstraightforward.
The audio quality of the callwas acceptable.
9. Please rate the call on the following:
9
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
StronglyDisagree Disagree Neutral Agree
StronglyAgree
Faculty team presentedcontent that was relevant tothe call topics and objectives.
Faculty team responded toaudience needs during thecall.
Faculty teams' knowledgeand expertise wereappropriate for this call.
Faculty team presentedcontent in an engagingmanner.
10. Faculty Team Feedback: Warren Newton, MD; Mark Gwynne, MD; and DonnaParker, MPH.
10
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
Quality Improvement
11. As a result of participating in this monthly webinar/call, I learned about one or more ideas/changes totest in my practice regarding family-centered care.
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
12. As a result of participating in this monthly webinar/call, in the next week I will test at least one idea(strategy, resource and/or tool) using the PDSA (rapid) cycle method.
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
11
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
13. Please describe what idea/change you will test
12
Family-Centered Care Quality Improvement Project Call Evaluation: Patient AdvisoryPanels
14. How would you rate the call overall?
Poor
Fair
Neutral
Good
Excellent
15. Do you have any additional comments or questions?
13
Family Engagement Quality Improvement Project Parent/Caregiver Core Improvement Team Member “Position Description”
Parent/caregiver partners are essential to enhancing family-centered care, family engagement and
improving services and client experience in the office
Parent/caregiver partners should have knowledge and experience in caring for children
Parent/caregiver partners will work with the other core improvement team members to identify skills, expertise, and current practices as they relate to family-centered care and family engagement
The following are suggested specific parent/caregiver partner activities as members of the core improvement team:
o Provide guidance, support, and feedback to the practice team from the family perspective. o Work with your practice team to make appropriate changes in the structure of how care is
monitored and delivered to patients and families. o Share results and progress about the project with other parents/caregivers in the practice. o Share results and progress with other parent/caregiver partners involved in the Family
Engagement Quality Improvement Project. o Participate in a 60-minute orientation conference call on April 27, 2016 or April 28, 2016 at
Noon Eastern and complete necessary pre-work with the practice team. o Attend a 1.5-day Learning Session on June 3-4, 2016, at or near the AAP Headquarters in Elk
Grove Village, IL (all travel expenses will be reimbursed). o Attend a 1.5-day workshop (Learning Session 2) in January 2017 (date is tentative) at or near
the AAP Headquarters in Elk Grove Village, IL (all travel expenses will be reimbursed). o Optional: Participate a telephone evaluation interview at the end of the project, discussing
your experiences with participating in, and satisfaction with, the project.
Family Engagement Quality Improvement Project Parent/Caregiver Core Improvement Team Member “Position Description”
Parent/caregiver partners are essential to enhancing family-centered care, family engagement and
improving services and client experience in the office
Parent/caregiver partners should have knowledge and experience in caring for children
Parent/caregiver partners will work with the other core improvement team members to identify skills, expertise, and current practices as they relate to family-centered care and family engagement
The following are suggested specific parent/caregiver partner activities as members of the core improvement team:
o Provide guidance, support, and feedback to the practice team from the family perspective. o Work with your practice team to make appropriate changes in the structure of how care is
monitored and delivered to patients and families. o Share results and progress about the project with other parents/caregivers in the practice. o Share results and progress with other parent/caregiver partners involved in the Family
Engagement Quality Improvement Project. o Participate in a 60-minute orientation conference call on April 27, 2016 or April 28, 2016 at
Noon Eastern and complete necessary pre-work with the practice team. o Attend a 1.5-day Learning Session on June 3-4, 2016, at or near the AAP Headquarters in Elk
Grove Village, IL (all travel expenses will be reimbursed). o Attend a 1.5-day workshop (Learning Session 2) in January 2017 (date is tentative) at or near
the AAP Headquarters in Elk Grove Village, IL (all travel expenses will be reimbursed). o Optional: Participate a telephone evaluation interview at the end of the project, discussing
your experiences with participating in, and satisfaction with, the project.
Family Engagement Quality Improvement Project: Interview Script Page 1
Participant ID______________________
Family Engagement Quality Improvement Project
Post-Implementation Telephone Interview Script
(For Parent/Caregiver Partners Participating Individually on Interviews)
Thank you for agreeing to participate in the Family Engagement Quality Improvement Project
Interview. The purpose of this call is to learn about your experiences as participant(s) in the
project. Your feedback will be used to help us make improvements to our family engagement
initiatives and resources in the future.
I will be asking you a set of questions about your experiences during the project. There are no
right or wrong answers—your truthful responses are what count. The interview will take no
more than one hour to complete. You may choose to skip one or more questions or stop the
interview at any time.
The interview will be recorded while I take detailed notes about what was said during our
conversation. Everything you say is confidential. Your individual name(s) will not appear
anywhere on any publications resulting from this interview.
Do you have any questions or concerns before we get started? OK, I am going to start the
recording.
1. How long (how many weeks/months) did you participate as a member of the pediatric
practice quality improvement (QI) team (for clarification, the QI team includes the
Notification Email for Those Who Were Not Selected
Dear Applicant,
Thank you for applying to participate in the Family Engagement Quality Improvement
Project, a project of the National Center for Medical Home Implementation in the
American Academy of Pediatrics.
The response was overwhelming and we regret to inform you that you have not been
selected for participation in the quality improvement project. We greatly appreciate your
interest and would welcome your involvement in future projects.
The National Center for Medical Home Implementation in the American Academy of Pediatrics proudly present this
Certificate of Participation and Practice Improvement to
NAME OF PRACTICE
for outstanding contributions to the
Family Engagement Quality Improvement Project
A project with the mission of improving family engagement in practice through shared decision making and connection of families to appropriate supports and services.
Megan M Tschudy, MD, MPH, FAAP Project Leader
Michelle Z Esquivel, MPH Director, National Center for Medical Home Implementation
Director, AAP Division of Children with Special Needs
Family Engagement Quality Improvement Project
A project of the National Center for Medical Home Implementation, a cooperative agreement between the American Academy of Pediatrics and
the Maternal and Child Health Bureau of the Health Resources and Services Administration
Project Aim:
By January 2017, 10 pediatric primary care practice teams will work individually and collaboratively to test, implement, disseminate, and plan to
sustain strategies to improve family engagement in clinical practice through enhanced shared decision-making and connection of families to
appropriate supports and services. Participating pediatric primary care practices will make improvements so that:
Measure Name/Type
Measure Definition Source of Measure
Measure Calculation
Measure Exclusion
Data Source/ Associated Collection tool
Measure Benchmark
Measure Target/ Goal
Data Collection Plan
Associated Questions
Elicit patient/ family concerns
Percent of patients for whom patient/family concerns were elicited at the most recent health supervision visit.
Bright Futures
Target Population: All patients 0 – 18 years of age who received a health supervision visits Numerator: Total number of patients/families whose individual and family concerns are elicited during a visit Denominator: Total number of medical records in a record set
Patients over 18 years of age; patients seen for acute care visits
Medical record review/Record review tool
N/A 80% Volume: 10 records Frequency: Monthly Transmission: QIDA
Is there documentation in the medical record indicating that patient/family concerns were elicited at the most recent health supervision visit?
Address patient/ family concerns
Percent of patients for whom a plan was created to address patient/family concerns at the most recent health supervision visit.
Target Population: All patients 0 – 18 years of age who received a health supervision visit Numerator: Total number of patients/families for whom a plan was created to address patient/family concerns Denominator: Total number of medical records for those patients for whom families/caregivers had identified concerns.
Patients over 18 years of age; medical records without identified family/caregiver concerns
Medical record review/Record review tool
N/A 80% Volume: 10 records Frequency: Monthly Transmission: QIDA
Is there documentation in the medical record indicating a plan was created to address patient/family concerns at the most recent health supervision visit?
Identify and discuss family strengths
Percent of patients for whom family strengths were identified and discussed at the most recent health supervision visit.
Bright Futures
Target Population: All patients 0-18 years of age who received a health supervision visit Numerator: Total number of patients whose family strengths
Patients over 18 years of age; patients who were seen for an acute care visit
Medical record review/Record review tool
N/A 80% Volume: 10 records Frequency: Monthly Transmission: QIDA
Is there documentation in the medical record indicating that family strengths were identified and discussed during the
were identified and discussed during a visit. Denominator: Total number of medical records in a medical record set.
most recent health supervision visit?
Medical summary (post-visit summary) or care plan created
Percent of patients who have a medical summary (post-visit summary) or a comprehensive care plan created or updated/maintained at a visit.
Florida CHIPRA Project, Round 2
Target Population: All patients 0 – 18 years of age who received a supervision visit Numerator: Total number of patients who have a medical summary or comprehensive care plan created or updated/maintained at this visit Denominator: Total number of medical records in a medical record set
Patients over 18 years of age
Medical record review/Record review tool
N/A 80% Volume: 10 medical records Frequency: Monthly Transmission: QIDA
Is there documentation in the medical record indicating that a medical summary or comprehensive care plan that was created or updated/maintained during a visit?
Medical summary or care plan reviewed
Percent of patients who have a current copy of their medical summary (post-visit summary)
Florida CHIPRA Project, Round 2
Target Population: All patients 0 – 18 years of age who received a
Exclude charts with a “No” answer to medical
Medical record review/Record review tool
N/A 80% Volume: 10 records Frequency: Monthly
Is there documentation in the medical record indicating that
and offered to patient
or comprehensive care plan reviewed through an active form of family engagement, such as, but not limited to:
Teach-back methodology
Motivational interviewing
Ask-me-3 and offered to patients/families at the visit.
health supervision visit Numerator: Total number of patients who have a current copy of their medical summary or comprehensive care plan reviewed and offered to them at this visit Denominator: Total number of medical records in a record set with a medical summary or comprehensive care plan created
summary created measure.
Transmission: QIDA
a medical summary or a comprehensive care plan was reviewed and offered to the patient and family during an office visit?
Communica-tion of age-appropriate screening results with patients/ families
Percent of patients whose family received a follow-up discussion of age-appropriate screening results on the same day as the screening.
Adapted from the Don’t Just Wait and See: Improving Developmental Screening and Follow-
Target Population: All patients 0-18 years of age who received a health supervision visit Numerator: Number of patients with documentation in chart of family
Patients over 0-18 years of age; patients seen for acute care visits
Medical record review/Record review tool
N/A 80% Volume: 10 records Frequency: Monthly Transmission: QIDA
Is there documentation that age-appropriate screening results were discussed with the family on the same day as the visit in
up QI Project
receiving a discussion of age-appropriate screening results on the same day as the screening visit. Denominator: Total number of medical records in a record set.
the medical record?
Families feel that they can be honest with the child’s providers/clinicians about the choices they make for their child
Percent of families who indicated that they felt they can be honest with their child’s doctors and nurses about the choices they make for their child
Adapted from CG CAHPs Cultural Competence Question set, with guidance from a plain language communication consultant
Target Population: Families of all patients 0-18 years of age who received a health supervision visit Numerator: Number of families reporting “Yes” to survey question. Denominator: Total number of surveys received
Families of patients over 18 years of age; families of patients who were seen for an acute care visit
Post-visit family survey /post visit family survey data entry tool
N/A 80% Volume: 10 surveys Frequency:Monthly Transmision: QIDA
Did you feel like you could be honest with your child’s doctors and nurses about the choices you make for your child?
1. Yes 2. No
Provider/Clinician explained things about the child’s health in a way that was easy for
Percent of families who indicated that the people providing medical care to their child explained things about their child’s health in a way that
Adapted from CG CAHPS Children’s PCMH Question Set, with guidance
Target Population: Families of all patients 0-18 years of age who received health supervision visit
Families of patients over 18 years of age; families of patients who were seen for an
Post-visit family survey /post visit family survey data entry tool
N/A 80% Volume: 10 surveys Frequency:Monthly Transmision: QIDA
During today’s visit, did the people providing medical care to your child explain things about your
the family to understand
was easy to understand.
from a plain language communication consultant
Numerator: Number of families reporting “Yes” to survey question. Denominator: Total number of surveys received
acute care visit
child’s health in a way that was easy to understand?
1. Yes 2. No
Provider/clinician listens to what the family has to say
Percent of families who indicated that doctors and nurses listened to what they had to say.
Adapted from CG CAHPs PCMH Children’s question set, altered with guidance from a plain language communication consultant
Target Population: Families of all patients 0-18 years of age who received health supervision visit Numerator: Number of families reporting “Yes” to survey question. Denominator: Total number of surveys received
Families of patients over 18 years of age; families of patients who were seen for an acute care visit
Post-visit family survey /post visit family survey data entry tool
N/A 80% Volume: 10 surveys Frequency:Monthly Transmision: QIDA
Did our doctors and nurses listen to what you and your family had to say?
1. Yes 2. No
Provider/clinician gave thoughtful responses to family questions and concerns
Percent of families who indicated that doctors and nurses gave thoughtful responses to their questions and concerns.
Adapted from CG CAHPs PCMH Children’s question set, altered with guidance from a plain language
Target Population: Families of all patients 0-18 years of age who received health supervision visit Numerator: Number of families reporting
Families of patients over 18 years of age; families of patients who were seen for an acute care visit
Post-visit family survey /post visit family survey data entry tool
N/A 80% Volume: 10 surveys Frequency:Monthly Transmision: QIDA
Did our doctors and nurses give thoughtful responses to your questions and concerns?
1. Yes 2. No
communication consultant
“Yes” to survey question. Denominator: Total number of surveys received
Receptionists and clinic staff treated the family with dignity and respect
Percent of families who indicated that receptions and other clinic staff treated them with dignity and respect.
Adapted from CG CAHPS Children’s PCMH Question Set, with guidance from a plain language communication consultant
Target Population: Families of all patients 0-18 years of age who received health supervision visit Numerator: Number of families reporting “Yes” to survey question. Denominator: Total number of surveys received
Families of patients over 18 years of age; families of patients who were seen for an acute care visit
Post-visit family survey /post visit family survey data entry tool
N/A 80% Volume: 10 surveys Frequency:Monthly Transmision: QIDA
Did our receptionists and other clinic staff treat you and your family with respect?
1. Yes 2. No
Provider/clinician involved family in decisions about child’s health
Percent of families who indicated doctors and nurses involved them in decisions about their child’s health.
Adapted from the Communication Climate Assessment Toolkit , with guidance from a plain language communicat
Target Population: Families of all patients 0-18 years of age who received health supervision visit Numerator: Number of families reporting
Families of patients over 18 years of age; families of patients who were seen for an acute care visit
Post-visit family survey /post visit family survey data entry tool
N/A 80% Volume: 10 surveys Frequency:Monthly Transmision: QIDA
Did our doctors and nurses involve you and your family in decisions about your child's health?
1. Yes 2. No
ion consultant
“Yes” to survey question. Denominator: Total number of surveys received
Communica-tion with patients and families (Balancing Measure)
Percent of practices that indicated participation in the Family Engagement Quality Improvement Project made communication with patients and families easier.
Florida CHIPRA Project Round 2
At the end of each Action Period, each practice team will complete a survey on a scale of 1-5 (1= much more difficult, 5= much easier). This will measure % of practices who answered 4-5.
Think about the changes your team has implemented as part of the “Family Engagement Quality Improvement Project.” Because of this project, the amount of time it takes staff and physicians to communicate with patients and families has taken: 1. Much more
time 2. More time 3. Remained
the same 4. Less time
5. Much less time
Health care team experience (Balancing Measure)
Percent of practices that indicated participation in the Family Engagement Quality Improvement Project made the experience of providing care for patients easier for the health care team.
At the end of each Action Period, each practice team will complete a survey on a scale of 1-5 (1= much more difficult, 5= much easier). This will measure % of practices who answered 4-5.
Think about the changes your team has implemented as part of the “Family Engagement Quality Improvement Project.” Because of this project, the care team’s confidence about engaging families in shared decision-making has become: 1. Much less
confident 2. Less
confident 3. Remained
the same
4. More confident
5. Much more confident
Family Engagement Quality Improvement Project
Resource List of Project Tools
Shared Decision-Making
Fostering Partnership and Teamwork in the Pediatric Medical Home: A “How -To” Video Serieso Care Partnership Supporto Family Advisory Groupso View the corresponding webinar series, which features real-life examples of practices that
are implementing each of these strategies on a daily basis.
Achieving a Shared Plan of Care with Children and Youth with Special Health Care Needso Features template care plans and an implementation guide on how to create a plan of
care in true partnership with families and children; emphasizes strategies for shareddecision-making
Family Voices: Tips for Partnering with Your Child’s Providero This handout is specifically for families, but clinicians can keep copies in their office to
hand out to families.
Decision Aids, Cincinnati Children’s Hospitalo Evidence-based tools that help families, patients, and clinicians make shared decisions
about plans of care for children with complex conditions. These are health conditionspecific, including ADHD treatment, anticoagulation therapy, bone infection, diarrhea,HPV vaccination, Autism, among others.
Powerful Partnerships: A Handbook for Families and Providers Working Together to Improve Careo Strategies to involve families as equal members of multidisciplinary care teams.
Health Promotion
Pre-visit Questionnaires, Medical Home Practice Brochures, Child and Adolescent Health Assessment Forms, Post-visit Family/Caregiver Survey (all available under the Family-CenteredCare section of the “Building Your Medical Home” online resource guide ).
o These allow families to express their priorities and goals related to their child’s care,ensuring that each doctor’s visit focuses on the most pressing issues (both health andnon-health related) for families.
Well-Visit Plannero Same idea as above, except these resources are specifically to help families pre pare for
well-child visits (so it is age specific).
Building Your Care Notebooko Downloadable and customizable forms that help families/caregivers to organize their
child’s care, includes tracking forms for clinicians, specialists, insurance, community resources, school information, among others.
Family Support
Parent Partners: Creative Forces on Medical Home Improvement Teamso Strategies/resources for practices looking to have a parent partner employed at their
practice. This is slightly outdated, but still a good resource. Written by a parent partner.
Family-to-Family Health Information Centers
o Each state has one; all are staffed by families/caregivers of children with special health
care needs and provide peer support to families/caregivers. Although not necessarily atool, these centers are always good for clinicians to know about and refer families to.
Congratulations on being selected to participate in the Family Engagement Quality Improvement Project,
an initiative of the National Center for Medical Home Implementation (NCMHI). The NCMHI is a
cooperative agreement between the American Academy of Pediatrics and the Maternal and Child Health
Bureau of the Health Resources and Services administration.
The following information provides instructions for participation in the project, including important
dates and procedures. Please include these dates on your calendar.
Item Due Date Procedure Send To
Pre-work/Pre-Learning Session
Orientation webinar April 27, 2016, 11 am – Noon Central/Noon – 1 pm Eastern OR April 28, 2016, 11 am- Noon Central/Noon – 1 pm Eastern
All participants are required to join one webinar.
Registration Link: April 27, 2016, Noon – 1 pm Eastern
Registration Link: April 28, 2016, Noon – 1 pm Eastern
Complete pre-work assignment by viewing this video on the Model for Improvement.
N/A
Register for QIDA Project Workspace
April 28, 2016 Practice teams will receive a QIDA User Manual with instructions on how to register and use QIDA. An overview of the QIDA will be provided during the orientation webinar.
N/A
RSVP for Learning Session
April 29, 2016 Submit an RSVP form for each team member attending the in-person learning session
May 13, 2016 Review medical records for the first 20 patients age 0 – 18 years seen in the practice for health supervision visits using the medical record review tool in the QIDA. Refer to the medical record review tip sheet for questions/details.
Data entered into the QIDA
Post-visit family survey review
May 13, 2016 Collect surveys from the first 10 families of patients age 0-18 years seen in the practice for health supervision visits.
All practice teams are required to attend the in-person learning session at the Hyatt in Rosemont, Illinois (right next to O’Hare International Airport).
June 3, 2016, 1:30 – 7:00 pm
June 4, 2016, 7:30 am – 1:30 pm
N/A
Action Period/Post Learning Session
Monthly medical record review
Due on the 30th of each month:
July 30, 2016
August 30, 2016
September 30, 2016
October 30, 2016
November 30, 2016
December 30, 2016
Review medical records for the first 10 patients age 0 – 18 years seen in the practice for a health supervision visit.
Data entered into the QIDA
Monthly post-visit survey collection
Due on the 30th of each month:
July 30, 2016
August 30, 2016
September 30, 2016
October 30, 2016
November 30, 2016
December 30, 2016
Collect surveys from the first 10 families with patients age 0 – 18 years seen in the practice for health supervision visits. Surveys must be collected using an anonymous survey box.
Data entered into the QIDA
Monthly Educational Webinars/Conference Calls
All webinars/conference calls are held on Tuesdays, from Noon – 1 pm Central time/ 1- 2 pm Eastern.
July 19, 2016
August 30, 2016
September 20, 2016
October 28, 2016
November 29, 2016
December 20, 2016
All practice teams are encouraged to participate in monthly educational webinars.
Webinars/calls include educational sessions on topics related to family-engagement.
Teams should be prepared to provide information on lessons
N/A
learned, challenges, and tests of change implemented each month.
Monthly Progress Reports
Due on the 30th of each month:
July 30, 2016
August 30, 2016
September 30, 2016
October 30, 2016
November 30, 2016
December 30, 2016
Each practice team is required to complete one monthly progress report via Survey Monkey link accessed through QIDA.
Completed via Survey Monkey, accessed through QIDA.
Quality Improvement Coaching Calls
Scheduled based on availability of each practice team.
Each practice team is required to participate on at least two quality improvement coaching calls with the project’s quality improvement advisor, Ruth Gubernick.
Alex Kuznetsov ([email protected]) will assist in scheduling these calls.
Post-Action Period/Evaluation
Post-implementation survey
January 30, 2017 Each practice team is required to complete one post-implementation survey via Survey Monkey accessed through QIDA.
Completed via Survey Monkey, accessed through QIDA.
Qualitative Phone Interviews (OPTIONAL)
Scheduled based on availability of practice teams
Practice teams have the option to participate in qualitative interviews upon the completion of the project to provide feedback on their experience participating in the project. Parent/caregiver partners may also choose to participate in these calls, individually or with the practice team.
Alex Kuznetsov ([email protected]) will assist in scheduling these calls.
Learning Session 2 January 2017 A second in-person learning session Is tentatively scheduled for January 2017.
A project of the National Center for Medical Home Implementation, supported by a cooperative agreement between the American Academy of Pediatrics and the Maternal and Child Health Bureau, Health Resources and Services Administration under grant number U43MC09134.
Welcome to the Family Engagement Quality Improvement Project!
We would like to find out some general information about the family engagement activities withinyour office setting. Please complete this pre-implementation survey after the orientation webinar. The survey will take no more than 15 minutes of your time. Only one survey is needed per practiceteam.
Your survey responses will be kept strictly confidential. We will never link your responses to yourname in reports or anywhere else.
If you have any questions, please contact Alex Kuznetsov, RD, at 847-434-7087 [email protected].
In order to progress through this survey, please use the following navigation buttons:
-Click the Next button to continue to the next page.
-Click the Previous button to return to the previous page.
-Click the Done button to submit your survey.
Family Engagment Quality Improvement Project Pre-Implementation Survey
1. Please enter your practice name:*
We would like to know what types of family engagement activities you are currently involved with.
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Pre-Implementation Survey
2. Which of the following methods for gathering patient and family feedback does your practice currentlyuse to support or inform its interactions with your patients and families? (select all that apply)
*
Family Advisory Council/Committee
Patient Suggestion Box
Patient/Family Focus Groups
Patient Satisfaction Surveys
Ask patients/families for informal feedback at visits
We have no system in place to obtain regular feedback from patients/families
Other (please specify)
3. For any of the methods you checked in the previous question, how does your practice use theinformation to support or inform its interactions with your patients and families? (select all that apply)
*
Review feedback to understand patient/family perspective and assess if patient/family needs are being met
We use the information to test/implement changes
Improvement teams review feedback, plan and test improvement ideas to incorporate patients’/families perspectives
We have not yet used the feedback from patients/families
Other (please specify)
4. In your direct interactions with your patients and families, describe your approach to identifying theirculture, beliefs, values, and practices (select all that apply):
*
Use of a patient/family history or demographic form
Use of open-ended questions
Use listening and other communication skills to assess
Use direct observation
We do not routinely obtain this information from patients
Other (please specify)
5. Do you provide a community resource list to your patients who may need it?*
Yes
No
Don't Know
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Pre-Implementation Survey
6. If yes, please describe the types of information included on the community resource list (select all thatapply):
*
Education resources
Child Development/Behavior resources
Peer supports or Family-to-Family health information centers
Safety resources
Physical health resources
Teen resources
Other (please specify)
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Pre-Implementation Survey
7. Do you have a system in place for tracking and following up on referrals to appropriate supports andservices for patients/families/caregivers (these supports could include community resources, peer-to-peersupports, medical specialists, etc)?
*
Yes
No
Don't Know
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Pre-Implementation Survey
8. If yes, please specify the system you have in place for tracking and following up on referrals toappropriate supports and services for patients/families/caregivers:
*
Checkbox in patient medical record
Referral fax back form
Requests for patient summary
Follow-up phone calls
Patient registry
Other (please specify)
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Pre-Implementation Survey
9. Does your practice create a post-visit medical summary or comprehensive care plan for patients/familiesat every visit? A comprehensive care plan includes an expanded medical summary, an emergencytreatment plan, and a dynamic, explicit plan of care, also known as an action plan. A post-visit medicalsummary is a history of medical information that includes the following:
Basic demographics and contact information, including the following:
Patient and family, with guardianship identified, if applicableContact information for patient and family, including cell phone numbers and email addressesMedical HomeEmergency Contacts
Key medical, surgical, and injury historyCurrent medications, including medication reconciliationAllergiesImmunization recordInsurance informationSpecial instructions
*
Yes
No
Don't Know
10. Does your practice review and update the post-visit medical summary or comprehensive care plan withthe patient and family at each visit?
*
Yes
No
Don't Know
11. Does your practice have processes to communicate age-appropriate screening results and theirimplications to patients and families? Age-appropriate screenings include any/all listed in the Bright FuturesPeriodicity Schedule, as well as other screenings related to social determinants of health, as appropriateand necessary.
*
Yes
No
Don't Know
Part Two: Partnering with Patients and Families
Family Engagment Quality Improvement Project Pre-Implementation Survey
12. "Shared decision making” is a collaborative process that allows patients and their health care providersto make health care decisions together, taking into account the best scientific evidence available, as well asthe patient’s values and preferences.
A model for shared decision making includes: 1) introducing choice; 2) describing options; and 3) helpingpatients explore preferences and make decisions.
Based on this definition, how often would you say you engage in shared decision making with the patientsand families in your care?
*
Never
Rarely
Occasionally
Frequently
Always
13. How do you implement shared decision making in your office (select all that apply):*
Discuss options with patients and families
Discuss the pros and cons of various treatments with patients and families
Use Motivational Interviewing (MI) techniques
Use existing knowledge of patient preferences
Use decision aids in practice
We do not use any shared decision making techniques
Other (please specify)
End of Survey
Family Engagment Quality Improvement Project Pre-Implementation Survey
14. If you have any other information you would like to share, please enter it below:
Please click "Done" to submit your survey.Thank you!
Family Engagement Quality Improvement Project: Learning Session
June 3-4 2016 Hyatt Rosemont
6350 N River Road Rosemont, Illinois, 60018
Room: Coleman B Day 1, June 3, 2016 (Half Day), 1:30 – 7:00 pm
Family Engagement Quality Improvement Project Learning Session Faculty
PROJECT LEADER Megan M. Tschudy, MD, MPH, FAAP Assistant Professor, Department of Pediatrics Assistant Medical Director, Harriet Lane Clinic Division of General Pediatrics and Adolescent Medicine Johns Hopkins School of Medicine 443-287-8954 [email protected] FACULTY Vicki Hunting, BA Director of Data and Evaluation
Hands & Voices, Inc. Headquarters 515-988-8512 [email protected] Camille Graham, MD, FAAP Executive Community Physician Leader Medical Director, Cincinnati Pediatric Research Group Assistant Professor, Division of General and Cincinnati Children’s Hospital 513-803-8065 [email protected] Julia Richerson, MD, FAAP Medical Director, Interim Family Health Centers of Louisville 502-772-8120 [email protected] Brad Thompson, MA LPC
Alan Weller, MD, FAAP Assistant Professor of Pediatrics Robert Wood Johnson University Hospital 732-235-7044 [email protected] CONSULTANTS Ruth Gubernick, PhDc, MPH Quality Improvement Advisor 856-477-2177 [email protected] STAFF Christina Boothby, MPA Manager, National Center for Medical Home Implementation American Academy of Pediatrics 847-434-4311 [email protected] Michelle Esquivel, MPH Director, Division of Children with Special Needs Director, National Center for Medical Home Implementation American Academy of Pediatrics 847-434-4989 [email protected] Krysta Gerndt, MPH Program Manager American Academy of Pediatrics 847-434-7616 [email protected] Alex Kuznetsov, RD Program Manager National Center for Medical Home Implementation American Academy of Pediatrics 847-434-7087 [email protected]
Family Engagement Quality Improvement Project Work Group Roster
PROJECT LEADER Megan M. Tschudy, MD, MPH, FAAP Assistant Professor, Department of Pediatrics Assistant Medical Director, Harriet Lane Clinic Division of General Pediatrics and Adolescent Medicine Johns Hopkins School of Medicine 443/287-8954 [email protected] MEMBERS Janet DesGeorges Executive Director, Hands and Voices, Inc. Parent Consultant, Colorado Home Intervention Program 303-492-6283 [email protected] Camille Graham, MD, FAAP Executive Community Physician Leader Medical Director, Cincinnati Pediatric Research Group Assistant Professor, Division of General and Cincinnati Children’s Hospital 513-803-8065 [email protected] Julia Richerson, MD, FAAP Medical Director, Interim Family Health Centers of Louisville 502-772-8120 [email protected] Alan Weller, MD, FAAP Assistant Professor of Pediatrics Robert Wood Johnson University Hospital 732/235-7044 [email protected]
CONSULTANTS Ruth Gubernick, PhDc, MPH Quality Improvement Advisor 856-477-2177 [email protected] Pam Kelley, PhD Research and Evaluation Consultant Kelley Analytics, LLC 732/742-8908 [email protected] STAFF Christina Boothby, MPA Manager, National Center for Medical Home Implementation American Academy of Pediatrics 847/434-4311 [email protected] Michelle Esquivel, MPH Director, Division of Children with Special Needs Director, National Center for Medical Home Implementation American Academy of Pediatrics 847/434-4989 [email protected] Krysta Gerndt, MPH Program Manager American Academy of Pediatrics 847/434-7616 [email protected] Alex Kuznetsov, RD Program Manager National Center for Medical Home Implementation American Academy of Pediatrics 847/434-7087 [email protected]
MODEL FOR IMPROVEMENT Team Name:
Plan a Test of Change Cycle #:___ Start Date: ____ End Date: ____
Objective for this PDSA Cycle (Aim):
PLAN: QUESTIONS PREDICTIONS
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/12/16 End Date: 7//13
Objective for this PDSA Cycle (Aim): By September 30, 2016, our practice will be using the shared decision making (SDM) aid, “ADHD Medication Choice Cards,” with at least 95% of the parents/caregivers of our patients who are newly diagnosed with ADHD and are interested in medication as a treatment option.
PLAN: QUESTIONS Can our care coordinator send out this decision aid, as well as the Pre-encounter/visit cards and booklet on ADHD treatment modalities to the appropriate parents/caregivers via the patient portal at least 1 week prior to the scheduled visit? Will parents/caregivers read and complete the personal information and cost estimates prior to being seen by the physician? Will Dr. Gordon have time to review and discuss it with the family? Will this aid be helpful to parents/caregivers?
PREDICTIONS We predict that our care coordinator, Linda, will successfully send these resources/tools at least 1 week prior to the visit at least 95% of the time. We predict at least 90% of the parents/caregivers will complete the treatment goals and preferences card; 70% will add behavior treatments tried, currently trying or interested in trying; 75% will add personal information to the Medication Choice card; only 50% will complete the out-of-pocket cost estimates. Dr. Gordon predicts this will increase the visit time but will help the parent/caregiver be more knowledgeable and involved with the treatment plan.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Tasks: Linda will confirm that there is 1 or more patient(s), <11 yrs. old and newly diagnosed with ADHD scheduled for appointments on July 12th and/or 13th. She will also print out the Medication Choice cards, as instructed on the Cincinnati Children’s website (http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/decision-aids/ ). Dr. Gordon will study the “Card Guide”( http://www.cincinnatichildrens.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=100745&libID=100440 ) for discussing medication treatment options with the parent/caregiver. On July 5th, Linda will send a message and the ADHD Pre-visit cards and Medication Choice cards via the patient portal to the parents/caregivers whose children meet the criteria, with instructions to complete the goals/preferences, behavior treatment(s) and personal information sections and out-of-pocket medication cost estimates, if appropriate. Parents will be asked to bring the completed information to their visit. Prior to entering the exam room, Dr. Gordon will be handed the parent-completed goal/preference card, behavioral treatment card and ADHD medication choice cards by the Joyce (MA).
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of each day, Linda will review the records of those newly diagnosed ADHD patients seen by Dr. Gordon. She will record total # of patients who brought with them the ADHD SDM aids and note what sections had been completed prior to the visit. Dr. Gordon will share parent/caregiver feedback and his own reflections about the process.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/12/16 End Date: 7/1316
Objective for this PDSA Cycle (Aim): By September 30, 2016, our practice will be using the shared decision making (SDM) aid, “ADHD Medication Choice Cards,” with at least 95% of the parents/caregivers of our patients who are newly diagnosed with ADHD and are interested in medication as a treatment option.
PLAN: QUESTIONS Can our care coordinator send out this decision aid, as well as the Pre-encounter cards and booklet on ADHD treatment modalities to the appropriate parents/caregivers via the patient portal at least 1 week prior to the scheduled visit? Will parents/caregivers read and complete the personal information and cost estimates prior to being seen by the physician? Will Dr. Gordon have time to review and discuss it with the family? Will this aid be helpful to parents/caregivers?
PREDICTIONS We predict that our care coordinator, Linda, will successfully send these resources/tools at least 1 week prior to the
visit at least 95% of the time. We predict at least 90% of the parents/caregivers will complete the treatment goals and preferences card; 70% will add behavior treatments tried, currently trying or interested in trying; 75% will add personal information to the Medication Choice card; only 50% will complete the out-of-pocket cost estimates. Dr. Gordon predicts this will increase the visit time but will help the parent/caregiver be more knowledgeable and involved with the treatment planning.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Tasks: Linda will confirm that there is 1 or more patient(s), <11 yrs. old and newly diagnosed with ADHD scheduled for appointments on July 12th and/or 13th. She will also print out the Medication cards, as instructed on the Cincinnati Children’s website (http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/decision-aids/ ). Dr. Gordon will study the “Card Guide” (http://www.cincinnatichildrens.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=100745&libID=100440) for discussing medication treatment options with the parent/caregiver. On July 5th, Linda will send a message and the ADHD Pre-visit cards and Medication cards via the patient portal to the parents/caregivers whose children meet the criteria, with instructions to complete the goals/preferences, behavior treatment(s) and personal information sections and out-of-pocket medication cost estimates, if appropriate. Parents will be asked to bring the completed information to their visit. Prior to entering the exam room, Dr. Gordon will be handed the parent-completed goal/preference card, behavioral treatment card and ADHD medication choice cards by the Joyce (MA).
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of each day, Linda will review the records of those newly diagnosed ADHD patients seen by Dr. Gordon. She will record total # of patients who brought with them the ADHD SDM aids and note what sections had been completed prior to the visit. Dr. Gordon will share parent/caregiver feedback and his own reflections about the process.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances. Linda sent messages and resources on July 5th to 3
parents/caregivers who children met the criteria and had appointments on July 13th. All 3 parents brought the cards with them but only one had completed all the requested information. All 3 parents wanted to discuss medication options. Dr. Gordon said the first discussion took a long time because he presented all of the medication choice issue cards but forgot to ask the parent which one she wanted to discuss first. Found he didn’t need to discuss all 5 cards when he remembered to do that (ask first) with the other 2 parents!
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED Only one parent completed the medication cost estimate. One parent was unable to get the info from her health plan and one forgot. Dr. Gordon reported that following the “card guide” was helpful for him but he feels he needs more practice! Parents reported that the aids increased their knowledge of ADHD treatment options, were easy to understand and helped them be involved in making the decision about their child’s treatment plan. Dr. Gordon reported parents more involved. They all liked the medication issue cards. One parent was surprised when Dr. Gordon asked her which medication issue she wanted to discuss first. One parent expressed appreciation for the booklet and for being referred to a parent support group.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test? Plan for
next cycle: What happens when parent/caregiver has not completed or brought the cards with them? Can they be given
to the parent/caregiver to complete in the exam room or completed by Dr. Gordon, in discussion with the family? Note: We also need to learn what summer behavioral treatment programs are available in our community/county!
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/2/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will use the Teach Back Method as a strategy to actively Engage patients and their families with their Asthma Actions Plan so that at least 80% have documentation in their record of the use of this patient engagement tool at their most recent appropriate acute or well-care visit.
PLAN: QUESTIONS Do Dr. Green and the clinical staff know how to conduct Teach Back?
Can this strategy be incorporated into the visit? Can it be documented in the EHR? PREDICTIONS It will take some practice for Dr. Green to feel comfortable asking for patient/parent
to share in own words what she explained regarding when to use which asthma medications.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Task: Prior to 7/1, Dr. Green and clinical staff will review the Teach Back toolkit (http://www.nchealthliteracy.org/toolkit/tool5.pdf ) and the “Always Use Teach Back” resources (http://www.ihi.org/resources/Pages/Tools/AlwaysUseTeachBack!.aspx) Dr. Green will conduct teach-back with the last patient scheduled tomorrow who has a diagnosis of asthma and a newly created or updated asthma action plan. Dr. Green will review the plan with the patient and/or parent/caregiver and then will ask “I want to be sure that I explained the medications correctly. Can you tell me how and when you are going to take/give these medicines?” This process will be repeated until the patient/parent or caregiver can explain it properly in own words. At end of visit, Dr. Green will ask patient and/or parent/caregiver for their feedback about the usefulness of the technique.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Documentation of feedback from patient and/or parent/caregiver about the usefulness of the method. Dr. Green will also give feedback and her reflections about using the teach-back method.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/216
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will use the Teach Back Method as a strategy to actively Engage patients and their families with their Asthma Actions Plan so that at least 80% have documentation in their record of the use of this patient engagement tool at their most recent appropriate acute or well-care visit.
PLAN: QUESTIONS Do Dr. Green and the clinical staff know how to conduct Teach Back?
Can this strategy be incorporated into the visit? Can it be documented in the EHR? PREDICTIONS It will take some practice for Dr. Green to feel comfortable asking for patient/parent to share in own words what she explained regarding when to use which asthma medications.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Task: Prior to 7/1, Dr. Green and clinical staff will review the Teach Back toolkit (http://www.nchealthliteracy.org/toolkit/tool5.pdf ) and the “Always Use Teach Back” resources (http://www.ihi.org/resources/Pages/Tools/AlwaysUseTeachBack!.aspx) Dr. Green will conduct teach-back with the last patient scheduled tomorrow who has a diagnosis of asthma and a newly created or updated asthma action plan. Dr. Green will review the plan with the patient and/or parent/caregiver and then will ask “I want to be sure that I explained the medications correctly. Can you tell me how and when you are going to take/give these medicines?” This process will be repeated until the patient/parent or caregiver can explain it properly in own words. At end of visit, Dr. Green will ask patient and/or parent/caregiver for their feedback about the usefulness of the technique. PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Documentation of feedback from patient and/or parent/caregiver about the usefulness of the method. Dr. Green will also give feedback and her reflections about using the teach-back method.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Dr. Gordon conducted the teach-back method, as planned. She found she talked too fast and needed to slow down so she could explain the plan clearly to the patient’s mother.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED The parent reported she felt intimidated at first that she was going to have to explain what she heard but said the way Dr. Gordon explained that she wanted to make sure she had explained it well made her feel better. Dr. Gordon said she learned to keep the instructions simple and not rush through them. She felt it will take some practice to get better at doing it, as well as to remember to do it routinely.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan for next cycle: Dr. Gordon will use the teach-back method for the first 2 patients scheduled tomorrow with a
diagnosis of asthma and will ask patients/families for feedback again. She will share what she’s learned with her colleagues at the staff meeting later in the week.
Plan a Test of Change Cycle #:_1_Start Date: 7/18/16 End Date: 8/5/16
Objective for this PDSA Cycle (Aim): By August 31, 2016, at least 90% of the primary caregivers of our 11 yrs. old patients who were seen for a well visit that month will have completed and returned the Pre-visit Contact form via the patient portal at least 24 hours prior to the scheduled appointment. This will help update our healthcare information since the patient’s last visit and the top 3 concerns/topics to be discussed at the visit.
PLAN: QUESTIONS Will the parents/caregivers respond to our request via the Patient Portal?
How far in advance of the appointment should staff send the request for the completion of the form?
PREDICTIONS At least 75% of the parents/caregivers will return the form at least 24 hrs. before scheduled appointment.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Starting in mid-July, secure emails will be sent by Mary (PSA) on Mondays via the patient portal to primary caregivers 2
weeks prior to each patient’s scheduled well-care visit. The email will include the Pre-visit Contact form and instructions on
how to complete and submit it at least 24 hrs. before the patient’s scheduled visit. Returned forms will be scanned into the patient’s record. Joyce (MA) will access and review the form when rooming the patient. If no form is there, she will ask the questions and document the answers in the patient’s record for physician/NP to use.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of 8/1, count # of 11 yrs. old patients seen that day for well visit and how many had documentation in the record of a completed pre-visit form (# completed prior to visit and # completed that day). At end of visit, parent/caregiver will be asked for feedback about the form…was it useful? What did they like about it? What changes should be made?
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/18/16 End Date: 8/5/16
Objective for this PDSA Cycle (Aim): By August 31, 2016, at least 90% of the primary caregivers of our 11 yrs. old patients who were seen for a well visit that month will have completed and returned the Pre-visit Contact form via the patient portal at least 24 hours prior to the scheduled appointment. This will help update our healthcare information since the patient’s last visit and the top 3 concerns/topics to be discussed at the visit.
PLAN: QUESTIONS Will the parents/caregivers respond to our request via the Patient
Portal? How far in advance of the appointment should staff send the request for the completion of the form?
PREDICTIONS At least 75% of the parents/caregivers will return the form at least 24 hrs. before scheduled appointment.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Starting in mid-July, secure emails will be sent by Mary (PSA) on Mondays via the patient portal to primary caregivers 2
weeks prior to each patient’s scheduled well-care visit. The email will include the Pre-visit Contact form and instructions on
how to complete and submit it at least 24 hrs. before the patient’s scheduled visit. Returned forms will be scanned into the patient’s record. Joyce (MA) will access and review the form when rooming the patient. If no form is there, she will ask the questions and document the answers in the patient’s record for physician/NP to use.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of each day during week of 8/1, count # of 11 yrs. old patients seen that day for well visit and how many had documentation in the record of a completed pre-visit form (# completed prior to visit). At end of visit, parent/caregiver will be asked for feedback about the form…was it useful? What did they like about it? What changes should be made?
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
On July 18th, Mary sent the secure emails to the primary caregiver of each 11 yrs. old patient with an appointment scheduled during the week of Aug.1st. Of the 10 families she emailed, all had portal accounts (thanks to our recent enrollment campaign!); 1 did not have a valid email address so she followed up with that mom by phone. Two completed forms were returned by the end of the day!
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED Of the 10 parents/caregivers contacted for that week’s appointments, only 6 (60%) completed and returned the form at least 24 hrs. prior to the visit. Joyce report that 2 completed/submitted forms were not found in the patient’s record to review and the questions had to be asked again which did not make the parent/caregiver happy. All 6 parents/caregivers offered feedback: Q2 had a duplicate question; for Q4, being asked “who” was confusing; for Q5, how do they know if the patient will need bloodwork? They all liked Q7 (top 3 concerns/topics to discuss at the visit). Four reported getting the email 2 weeks before the visit gave them time to put it aside. A reminder would be helpful. Dr. Gordon reported she forgot to review the form for the first two 11 yrs. old patients she saw (she’d missed Huddle that morning!). An additional 4 parents/caregivers who scheduled the patient’s adol. well-visit less than 2 week before the appointment date did not receive a form via the portal prior to the appointment so all had to complete the form at the appointment!
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE: Mary will generate emails, with form, 1 week before appointment data and will edit message of auto-reminder sent 48 hrs. before appointment date. Joyce will download submitted forms each day and scan them into the patient’s record prior to the visit. Huddle will include # of 11 yrs. old being seen for well-visits that day (as reminder to review/discuss pre-visit form and HPV decision aid which are both currently being tested).
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/15/16 End Date: 8/1/16
Objective for this PDSA Cycle (Aim): By August 1, 2016, at least 90% of our patients who receive care coordination services and are scheduled to be seen for a visit that month will complete the Family- Centered Care (FCC) Coordination Questionnaire via our patient portal prior to the scheduled appointment so we have better information about family concerns, needs and preferences in the care their child receives.
PLAN: QUESTIONS What percentage (%) of those patients/families have an activated
portal account? Will these questionnaires be completed and returned to our care coordinator prior to the patient’s scheduled visit?
PREDICTIONS Since we have worked hard to document a current email address in the EHR for each patient/family, we believe that at least 75% of our families with children with special health care needs (CSHCNs) will have completed the form prior to their appointment.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Task: Harriet (Care Coordinator) will assess portal account status of families with CSHCNs who are scheduled to be seen in August in our office. Those families without an activated account will be referred to our tech support staff member (Ernest) to do follow up and help them sign up for the portal and gain access. On July 15h, Harriet will send a secure email via the patient portal with the 1-page FCC Coordination Questionnaire (https://medicalhomes.aap.org/Documents/FamilyCenteredCareCoordination.pdf ) attached. Instructions to email the completed form back to her prior to the scheduled visit, using the portal’s secure email system or to fax it back to her attention or bring the completed form to the visit.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Harriet will document and count how many emails were sent out by her via the portal. Of those how many completed questionnaires were returned via the portal email, the fax or returned at the time of the visit.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/15/16 End Date: 8/1/16
Objective for this PDSA Cycle (Aim): By August 1, 2016, at least 90% of our patients who receive care coordination services and are scheduled to be seen for a visit that month will complete the Family- Centered Care (FCC) Coordination Questionnaire via our patient portal prior to the scheduled appointment so we have better information about family concerns, needs and preferences in the care their child receives.
PLAN: QUESTIONS What percentage (%) of those patients/families have an activated
portal account? Will these questionnaires be completed and returned to our care coordinator prior to the patient’s scheduled visit?
PREDICTIONS Since we have worked hard to document a current email address in the EHR for each patient/family, we believe that at least 75% of our families with children with special health care needs (CSHCNs) will have completed the form prior to their appointment.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Task: Harriet (Care Coordinator) will assess portal account status of families with CSHCNs who are scheduled to be seen in August in our office. Those families without an activated account will be referred to our tech support staff member (Ernest) to do follow up and help them sign up for the portal and gain access. On July 15h, Harriet will send a secure email via the patient portal with the FCC Coordination Questionnaire (https://medicalhomes.aap.org/Documents/FamilyCenteredCareCoordination.pdf ) attached. Instructions to email the completed form back to her prior to the scheduled visit, using the portal’s secure email system or to fax it back to her attention or bring the completed form to the visit.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Harriet will document and count how many emails were sent out by her via the portal. Of those how many completed questionnaires were returned via the portal email, the fax or returned at the time of the visit.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Harriet found that only about 50% of those families with CSHCNs have an activated patient portal account. Those without an active portal account were referred to Ernest for follow up. Emails were sent on July 15th by Harriet via the portal to all parents/caregivers with an activated account.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED Of those families referred for follow up by Ernest, he reported that only 15% of those he contacted signed up and activated their portal account. Harriet will plan to meet with the QI team to discuss how to improve patient portal enrollment and to plan one or more tests of change with an aim to increase portal participation. Of those who received the email with the FCC questionnaire, 60% completed and returned the questionnaire via the secure email system, 10% faxed the form back prior to the appointment date and 10% brought the completed form to the visit.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan for next cycle: Need to increase patient portal enrollment and activation before conducting the next cycle.
For next cycle, Harriet will also ask parents/caregivers for feedback about the communication process and about the questionnaire.
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/1/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will routinely ask a set of questions to assess resilience of primary caregivers of our patients 0-3 yrs. old, as part of the well-child care (WCC) visit so we can better help them build their resilience and plan proactively how to respond to stressful parenting situations.
PLAN: QUESTIONS Can additional questions be integrated into the WCC visit?
How will they be documented in the patient’s record?
PREDICTIONS Questions will be verbally asked by Dr. Richards to at least 75% of the primary caregivers seen for a WCC visit tomorrow afternoon and documented in the patient records.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Completed Tasks: The 7 “Questions to ask” on the Strengthening Families’ “Parental Resilience: Action Sheet” (http://www.cssp.org/reform/strengtheningfamilies/about/body/ProtectiveFactorsActionSheets.pdf ) were reviewed by Parents/Caregivers who attended our June 15th Advisory Group meeting (PFAG). They reached consensus for Dr. Richards to test asking questions #4-6 at the initial visit. A smart set of those questions has been added to the EHR by Dr. Green. On Tuesday afternoon, Dr. Richards will test asking those questions to primary caregivers of patients 0-3 yrs. old being seen by him for a WCC visit.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of the afternoon, Joyce (MA) will tally the total # of patients 0-3 seen by Dr. Richards and the # of those with documentation that the “resilience” related questions were asked. The aggregate de-identified results also will be shared via email with the members of our PFAG.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/1/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will routinely ask a set of questions to assess resilience of primary caregivers of our patients 0-3 yrs. old, as part of the well-child care (WCC) visit so we can better help them build their resilience and plan proactively how to respond to stressful parenting situations.
PLAN: QUESTIONS Can additional questions be integrated into the WCC visit?
How will they be documented in the patient’s record?
PREDICTIONS Questions will be verbally asked by Dr. Richards to at least 75% of the primary caregivers seen for a WCC visit tomorrow afternoon and documented in the patient records .
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Completed Tasks: The 7 “Questions to ask” on the Strengthening Families’ “Parental Resilience: Action Sheet” (http://www.cssp.org/reform/strengtheningfamilies/about/body/ProtectiveFactorsActionSheets.pdf ) were reviewed by Parents/Caregivers who attended our June 15th Advisory Group meeting (PFAG). They reached consensus for Dr. Richards to test asking questions #4-6 at the initial visit. A smart set of those questions has been added to the EHR by Dr. Green. On Tuesday afternoon, Dr. Richards will test asking those questions to primary caregivers of patients 0-3 yrs. old being seen by him for a WCC visit.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of the afternoon, Joyce (MA) will tally the total # of patients 0-3 seen by Dr. Richards and the # of those with documentation that the “resilience” related questions were asked. The aggregate de-identified results also will be shared via email with the members of our PFAG.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Dr. Richards used the smart set questions as part of the appropriate WCC visits. He also took time to document the responses in the Notes section of the visit record. He felt it would be helpful information for future interactions with the family. He reported that the reaction from the parent of a 2-yrs. old was “why are you asking me these questions?” so he started prefacing his questions by saying that he is asking them to all parents/caregivers with a child 0-3 yrs. old.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED All 5 of the primary caregivers seen by Dr. Richards this afternoon were asked the resilience questions during the visit (except 1 grandmother who was not the primary caregiver) = 100%. Dr. Richards shared that the patients/families he saw this afternoon did not have any special needs so asking the questions did not blow his schedule out of the water but he expressed concern about taking the time when that is not the case. Can someone else ask those questions or should we consider sharing these questions with the family prior to the scheduled appointment and asking them to write down their answers?
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan for next cycle: PFAG members would like to get informal feedback from the primary caregivers at the end of the
visit. For Cycle 2, Alice (N Manager) will ask those parents/caregivers (before check-out) for feedback about those
questions they were asked and what else they may want/need (e.g., would they like information or help developing a plan in advance for how they will keep themselves calm and centered in these stressful circumstances).
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/25/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will invite at least 1 community-based organization (CBO) or state agency on our referral/resource list, such as Early Intervention (EI) to attend our monthly physician and staff meeting to help us better connect our families with appropriate supports and services, based on their needs.
PLAN: QUESTIONS Who should we invite first? Will a rep from the organization/agency be
willing/able to attend our meeting? Can we allot a half hour of our agenda for this purpose? Will it be useful for everyone or just physicians?
PREDICTIONS We can schedule a rep to attend our next meeting but it may be difficult because it is summer and people are on vacation. This opportunity to meet with a CBO or state agency we currently refer patients to will be useful for both physicians and staff members.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Our core team decided that Mary Jo (Nurse Manager) will contact the EI program tomorrow and invite someone to attend our monthly meeting in our office and give a brief 15-20 minute presentation about services and eligibility and be prepared to take 10-15 minutes of questions from the group.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE An evaluation form will be completed by each participant at the end of the meeting: Was it helpful/useful? Why or why not? How can we improve it next time? What organization/agency should be invited to our next meeting?
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/25/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will invite at least 1 community-based organization (CBO) or state agency on our referral/resource list, such as Early Intervention (EI) to attend our monthly physician and staff meeting to help us better connect our families with appropriate supports and services, based on their needs.
PLAN: QUESTIONS Who should we invite first? Will a rep from the organization/agency be
willing/able to attend our meeting? Can we allot a half hour of our agenda for this purpose? Will it be useful for everyone or just physicians?
PREDICTIONS We can schedule a rep to attend our next meeting but it may be difficult because it is summer and people are on vacation. This opportunity to meet with a CBO or state agency we currently refer patients to will be useful for both physicians and staff members.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Our core team decided that Mary Jo (Nurse Manager) will contact the EI program tomorrow and invite someone to attend our monthly meeting in our office and give a brief 15-20 minute presentation about services and eligibility and be prepared to take 10-15 minutes of questions from the group.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE An evaluation form will be completed by each participant at the end of the meeting: Was it helpful/useful? Why or why not? How can we improve it next time? What organization/agency should be invited to our next meeting?
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Two representatives from the EI program our staff meeting on July 25th. Good questions were asked. There was some confusion among the physicians about the referral process. A lengthy discussion followed about how communication and information sharing by EI with our practice needs to be improved. The program manager left her card and encouraged the physicians and staff to call her in the future with any questions or concerns related to these issues.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED All participants completed the evaluation form but it up took too much time. Overall, everyone thought the presentation and information shared was useful. The physicians especially liked the face-to-face interaction. Feedback included that next time 1 or more parents/caregivers who use or have used the services of the invited org/agency should be invited to attend that part of our meeting. Three physicians would like to learn more about the Family-to-Family Health Information Centers.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan for next cycle: There is no August meeting. Mary Jo will contact our state’s Family-to-Family Health Information
Center and invite them to attend our Sept. meeting. We will also identify 1 or more family(ies) who use the support and/or services that they offer and invite them to attend that portion of our meeting. Rather than collecting the evaluation/feedback on paper, we will test using Survey Monkey and send the URL via email to each meeting attendee after our next meeting.
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/1/16
Objective for this PDSA Cycle (Aim): By July 1, 2016, our practice will test a care plan that includes elements needed by healthcare professionals, patients and parents/caregivers to ensure seamless planned care.
PLAN: QUESTIONS What elements can currently be populated from our EHR?
What elements do the physicians and other clinicians in our practice want included? What elements do patients and parents/caregivers want/need?
PREDICTIONS This will require an iterative process but, over time, we will be able to create a balance between the practice and patient/family needs (and not be >4-pages).
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Tasks: By June 10th, Alice (N Manager) will export to Excel a list of all of the care plan elements included as possible choices in the NICHQ Care Plan Template which she downloaded from http://medicalhome.nichq.org/resources/chipra-care-plan-template. She will cross-walk it with data fields currently in our EHR. She will also share the file via email with all of the physicians and clinicians, as well as the 15 members of our Parent/Family Advisory Group, asking them by June 17th to place an “X” in the appropriate column for each element which is a “must include” and for each element viewed as a “could include.” Alice will tally the results to share with our core QI team, including our parent partner, when they meet on June 24thto identify the initial care plan elements to be included and tested by Dr. Green. On July 1, this initial care plan template will be tested by Dr. Green with the last patient with special healthcare needs he is scheduled to see that day.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Feedback will be collected from Dr. Green about the ease in creating, sharing and reviewing the care plan with the patient/family. Feedback will also be collected from the patient and/or parent/caregiver about the usefulness of the information provided and ease in understanding the plan, based on format and organization. Both physician and parent/caregiver will be asked what else is needed or should be changed.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/1/16
Objective for this PDSA Cycle (Aim): By July 1, 2016, our practice will test a care plan that includes elements needed by healthcare professionals, patients and parents/caregivers to ensure seamless planned care.
PLAN: QUESTIONS What elements can currently be populated from our EHR?
What elements do the physicians and other clinicians in our practice want included? What elements do patients and parents/caregivers want/need?
PREDICTIONS This will require an iterative process but, over time, we will be able to create a balance between the practice and patient/family needs (and not be >4-pages).
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Tasks: By June 10th, Alice (N Manager) will export to Excel a list of all of the care plan elements included as possible choices in the NICHQ Care Plan Template which she downloaded from http://medicalhome.nichq.org/resources/chipra-care-plan-template. She will cross-walk it with data fields currently in our EHR. She will also share the file via email with all of the physicians and clinicians, as well as the 15 members of our Parent/Family Advisory Group, asking them by June 17th to place an “X” in the appropriate column for each element which is a “must include” and for each element viewed as a “could include.” Alice will tally the results to share with our core QI team, including our parent partner, when they meet on June 24thto identify the initial care plan elements to be included and tested by Dr. Green. On July 1, this initial care plan template will be tested by Dr. Green with the last patient with special healthcare needs he is scheduled to see that day.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Feedback will be collected from Dr. Green about the ease in creating, sharing and reviewing the care plan with the patient/family. Feedback will also be collected from the patient and/or parent/caregiver about the usefulness of the information provided and ease in understanding the plan, based on format and organization. Both physician and parent/caregiver will be asked what else is needed or should be changed.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Tasks were completed as described in Plan. Dr. Green was able to create, print out, share and review the care plan with the last patient with special healthcare needs that he saw today. Many fields were populated with data from our EHR which was helpful but that did not include information recorded as a “Note.” It was “tested” with a 5 yrs. old child whose mom has been good advocate for her at her school. She reported that she likes the information about her child’s strengths and favorite activities but doesn’t like that it includes the fact that she has trouble paying for her daughter’s medications, since she shares this plan with the school nurse.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED The feedback was shared with the QI team. Since the printed care plan was only 3 pages long, there is an opportunity to add some additional elements, preferably one or two “could include” that are already being collected in the EHR. The QI team is reconsidering including social risks which the physicians/clinicians wanted but not the parents/caregivers. Need to prioritize “must have” elements that currently require typing the information into the template, to see which could be created as data fields in the EHR that could then populate the care plan electronically.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE: Care plan template was tweaked, to remove social risks and add list of “primary”
school team members and community-based providers engaged with the child/youth (daycare, Early Intervention, Head Start, transportation providers, etc.), and contact information. Dr. Green will test the use, sharing and review of care plan with patients/families with CSHCNs seen tomorrow and will gather and give feedback to the QI team. Findings of these cycles will also be shared and discussed at the full staff meeting next week.
METHODS FOR TEACHERS AND PARENTS TO USE TO IMPROVE CLASSROOM PERFORMANCE How does this help?Teachers can use many of the same methods as parents to help children
behave in class (e.g. set small goals, use time-outs, reward systems, and point
systems). Daily Report Cards are often used to change behavior in class.
They provide a way for teachers and parents to better communicate about
progress toward goals. Classroom aides or tutors help children with
organization and study skills.
What is usually involved?In studies where this helped, teachers and classroom aides and tutors received
formal training on methods that are helpful for children with ADHD. This
was important because many teachers receive no formal education about ADHD
during their training. There are key differences in the types of methods that
work best for children with ADHD compared to those without ADHD.
What is available nearby?There are no programs nearby that will go to your child’s school and
work with your child’s teacher. The parent groups (described before) offered
by Cincinnati Children’s Hospital do include advice about how to work
better with your child’s teacher. This includes how to use a daily report card,
how to tailor classroom methods for children with ADHD, and how to
request aid for your child. For more information, call (513) 636-4336 and
press the pound key (#) or visit: http://www.cincinnatichildrens.org/
· The website “Parents Helping Parents” offers a sample letter
to request further educational testing be done at school.
– http://www.php.com/specialed/story2
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METHODS TO IMPROVE PEER RELATIONS IN CLASSROOM AND PLAY SETTINGS How does this help?Children learn how to more effectively interact with and relate to their peers
(e.g. social skills training). This helps children make and improve friendships
with their peers in classroom and play settings. Teachers and counselors use goal
setting, reward systems, point systems, and daily report cards. Children practice
social skills in the classroom, in team sports, and in other activities. The staff
works with parents to develop daily goals for each child. If the child achieves his
or her goal, the parent provides rewards at home.
What is usually involved?In studies where this helped, children typically attended a Summer Treatment
Program that lasted all day for 5 to 8 weeks. It is important to know that
social skills programs that meet once or twice a week at a clinic are not as helpful
as the summer programs that work with children in real world settings.
What is available nearby?There are no programs nearby that work with children in classroom and
play settings. The most well known summer treatment program is located in
Buffalo, New York (http://ccf.buffalo.edu/STP.php).
The two closest programs to Cincinnati are:
· Cleveland: www.clevelandclinic.org/STP.
· Chicago: www.jcys.org/campstar/
What can I read to learn more about this on my own?· Why Don’t They Like Me? Helping Your Child Make and Keep Friends
By Susan M. Sheridan, PhD
This is great book for parents of children with peer difficulties. The
methods Dr. Sheridan describes are similar to those taught in Summer
Treatment Programs for children with ADHD.
17
PROS & CONSHow can this treatment help my child?
· Behavioral treatment alone will help about one-third of children with ADHD. These
children will pay attention and control their impulses as well as the average child
their age that does not have ADHD. They also will be less hyper. Other children may
find behavioral treatment helpful without the same high level of success.
· You do not have to deal with the possible side effects from medicine.
· You can always change your mind and try medicine also.
Here is our best guess of what will happen to 100 children with ADHD if they
get behavioral treatment alone (with all 3 types described before) for 14 months.
What are possible problems with this treatment?
· Behavioral treatments take time for parents, teachers, and children to do.
· Formal programs may be limited nearby. There may be a wait list to access
the programs that are available.
· Behavioral treatments cost money (to you and/or your insurance plan).
IF YOU CHOOSE BEHAVIORAL TREATMENT:· Continuing behavioral treatment: The first step is learning methods to help
your child manage his or her behavior. Next, you need to use these methods
regularly. These methods will become part of your parenting skills. You may
need to refresh these skills through reading and/or meeting with professionals.
· Behavioral treatment changes: Certain methods may work for a while and
then stop working. You may need to learn different methods. It is very important
for you and your child’s teacher to keep a close eye on how things are going.
Contact your child’s doctor if any problems come up.
HERE IS AN EXAMPLE OF HOW CHOICES ABOUT TREATMENT CAN CHANGE OVER TIME:Erik’s mom used a reward system at home over the summer to help him complete tasks.
She noticed that he struggled with task completion when he started back to school. She
met with his teacher and they developed a daily behavioral report card.
34
66
Number who have self-control and focus as well as the average child their age who doesn’t have ADHD
Number who don’t improve to that level
18
19
Medication treatment is an active treatment that uses drug therapy to control ADHD
symptoms.
HOW DOES MEDICINE FOR ADHD WORK?These pictures show what the brain looks like when a child pays attention.
The yellow box shows the parts of the brain that are needed for attention.
Medicine for ADHD works by helping the brain send messages to these parts of the brain.
This helps children pay attention.
WHAT HAPPENS IF WE TRY MEDICINE?Unlike other medicines, the right amount of ADHD medicine is not based only on your
child’s weight. Instead, you must work with your child’s doctor to try a range of doses
(lower, medium, higher) and see how your child responds. You and your child’s teacher
will need to watch your child closely and complete evaluation forms. You will also need
to stay in close contact with the doctor’s office through follow-up calls and visits.
Here is our best guess of what will happen to 100 children with ADHD who try
3 different amounts of methylphenidate-based medicine.
77 CHILDREN FIND A DOSAGE THAT HELPS
MEDICATION
22 Children do best on the lower dosage
25 Children do best on the medium dosage
30 Children do best on the higher dosage
23 Children do NOT improve About half of these children will improve when they try an amphetamine-based medicine (e.g. Adderall, etc.)
77 CHILDREN FIND A DOSAGE
THAT HELPS
CHILDREN WITH ADHDNO MEDICATION
CHILDREN WITH ADHDWITH MEDICATIONWith medicine, children with ADHD have more activity in the parts of the brain that help them focus.
CHILDREN WITHOUT ADHDChildren without ADHD have more activity in the parts of the brain that help them focus.
20
TYPES OF ADHD MEDICATIONThere are two types of medicines that can be used. They are called stimulants and non-
stimulants.
Stimulant medicines are often tried first. In studies, more children benefit from stimulant
medicines than non-stimulant medicines. On average, stimulants reduce ADHD symptoms
better than non-stimulant medicines.
Among the different stimulant medicines available, some children do better on a
methylphenidate-based medicine. Others do better on an amphetamine-based medicine.
Some children do equally well on both. Others don’t respond to either.
Bottom-line: Each child is unique. At present, there is no way to predict which medicine
will work best for your child. Your child’s doctor can tell you about the differences
between medications. He or she can help you pick a medicine to try first, and work with
you to find a dose that is best for your child.
PROS & CONSHow can this treatment help my child?
· Medicine alone will help about half of children with ADHD. These children will pay
attention and control their impulses as well as the average child their age that does
not have ADHD. They also will be less hyper. Other children may find medicine
helpful without the same high level of success.· You can always change your mind
and try behavior therapy also.
Here is our best guess of what will happen to 100 children with ADHD if they get
medication treatment alone for 14 months.
What are possible problems with this treatment?
· Medicine must be taken, or it will not work.
· Medicine costs money (to you and/or your insurance plan).
· Your child may have side effects. These are usually minor. Side effects will
often decrease as a child gets used to the medicine. Other side effects
can persist. Taking less medicine often relieves these. Sometimes switching
to a different medicine is needed.
56
44
Number who have self-control and focus as well as the average child their age who doesn’t have ADHD
Number who don’t improve to that level
21
SIDE EFFECTS OF STIMULANT MEDICINESMost common side effects:
· Decreased appetite (this is usually worst at lunchtime)
· Trouble falling asleep
· Stomach aches
· Headaches
· Increased crabbiness
· Social withdrawal (i.e. they look like a ‘zombie,’ they are not interested
in normal activities): This is a sign that the child is taking too much medicine.
The amount needs to be lowered.
· Increased anxiety and/or crying over little things
· Rebound: Some children are more active or get in a bad mood when
the medicine is wearing off
Less common side effects: Tics (i.e. muscle twitches, movements, or unusual vocal sounds that a child can’t
control). Medicine does not cause tics, but may make them more likely to happen.
In general, tics are more likely in children with ADHD. In children who have tics
and start medicine for ADHD, tics may get better, worse, or stay about the same.
Rare side effects: · Increased heart rate and/or blood pressure
· Growth suppression/delay: On average, children with ADHD who take
medicine grow less than those children with ADHD who do not take medicine.
In the MTA study, some children took medicine for ADHD regularly for 3
years. Other children did not take medicine for 3 years. The children who took
medicine were 0.8 inches shorter. They were also about 0.9 pounds lighter.
This problem is more likely if the medicine makes your child feel less hungry.
Height and weight are checked at every doctor’s visit. We still do not know
if there is catch-up growth during adolescence.
· Hallucinations (i.e., seeing or hearing something that is not real): This
happens in about 3 out of 100 children who take medicine for a year. When
the medicine is stopped the hallucination goes away. Some children can
re-start a lower amount of medicine without a problem. Some children need
to try a different medicine.
22
36 Children have no side effects
50 Children have mild side effects: usually do not trouble the child or their parents enough to stop or change the medicine or dosage
11 Children have moderate side effects: troubling enough to adjust treatment
3 Children have severe side effects: troubling enough to adjust treatment
Children with pre-existing heart problems: Children who have heart problems may need to see a heart doctor before trying
medicine for ADHD. At present, there is no proof to suggest that taking medicine for
ADHD raises the risk of sudden death among children with a normal heart.
· Does your child have a history of heart disease, palpitations (feeling his
or her heart flutter), passing out, or seizures?
· Does anyone in your family have a history of sudden, unexplained death
in children or young adults? Hypertrophic cardiomyopathy? Heart rhythm
abnormality (e.g. Long QT syndrome)?
· If so, be sure to mention these things to your child’s doctor.
Here is our best guess of what will happen to 100 children with ADHD who take
medicine for 14 months:
23
IF YOU CHOOSE MEDICATION:Continuing medication: The first step is working with your child’s doctor to find a medicine and dose that
works. It should help your child without causing troubling side effects. Next, your child
has to continue taking medicine for it to work. If your child is taking a stimulant
medicine (e.g. methylphenidate, amphetamine), you will need to come to the doctor’s
office every month to pick up a refill. Let your child’s doctor know how things are going.
It is important to have regular follow-up visits with your child’s doctor. They will check
your child’s growth (i.e. height and weight). They will also check your child’s heart rate
and blood pressure. They might make changes to the medicine.
Medication changes: Even if you find a medicine and amount that works for your child, things can change
over time. You and your child’s teacher need to keep a close eye on how things are
going. Call your child’s doctor if problems arise. Sometimes the medicine stops working
as well as it did before. Sometimes children start having side effects.
Many children change the amount or type of medicine within 14 months of treatment.
Here is our best guess of what will happen to 100 children with ADHD who have
a good response to an ADHD medicine and keep taking it.
The average time to first medicine change is about 5 months.
The average number of medicine changes is 2 per child.
HERE IS AN EXAMPLE OF HOW CHOICES ABOUT TREATMENT CAN CHANGE OVER TIME: After trying 3 different doses of medicine, the medium dose seemed to work
best for Beth. After a few months her mother noticed that Beth was putting off
doing her homework and forgetting to turn in her homework. These were the
same problems that Beth had before starting medicine. After meeting with Beth’s
doctor, they decided to try a higher dose of the same medicine.
29 Children on same medicine and dose because medicine is still working well
18 Children change to lower dose because they start having troubling side effects
41 Children change to higher dose because the dose isn’t helping as much as before
12 Children change to a different medicine because it isn’t helping and/or they start having new side effects
24
25
Combined treatment means the child gets both behavioral and medication treatments.
See prior sections which describe behavioral treatment and medicine.
PROS & CONS How can this treatment help my child?
· Combined treatment will help about two-thirds of children with ADHD. These
children will pay attention and control their impulses as well as the average child
their age that does not have ADHD. They also will be less hyper. Other children may
find combined treatment helpful without the same high level of success.
· Compared to children who only take medicine, children who get combined
treatment need 19% less medicine to improve the same amount. As a result,
side effects may be less severe on lower amounts of medicine.
Here is our best guess of what will happen to 100 children with ADHD if they get both
behavioral and medication treatments for 14 months.
What are possible problems with this treatment?· Behavioral treatments take time.
· Behavioral treatments and medicine cost money
(to you and/or your insurance plan).
· Your child may have side effects from medicine.
HERE IS AN EXAMPLE OF HOW CHOICES ABOUT TREATMENT CAN CHANGE OVER TIME:David was taking medicine for ADHD, but still had problems behaving at
home. David’s parents decided to try combined treatment. The doctor gave
them the phone number to a parenting class that was offered in their
town. The next month, David continued taking his medicine and his parents
went to their first parenting class.
COMBINED TREATMENT
68
32
Number who have self-control and focus as well as the average child their age who doesn’t have ADHD
Number who don’t improve to that level
26
Number who have self-control and focus as well as the average child their age who doesn’t have ADHD
Number who don’t improve to that level
COMPARING TREATMENT CHOICESHere is our best guess of what will happen to 100 children with ADHD
if they get the following treatments for 14 months.
BEHAVIOR THERAPY
34child their age who doesn’t have ADHD
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27
BEHAVIOR THERAPY MEDICATION COMBINED TREATMENT
68
32
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44
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SOME CONSIDERATIONS REGARDING YOUR DECISION
Ongoing monitoring
· No matter what treatment you try, it is important
to keep a close eye on your child’s progress.
· You and your child’s teacher can fill out rating forms
(e.g. Vanderbilt, Conners, etc.) to see if symptoms are
getting better.
· Think about the goals that you, your child,
and your child’s teacher and doctor set.
· Meet with your child’s teacher and doctor to see
if your goals have been achieved.
· If a treatment goal is not achieved by a set
date, the treatment plan may need to be adjusted.
This may include adjusting a current treatment
(e.g. behavioral approach or medicine) or adding
a new approach that you haven’t tried yet (e.g.
behavioral approaches or medicine).
29
HERE ARE EXAMPLES OF HOW CHOICES ABOUT TREATMENT CAN CHANGE OVER TIME:Example 1: Johnny’s behavior improved after his mom started using
a reward system at home. He still had a very hard time paying attention
at school. As a result, she decided to give medicine a try.
Example 2: Vicky’s parents were pleased with the progress that she made
at school since starting medicine. They were still concerned about her
defiant behavior at home. As a result, they decided to attend a class designed
to help parents manage their child’s behavior.
Example 3: Albert was started on ADHD medicine when he was 7 years
of age. Albert also learned study skills that helped him. Each year, Albert and
his parents would meet with his doctor. They would plan a trial without
medicine to see if he still benefited from it. In the first year, Albert’s teacher
and parents knew that medicine was still needed to help Albert achieve
his goals. In later years, the trials off medicine lasted longer. Yet, Albert and
his parents still found that medicine was helpful for him. During a trial off
medicine when he was 15, using his study skills alone he was able to keep his
good grades. He remained off medicine. Since then, his parents and teachers have
continued to set goals and watch his progress closely.
30
FREQUENTLY ASKED QUESTIONS (1) Will my child outgrow ADHD?Many people think of ADHD as a childhood problem. However, ADHD can continue
through the teen years and into adulthood. Symptoms of ADHD do change over time.
(2) How do you know for sure if ADHD is the problem?There are no tests for ADHD. Your child’s doctor may make a diagnosis. Sometimes
the doctor may refer you to an expert to assist with diagnosis.
(3) What causes ADHD?No one knows for sure. ADHD probably comes from a combination of things.
Some possibilities are:
· Genes, because ADHD sometimes runs in families
· Lead in old paint and plumbing parts
· Smoking and drinking alcohol while pregnant
· Certain brain injuries
Food additives like artificial colors might make children more hyper, but they do not
cause ADHD.
Although the cause of ADHD is not certain, family stress, such as divorce,
does not cause ADHD.
(4) Who can develop ADHD?Children of all backgrounds can have ADHD. Teens and adults can have ADHD too.
(5) Will medication change my child’s personality? While your child may stop and think before talking or acting, his or her personality
should not change. If your child loses interest in the things he or she enjoys, he or she
may be on a dose that is too high.
(6) Will my child become addicted to the medication? Children do not crave the medicine when it is not given. Some children do notice
that it is harder to focus on days that they don’t take their medicine.
(7) Are there other resources to help me make the best choice for my child?See the Resources listed on the next page.
(8) Are there behavioral options nearby?Cincinnati Children’s Hospital Medical Center offers parent groups at several places.
The groups have 8 weekly meetings. Parents learn about ADHD, how to manage child
behavior, and how to work with teachers and doctors to help their child.
For more information, call (513) 636-4336 and press the pound key (#) option
or visit http://www.cincinnatichildrens.org/svc/alpha/b/behavioral-psych/
clinical/group/default.htm
31
RESOURCESThis list provides support groups and other resources for ADHD.
Check with your child’s doctor for other resources near you.
Organizations· Cincinnati Children’s Hospital Center for ADHD
These cards will help you and your child set goals for treatment. It provides an overview of treatment options available to you.
The booklet lists more information on treatment options. The booklet also lists resources available to you. The booklet will help you to determine if your child reaches the goals you set in these cards.
Share these cards with your child’s doctor. Talk with the doctor about your goals and work together to make a treatment plan.
Even if you choose to let the doctor decide what treatment(s) to give your child for ADHD, you need to be well informed and monitor progress toward your goals.
If a doctor is evaluating your child for ADHD, these cards are for you.
Behavioral treatment is an active treatment where parents and teachers can learn methods to help children with ADHD. Three types of methods have been proven to improve performance at school and at home:
Methods for parents to use at homeIn studies where this helped, parents met in groups with other parents. Parents learn how to manage their child’s problems caused by ADHD. They learn how to give better commands, set small goals, and use time-outs, reward systems, and point systems. The groups meet between 8 and 16 times. Parents often get support from being in a group with other parents of children with ADHD.
Methods for teachers and parents to use to improve classroom performanceTeachers can use many of the same methods as parents to help children behave in class (e.g. setting small goals, using time-outs, reward systems, and point systems). In studies where this helped, teachers, classroom aides, and
tutors received formal training on methods that are helpful for children with ADHD. This was important because many teachers receive no formal education about ADHD during their training. There are key differences in the types of methods that work best for children with ADHD compared to those without ADHD.
Methods to improve peer relations in classroom and play settingsChildren learn how to more effectively interact with and relate to their peers (e.g. social skills training). This helps children make and improve friendships with their peers in classroom and play settings. In studies where this helped, children attended a Summer Treatment Program that lasted all day for 5 to 8 weeks. It is important to know that social skills programs that meet once or twice a week at a clinic or hospital are not as helpful as the summer programs that work with children in real world settings.
INTRODUCTION
· Behavioral treatments take time for parents, teachers, and children to do. · Formal programs may be limited nearby. There may be a wait list to access the
programs that are available.
· Behavioral treatments cost money (to you and/or your insurance plan).
DOWNSIDES
34
66
Here is our best guess of what will happen to 100 children with ADHD if they get behavioral treatment alone for 14 months.
BENEFIT
2.BEHAVIORAL TREATMENT
Number who have self-control and focus as well as the average child their age who doesn’t have ADHD
· Medicine costs money. · Your child may have side effects. These are usually minor and decrease as a child gets used to the medicine. Side effects of stimulant medicines include:
· Most common: Decreased appetite, trouble falling asleep, stomach aches, headaches, increased crabbiness, social withdrawal, anxiety and/or
crying. Some children are more active or get in a bad mood when the medicine is wearing off.
· Less common: Tics (i.e. muscle twitches, movements, or unusual vocal sounds that a child can’t control).
Talk with your doctor to discuss these side effects in more detail.
DOWNSIDES
Medication treatment is an active treatment that uses drug therapy to control ADHD symptoms.
Parts of the brain help children pay attention. Medicine for ADHD works by helping the brain send messages to these parts of the brain. This helps children to pay attention.
There are two types of medicines that can be used. One type is called stimulants and the second is called non-stimulants. Stimulant medicines are often tried first. In studies, more children benefit from
stimulant medicines than non-stimulant medicines.
Unlike other medicines, the right amount of ADHD medicine is not based only on your child’s weight. Instead, you must work with your child’s doctor to try a range of doses (lower, medium, higher) and see how your child responds. You and your child’s teacher will need to watch your child closely and complete evaluation forms. You will also need to stay in close contact with the doctor’s office through follow-up calls and visits.
INTRODUCTION
Here is our best guess of what will happen to 100 children with ADHD if they get medication treatment alone for 14 months.
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44
BENEFIT
3. MEDICATION TREATMENT
Number who have self-control and focus as well as the average child their age who doesn’t have ADHD
Combined treatment means the child gets both behavioral and medication treatments. See prior sections which describe behavioral and medication treatments.
Compared to children who only take medicine, children who get combined treatment need 19% less medicine to improve the same amount. As a result, side effects may be less severe on lower amounts of medicine.
DOWNSIDES
Here is our best guess of what will happen to 100 children with ADHD if they get both behavioral and medication treatments for 14 months.
BENEFIT
· Behavioral treatments take time.· Behavioral treatments and medicine cost · money.· Your child may have side effects from · medicine.
4. COMBINED TREATMENT
Number who have self-control and focus as well as the average child their age who doesn’t have ADHD
What would you like to see change? __________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
What would your child like to see change? ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
To get started, please complete the following sentences regarding you and your child’s treatment goals.
You do not have to deal with the possible side effects from medicine. You can always change your mind and begin active treatment.
What problems or behaviors will you watch for? _______________________________________
IF YOU ARE INTERESTED IN TRYING BEHAVIORAL TREATMENT…
In order to decide which behavioral options to try, it may help your child’s doctor to know what you’ve done in the past and what you are doing now. Please think about methods you’ve done and answer these questions.
What behavioral methods…... have you
tried in the past
... are you currently trying
… are you interested in trying next
Methods for teachers & parents to use to improve classroom performance:
Seat child in front of class near the board.
Utilize a daily report card for teacher to communicate with parents.
Meet with your child’s teacher to set goals and develop a plan.
Request in writing that child’s school tests for learning disabilities.
Other: _________________________________
What behavioral methods…... have you
tried in the past
... are you currently trying
… are you interested in trying next
Methods for parents:
Watch an episode of “Supernanny” that deals with children who have ADHD.
Read a book about managing behaviors for ADHD children.
Visit a website about ADHD.
Call a psychologist recommended by your doctor to ask about services offered for ADHD.
Call Cincinnati Children’s to ask about “Understanding & Managing ADHD” groups.
Attend a support group for parents to learn about managing ADHD.
1. What are the options for treating children with a bone infection? (also called osteomyelitis) After getting medicine through an intravenous line (IV) while in the hospital (i.e. <7 days), your child could…..
A. Go home and take medicine by mouth for a
total of 4–6 weeks
OR
B. Get a peripherally inserted central catheter (PICC), you would learn how to use and care for it, then go home and give IV medicine by PICC line for a total of 4–6 weeks
2. Issues you and your doctor may discuss:
• How your child is responding to medicine (e.g. fever, symptoms)
• The bacteria causing the infection, if known • What is involved in giving your child medicine
by mouth at home? (e.g. liquid vs. pill, how often)
• What is involved in getting a PICC line? • What is involved in caring for a PICC line at
home? • What is involved in giving medicine through a
PICC line at home? • Your preferences for treatment
3. What is known about the risk of a bone infection that fails to get better after 4–6 weeks? (also called chronic osteomyelitis)
Medicine by mouth • Less than 5% risk*
Medicine by PICC line • Less than 5% risk*
*No significant risk difference between these treatment options 4. What are the potential risks and complications?
Medicine by mouth • Allergic reaction • Child spits it up
Medicine by PICC line • Allergic reaction • Line stops working (e.g. it comes out or clogs) • Bacteria gets into blood through the line and
causes another infection • Skin gets infected where the line enters skin • At CCHMC, 15-20% of PICC lines for bone
infections had one of these problems last year
5. Assessment A. Do you know enough about the benefits and
side effects of each option? Y / N B. Do you have enough support and advice from
others to make a choice? Y / N C. Do you feel relatively sure about the best
choice for your son/daughter? Y / N 6. What do you want to do now?
Go home and take medicine by mouth for a total of 4-6 weeks
Get a peripherally inserted central catheter (PICC), learn how to use and care for it, then go home and give medicine for a total of 4-6 weeks
Not sure, prefer to decide later or need more help choosing
7. How could we have engaged you and your family in the decision more successfully?
Why use a Sustainability Planner? An important part of the improvement journey is planning how you are going to sustain your improvement efforts. The beneficial results of an improvement project have been sustained when the new ways of working have become the norm, or when things have not returned to the old way of doing things after a year. In order to ensure that an improvement is sustained, the changes made need continuously improve, evolve and adapt to both internal and external pressures. The Sustainability Planner encourages quality improvement teams to think about the seven key factors that will help practices sustain the improvements that they have made. These seven factors are:
1. Clarify what you are sustaining 2. Engage leaders 3. Involve and support front-line staff 4. Communicate the benefits of the improved process 5. Ensure the change is ready to be implemented and sustained 6. Embed the improved process 7. Build in ongoing measurement
The seven key factors for success are discussed below. For each factor, a set of ideas to consider has been provided, as has a small area for your team to plan your next steps. Although not all of the ideas provided will be applicable to your practice, the more ideas that are considered, the higher the chances of successful sustainability. How do I consider the key factors for success? 1. Clarifying what you are sustaining It is necessary that the entire team agrees upon what is being sustained. Is your team planning on sustaining a specific change idea, such as max packing patient visits to do as much as possible with the patient at each visit? Or is the team trying to sustain a change concept, such as reducing demand for visits through a number of different change ideas.
We are planning to sustain:
2. Engage leaders Research and experience demonstrate that the support of organizational leadership is essential to successful quality improvement work. Clinical and administrative leaders who work directly on, or indirectly support, the improvement project must ensure that all barriers to success are removed and project priorities are clearly identified and communicated.
Think about who needs to be on-side for changes to happen. Think about who ultimately influences whether or not something happens - these are the leaders within your practice/clinic. For small offices, the leaders may be everyone who works in the office (e.g., physicians/NPs, RN and receptionist).
Ideas to Consider Next Steps ☐ A provider champion (physician and/or NP), has been identified and has
agreed to participate in the improvement efforts.
☐ The provider champion has devoted time to dialogue with and participate as a member of the improvement team.
☐ If applicable, your business manager or executive director has agreed to support the improvement efforts.
☐ Leaders have the skills/knowledge required to support successful implementation.
☐ Leaders have removed barriers or threats to facilitate process improvement.
☐ Leaders are able to clearly articulate the benefits of the improvement project such as: improved access to care, patient safety, improved patient experience and/or increased staff skills.
☐ Leaders have provided the required resources to ensure the changes are sustained (e.g., time for staff to incorporate the changes into day to day operations).
To strengthen leadership engagement, we will:
3. Involve and support front-line staff Front-line staff members play an important role throughout every quality improvement initiative. In the early phases of a project, they may be involved in identifying problem areas and solutions to test. Later, they may be involved in identifying training needs and delivering / receiving training themselves. Continual support and evaluation of the needs of those working within changed processes is necessary to ensure that changes are sustained.
Ideas to Consider Next Steps ☐ Staff members were provided with information about the purpose and
significance of the improvement initiative.
☐ Front-line staff helped to identify issues from their perspective.
☐ Front-line staff members have been involved in developing solutions.
☐ The ‘right’ (most appropriate or qualified) staff are involved in the improvement project.
☐ Methods to regularly communicate with staff other than those directly working on the improvement team have been identified and used.
☐ A plan to address future skills and training needs has been created.
To strengthen the involvement of front-line staff, we will:
4. Communicate the benefits of the improved process Changes should address the root causes of problems and produce measurable benefits that meet the needs of all stakeholders (i.e., patients, front-line staff, providers, and leaders). Each stakeholder should be able to determine what benefits the changes bring to him or her.
Ideas to Consider Next Steps ☐ Unique and targeted ‘what’s in it for me’ characteristics have been
communicated to different stakeholders.
☐ Baseline data and ongoing real-time data for the measures is being collected regularly, tracked on a run chart and shared.
☐ Stories, updates at staff meetings and a visual display of data have been shared.
☐ Information about the improvement (i.e., patient outcomes, improved efficiencies, how the improvement efforts have been able to reduce or eliminate duplication of effort, unnecessary or repetitive work, unreliable processes, or excessive waits or delays) have been shared with stakeholders as the new way of work.
To communicate the benefits of change, we will:
5. Ensure the change is ready to be implemented and sustained If your improvement team has not finished testing their change ideas through PDSA cycles, then it is too early to consider full implementation and sustainability. Similarly, if the change is perceived as an additional duty or task, then the improvement is unlikely to be integrated into the clinic’s culture or become ‘the way things are done’. It is important to ensure that the change idea is effective and beneficial before moving to the implementation/sustainability phase. Many practices have expended a great deal of energy and time on the implementation of change ideas that did not improve quality or streamline processes.
Ideas to Consider Next steps ☐ There is clear evidence that solutions address the root causes of real
issues.
☐ The change has been successfully tested in a variety of conditions.
☐ The change will not benefit from any further testing or modification.
☐ The project measures are demonstrating real improvement.
☐ Improvement targets or goals have been achieved or are close to being achieved.
☐ The changes have improved efficiency or made jobs easier (reduced waste, avoided duplication, made things run smoother).
To ensure the change is ready to be implemented and sustained, we will:
6. Embed the improved process A common barrier to sustainability is not linking the goal of the improvement project to the strategy or vision of the organization. Without this link, it is often difficult for people to determine why valuable resources are being allocated to the improvement project. An improvement is much more likely to be sustained if it is well integrated into the culture and core processes of a practice/clinic and if it is flexible and able to respond to changes in the environment. In order to do so, the systems supporting the improvement need to be adapted so that they are compatible with the change.
Ideas to Consider Next Steps ☐ The improvement project is important to the continued success of the
practice/clinic.
☐ The necessary facilities, supplies, and equipment are in place to support the new process.
☐ Training has been provided to staff and providers about the improved processes and changes so they know what is expected of them.
☐ Job descriptions have been updated to reflect the altered roles.
☐ Policies and procedures have been updated or created to reflect the new processes.
☐ The new processes are now “standard work” and supported with medical directives, forms, checklists, reminders (visual cues), and technology.
☐ The team has a mechanism for discussing, examining and adapting the improved processes in response to internal and external changes.
To embed the improved process and make it the new standard, we will:
7. Build in ongoing measurement Establishing an ongoing measurement system and a standardized way of communicating results reinforces that the change is important to the practice. A mechanism for looking at a few key and relatively easy to extract measures allows teams to see if there is slippage and to take action to resolve any issues. It also allows teams to celebrate when an indicator has stayed at an improved level over time.
Ideas to Consider Next Steps ☐ There are internal skills and a culture for continuous improvement.
☐ A refined set of measures to track on an ongoing basis is identified. (If the team is sustaining improvements in access, track future open capacity and third next available appointment.)
☐ A group or person has been assigned responsibility to extract the data for this refined set of measures.
☐ There is a structure or mechanism in place for reviewing the measures on a regular basis.
☐ There is a plan for communicating performance to front-line staff, providers, and leaders within the practice.
☐ There is a plan to outline what we will do to reflect on our progress – to celebrate continued success and to respond if our measures start to slip.
☐ Celebrate accomplishments and aspire to take performance to a new level.
To strengthen our capacity for ongoing measurement, we will:
Helpful Sources
x Centre for Healthcare Quality Improvement (2010). Sustainability Planning: A Guide for ED-PIP Coaches &Team Leads. CHQI: Toronto, Ontario.
x NHS Modernization Agency (2002). Improvement leader’s guide to sustainability and spread. Ancient House Printing Group: Ipswich, England.
x Maher, Lynn, Gustafson, D. and Evans, A. (2007). NHS Sustainability: Model and Guide. NHS Institute for Innovation and Improvement: England.
ISBN 978-1-4606-3780-7 (PDF)
Key factors What is important? Key to success Questions for you
INNOVATION We need to continue improving quality of care for patients in safe, effective and person-centred ways
There is clear benefit and innovation in the improvement
What are the benefits of the change?What is the plan to articulate the benefits? Who are your early adopters to support you in making the change?
MEASUREMENT We need to measure changes to determine which demonstrate improvement and by how much
Staff are able to use real time data to drive improvement
Do you have existing data you can use?How will you collect your data?How are you going to analyse and communicate the results?
HUMAN FACTORS
We need to design systems and processes that take into account what we know about human behaviour
Understanding why common errors are happening and then redesigning the process to prevent the errors
Are there changes you can make to the design of the process that will reduce the likelihood of errors? How can you design the process so that it encourages people to sustain the new way of doing things?
CULTURE We must be aware of fundamental beliefs in our culture and work to change those which block QI work
Seek to understand the role of culture on our behaviours and ability to deliver improvements
What words describe the current culture you want? What needs to be done to move to the new culture? What different cultures exist in your setting and how will you package change to appeal to each of their values?
CHANGE MANAGEMENT
We must acknowledge both the technical and social aspects of change and improvement efforts
People are supported to understand the problem a change is attempting to fix and involved in designing and testing the solutions
What technical and social elements need to be considered in terms of the proposed change. If someone is resisting change, have you taken the time to understand why? Is there anything you need to do differently to address the concerns of those resisting the change?
LEADERSHIP We need to embrace leadership that sacrifices self-interest and puts quality and safety at the centre of all we do
Leaders who can combine technical QI skills with effective interpersonal and relational skills
How have you connected with stakeholders to enable them all to contribute views, expertise and ideas?How are you planning to communicate to stakeholders any improvements you make?
KNOWLEDGE INTO ACTION
We need to understand how to translate and embed our best ideas and evidence
Knowledge and resources of all kinds are accessible, used and shared
What knowledge supported your innovation and where did it come from?What methods could you use to share knowledge to support other QI teams to spread the improvement?
ENGAGEMENT We need to support mobilisation for improvement across a diverse set of health and social care stakeholders
Everyone with a vested interest, across all levels and roles, has a voice in the improvement team
How are you connecting with people to remind them why the work is needed?How will you help them feel part of the change and have an important role to play?
EVALUATION We need evidence as to what changes have been made, and when and how they made an impact
Develop plans from the outset to understand how activities, outputs outcomes link and ensuring learning and feedback loops are in place
How do you currently evaluate your QI work? How do you capture feedback from staff, patient, carers and act on your learning?
EMPOWERMENT We must listen to the experiences and views of people who provide services and people who use services to drive improvement
Hear, listen and respond to the voices of staff, patients and carers when attempting to improve services
How do you engage with staff, patients and carers to hear about their experiences and ideas for improvement?How much are people able to influence the process of improvement work?
Figure 2: The 10 factors explained! What to start thinking about and asking about in terms of QI spread and sustainability
16
Thank you for your participation and feedback! Please return completed evaluation to AAP staff at the end of the Learning Session.
Family Engagement Quality Improvement Project Learning Session Evaluation
June 3 – 4, 2016
1. Overall, to what extent did the Learning Session meet your expectations with regard to the following?
Exceeded (5)
(4)
Met (3)
(2)
Failed (1)
a) Content of the presentations
b) Organization of the presentations
c) Effectiveness of the teaching and instructional methods
3. How would you rate each of the following sessions in terms of usefulness in your practice?
Very Useful
(5)
(4)
Somewhat Useful
(3)
(2)
Not Useful
(1)
N/A
Family Story and Introduction to Family Engagement (Hunting)
Quality Improvement in the Real World (Gubernick)
Parent/Caregivers only: Introduction to Quality Improvement (Hunting)
Storyboard Presentations (Teams)
Sustainability (Weller)
Shared Decision Making (Thompson & Graham)
Report on Baseline Data and Pre-Implementation Survey (Gubernick)
Parent/Caregivers only: Helpful Tools for Your Role as a Parent Partner (Hunting)
4. What part(s) of the Learning Session did you find most valuable?
5. Please suggest any topics you think we should cover during the QI project via email and/or during monthly calls.
6. Share any additional comments or feedback on the Learning Session.
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/12/16 End Date: 7//13
Objective for this PDSA Cycle (Aim): By September 30, 2016, our practice will be using the shared decision making (SDM) aid, “ADHD Medication Choice Cards,” with at least 95% of the parents/caregivers of our patients who are newly diagnosed with ADHD and are interested in medication as a treatment option.
PLAN: QUESTIONS Can our care coordinator send out this decision aid, as well as the Pre-encounter/visit cards and booklet on ADHD treatment modalities to the appropriate parents/caregivers via the patient portal at least 1 week prior to the scheduled visit? Will parents/caregivers read and complete the personal information and cost estimates prior to being seen by the physician? Will Dr. Gordon have time to review and discuss it with the family? Will this aid be helpful to parents/caregivers?
PREDICTIONS We predict that our care coordinator, Linda, will successfully send these resources/tools at least 1 week prior to the visit at least 95% of the time. We predict at least 90% of the parents/caregivers will complete the treatment goals and preferences card; 70% will add behavior treatments tried, currently trying or interested in trying; 75% will add personal information to the Medication Choice card; only 50% will complete the out-of-pocket cost estimates. Dr. Gordon predicts this will increase the visit time but will help the parent/caregiver be more knowledgeable and involved with the treatment plan.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Tasks: Linda will confirm that there is 1 or more patient(s), <11 yrs. old and newly diagnosed with ADHD scheduled for appointments on July 12th and/or 13th. She will also print out the Medication Choice cards, as instructed on the Cincinnati Children’s website (http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/decision-aids/ ). Dr. Gordon will study the “Card Guide”( http://www.cincinnatichildrens.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=100745&libID=100440 ) for discussing medication treatment options with the parent/caregiver. On July 5th, Linda will send a message and the ADHD Pre-visit cards and Medication Choice cards via the patient portal to the parents/caregivers whose children meet the criteria, with instructions to complete the goals/preferences, behavior treatment(s) and personal information sections and out-of-pocket medication cost estimates, if appropriate. Parents will be asked to bring the completed information to their visit. Prior to entering the exam room, Dr. Gordon will be handed the parent-completed goal/preference card, behavioral treatment card and ADHD medication choice cards by the Joyce (MA).
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of each day, Linda will review the records of those newly diagnosed ADHD patients seen by Dr. Gordon. She will record total # of patients who brought with them the ADHD SDM aids and note what sections had been completed prior to the visit. Dr. Gordon will share parent/caregiver feedback and his own reflections about the process.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/12/16 End Date: 7/1316
Objective for this PDSA Cycle (Aim): By September 30, 2016, our practice will be using the shared decision making (SDM) aid, “ADHD Medication Choice Cards,” with at least 95% of the parents/caregivers of our patients who are newly diagnosed with ADHD and are interested in medication as a treatment option.
PLAN: QUESTIONS Can our care coordinator send out this decision aid, as well as the Pre-encounter cards and booklet on ADHD treatment modalities to the appropriate parents/caregivers via the patient portal at least 1 week prior to the scheduled visit? Will parents/caregivers read and complete the personal information and cost estimates prior to being seen by the physician? Will Dr. Gordon have time to review and discuss it with the family? Will this aid be helpful to parents/caregivers?
PREDICTIONS We predict that our care coordinator, Linda, will successfully send these resources/tools at least 1 week prior to the
visit at least 95% of the time. We predict at least 90% of the parents/caregivers will complete the treatment goals and preferences card; 70% will add behavior treatments tried, currently trying or interested in trying; 75% will add personal information to the Medication Choice card; only 50% will complete the out-of-pocket cost estimates. Dr. Gordon predicts this will increase the visit time but will help the parent/caregiver be more knowledgeable and involved with the treatment planning.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Tasks: Linda will confirm that there is 1 or more patient(s), <11 yrs. old and newly diagnosed with ADHD scheduled for appointments on July 12th and/or 13th. She will also print out the Medication cards, as instructed on the Cincinnati Children’s website (http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/decision-aids/ ). Dr. Gordon will study the “Card Guide” (http://www.cincinnatichildrens.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=100745&libID=100440) for discussing medication treatment options with the parent/caregiver. On July 5th, Linda will send a message and the ADHD Pre-visit cards and Medication cards via the patient portal to the parents/caregivers whose children meet the criteria, with instructions to complete the goals/preferences, behavior treatment(s) and personal information sections and out-of-pocket medication cost estimates, if appropriate. Parents will be asked to bring the completed information to their visit. Prior to entering the exam room, Dr. Gordon will be handed the parent-completed goal/preference card, behavioral treatment card and ADHD medication choice cards by the Joyce (MA).
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of each day, Linda will review the records of those newly diagnosed ADHD patients seen by Dr. Gordon. She will record total # of patients who brought with them the ADHD SDM aids and note what sections had been completed prior to the visit. Dr. Gordon will share parent/caregiver feedback and his own reflections about the process.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances. Linda sent messages and resources on July 5th to 3
parents/caregivers who children met the criteria and had appointments on July 13th. All 3 parents brought the cards with them but only one had completed all the requested information. All 3 parents wanted to discuss medication options. Dr. Gordon said the first discussion took a long time because he presented all of the medication choice issue cards but forgot to ask the parent which one she wanted to discuss first. Found he didn’t need to discuss all 5 cards when he remembered to do that (ask first) with the other 2 parents!
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED Only one parent completed the medication cost estimate. One parent was unable to get the info from her health plan and one forgot. Dr. Gordon reported that following the “card guide” was helpful for him but he feels he needs more practice! Parents reported that the aids increased their knowledge of ADHD treatment options, were easy to understand and helped them be involved in making the decision about their child’s treatment plan. Dr. Gordon reported parents more involved. They all liked the medication issue cards. One parent was surprised when Dr. Gordon asked her which medication issue she wanted to discuss first. One parent expressed appreciation for the booklet and for being referred to a parent support group.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test? Plan for
next cycle: What happens when parent/caregiver has not completed or brought the cards with them? Can they be given
to the parent/caregiver to complete in the exam room or completed by Dr. Gordon, in discussion with the family? Note: We also need to learn what summer behavioral treatment programs are available in our community/county!
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/2/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will use the Teach Back Method as a strategy to actively Engage patients and their families with their Asthma Actions Plan so that at least 80% have documentation in their record of the use of this patient engagement tool at their most recent appropriate acute or well-care visit.
PLAN: QUESTIONS Do Dr. Green and the clinical staff know how to conduct Teach Back?
Can this strategy be incorporated into the visit? Can it be documented in the EHR? PREDICTIONS It will take some practice for Dr. Green to feel comfortable asking for patient/parent
to share in own words what she explained regarding when to use which asthma medications.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Task: Prior to 7/1, Dr. Green and clinical staff will review the Teach Back toolkit (http://www.nchealthliteracy.org/toolkit/tool5.pdf ) and the “Always Use Teach Back” resources (http://www.ihi.org/resources/Pages/Tools/AlwaysUseTeachBack!.aspx) Dr. Green will conduct teach-back with the last patient scheduled tomorrow who has a diagnosis of asthma and a newly created or updated asthma action plan. Dr. Green will review the plan with the patient and/or parent/caregiver and then will ask “I want to be sure that I explained the medications correctly. Can you tell me how and when you are going to take/give these medicines?” This process will be repeated until the patient/parent or caregiver can explain it properly in own words. At end of visit, Dr. Green will ask patient and/or parent/caregiver for their feedback about the usefulness of the technique.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Documentation of feedback from patient and/or parent/caregiver about the usefulness of the method. Dr. Green will also give feedback and her reflections about using the teach-back method.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/216
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will use the Teach Back Method as a strategy to actively Engage patients and their families with their Asthma Actions Plan so that at least 80% have documentation in their record of the use of this patient engagement tool at their most recent appropriate acute or well-care visit.
PLAN: QUESTIONS Do Dr. Green and the clinical staff know how to conduct Teach Back?
Can this strategy be incorporated into the visit? Can it be documented in the EHR? PREDICTIONS It will take some practice for Dr. Green to feel comfortable asking for patient/parent to share in own words what she explained regarding when to use which asthma medications.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Task: Prior to 7/1, Dr. Green and clinical staff will review the Teach Back toolkit (http://www.nchealthliteracy.org/toolkit/tool5.pdf ) and the “Always Use Teach Back” resources (http://www.ihi.org/resources/Pages/Tools/AlwaysUseTeachBack!.aspx) Dr. Green will conduct teach-back with the last patient scheduled tomorrow who has a diagnosis of asthma and a newly created or updated asthma action plan. Dr. Green will review the plan with the patient and/or parent/caregiver and then will ask “I want to be sure that I explained the medications correctly. Can you tell me how and when you are going to take/give these medicines?” This process will be repeated until the patient/parent or caregiver can explain it properly in own words. At end of visit, Dr. Green will ask patient and/or parent/caregiver for their feedback about the usefulness of the technique. PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Documentation of feedback from patient and/or parent/caregiver about the usefulness of the method. Dr. Green will also give feedback and her reflections about using the teach-back method.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Dr. Gordon conducted the teach-back method, as planned. She found she talked too fast and needed to slow down so she could explain the plan clearly to the patient’s mother.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED The parent reported she felt intimidated at first that she was going to have to explain what she heard but said the way Dr. Gordon explained that she wanted to make sure she had explained it well made her feel better. Dr. Gordon said she learned to keep the instructions simple and not rush through them. She felt it will take some practice to get better at doing it, as well as to remember to do it routinely.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan for next cycle: Dr. Gordon will use the teach-back method for the first 2 patients scheduled tomorrow with a
diagnosis of asthma and will ask patients/families for feedback again. She will share what she’s learned with her colleagues at the staff meeting later in the week.
Plan a Test of Change Cycle #:_1_Start Date: 7/18/16 End Date: 8/5/16
Objective for this PDSA Cycle (Aim): By August 31, 2016, at least 90% of the primary caregivers of our 11 yrs. old patients who were seen for a well visit that month will have completed and returned the Pre-visit Contact form via the patient portal at least 24 hours prior to the scheduled appointment. This will help update our healthcare information since the patient’s last visit and the top 3 concerns/topics to be discussed at the visit.
PLAN: QUESTIONS Will the parents/caregivers respond to our request via the Patient Portal?
How far in advance of the appointment should staff send the request for the completion of the form?
PREDICTIONS At least 75% of the parents/caregivers will return the form at least 24 hrs. before scheduled appointment.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Starting in mid-July, secure emails will be sent by Mary (PSA) on Mondays via the patient portal to primary caregivers 2
weeks prior to each patient’s scheduled well-care visit. The email will include the Pre-visit Contact form and instructions on
how to complete and submit it at least 24 hrs. before the patient’s scheduled visit. Returned forms will be scanned into the patient’s record. Joyce (MA) will access and review the form when rooming the patient. If no form is there, she will ask the questions and document the answers in the patient’s record for physician/NP to use.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of 8/1, count # of 11 yrs. old patients seen that day for well visit and how many had documentation in the record of a completed pre-visit form (# completed prior to visit and # completed that day). At end of visit, parent/caregiver will be asked for feedback about the form…was it useful? What did they like about it? What changes should be made?
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/18/16 End Date: 8/5/16
Objective for this PDSA Cycle (Aim): By August 31, 2016, at least 90% of the primary caregivers of our 11 yrs. old patients who were seen for a well visit that month will have completed and returned the Pre-visit Contact form via the patient portal at least 24 hours prior to the scheduled appointment. This will help update our healthcare information since the patient’s last visit and the top 3 concerns/topics to be discussed at the visit.
PLAN: QUESTIONS Will the parents/caregivers respond to our request via the Patient
Portal? How far in advance of the appointment should staff send the request for the completion of the form?
PREDICTIONS At least 75% of the parents/caregivers will return the form at least 24 hrs. before scheduled appointment.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Starting in mid-July, secure emails will be sent by Mary (PSA) on Mondays via the patient portal to primary caregivers 2
weeks prior to each patient’s scheduled well-care visit. The email will include the Pre-visit Contact form and instructions on
how to complete and submit it at least 24 hrs. before the patient’s scheduled visit. Returned forms will be scanned into the patient’s record. Joyce (MA) will access and review the form when rooming the patient. If no form is there, she will ask the questions and document the answers in the patient’s record for physician/NP to use.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of each day during week of 8/1, count # of 11 yrs. old patients seen that day for well visit and how many had documentation in the record of a completed pre-visit form (# completed prior to visit). At end of visit, parent/caregiver will be asked for feedback about the form…was it useful? What did they like about it? What changes should be made?
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
On July 18th, Mary sent the secure emails to the primary caregiver of each 11 yrs. old patient with an appointment scheduled during the week of Aug.1st. Of the 10 families she emailed, all had portal accounts (thanks to our recent enrollment campaign!); 1 did not have a valid email address so she followed up with that mom by phone. Two completed forms were returned by the end of the day!
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED Of the 10 parents/caregivers contacted for that week’s appointments, only 6 (60%) completed and returned the form at least 24 hrs. prior to the visit. Joyce report that 2 completed/submitted forms were not found in the patient’s record to review and the questions had to be asked again which did not make the parent/caregiver happy. All 6 parents/caregivers offered feedback: Q2 had a duplicate question; for Q4, being asked “who” was confusing; for Q5, how do they know if the patient will need bloodwork? They all liked Q7 (top 3 concerns/topics to discuss at the visit). Four reported getting the email 2 weeks before the visit gave them time to put it aside. A reminder would be helpful. Dr. Gordon reported she forgot to review the form for the first two 11 yrs. old patients she saw (she’d missed Huddle that morning!). An additional 4 parents/caregivers who scheduled the patient’s adol. well-visit less than 2 week before the appointment date did not receive a form via the portal prior to the appointment so all had to complete the form at the appointment!
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE: Mary will generate emails, with form, 1 week before appointment data and will edit message of auto-reminder sent 48 hrs. before appointment date. Joyce will download submitted forms each day and scan them into the patient’s record prior to the visit. Huddle will include # of 11 yrs. old being seen for well-visits that day (as reminder to review/discuss pre-visit form and HPV decision aid which are both currently being tested).
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/15/16 End Date: 8/1/16
Objective for this PDSA Cycle (Aim): By August 1, 2016, at least 90% of our patients who receive care coordination services and are scheduled to be seen for a visit that month will complete the Family- Centered Care (FCC) Coordination Questionnaire via our patient portal prior to the scheduled appointment so we have better information about family concerns, needs and preferences in the care their child receives.
PLAN: QUESTIONS What percentage (%) of those patients/families have an activated
portal account? Will these questionnaires be completed and returned to our care coordinator prior to the patient’s scheduled visit?
PREDICTIONS Since we have worked hard to document a current email address in the EHR for each patient/family, we believe that at least 75% of our families with children with special health care needs (CSHCNs) will have completed the form prior to their appointment.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Task: Harriet (Care Coordinator) will assess portal account status of families with CSHCNs who are scheduled to be seen in August in our office. Those families without an activated account will be referred to our tech support staff member (Ernest) to do follow up and help them sign up for the portal and gain access. On July 15h, Harriet will send a secure email via the patient portal with the 1-page FCC Coordination Questionnaire (https://medicalhomes.aap.org/Documents/FamilyCenteredCareCoordination.pdf ) attached. Instructions to email the completed form back to her prior to the scheduled visit, using the portal’s secure email system or to fax it back to her attention or bring the completed form to the visit.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Harriet will document and count how many emails were sent out by her via the portal. Of those how many completed questionnaires were returned via the portal email, the fax or returned at the time of the visit.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/15/16 End Date: 8/1/16
Objective for this PDSA Cycle (Aim): By August 1, 2016, at least 90% of our patients who receive care coordination services and are scheduled to be seen for a visit that month will complete the Family- Centered Care (FCC) Coordination Questionnaire via our patient portal prior to the scheduled appointment so we have better information about family concerns, needs and preferences in the care their child receives.
PLAN: QUESTIONS What percentage (%) of those patients/families have an activated
portal account? Will these questionnaires be completed and returned to our care coordinator prior to the patient’s scheduled visit?
PREDICTIONS Since we have worked hard to document a current email address in the EHR for each patient/family, we believe that at least 75% of our families with children with special health care needs (CSHCNs) will have completed the form prior to their appointment.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Task: Harriet (Care Coordinator) will assess portal account status of families with CSHCNs who are scheduled to be seen in August in our office. Those families without an activated account will be referred to our tech support staff member (Ernest) to do follow up and help them sign up for the portal and gain access. On July 15h, Harriet will send a secure email via the patient portal with the FCC Coordination Questionnaire (https://medicalhomes.aap.org/Documents/FamilyCenteredCareCoordination.pdf ) attached. Instructions to email the completed form back to her prior to the scheduled visit, using the portal’s secure email system or to fax it back to her attention or bring the completed form to the visit.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Harriet will document and count how many emails were sent out by her via the portal. Of those how many completed questionnaires were returned via the portal email, the fax or returned at the time of the visit.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Harriet found that only about 50% of those families with CSHCNs have an activated patient portal account. Those without an active portal account were referred to Ernest for follow up. Emails were sent on July 15th by Harriet via the portal to all parents/caregivers with an activated account.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED Of those families referred for follow up by Ernest, he reported that only 15% of those he contacted signed up and activated their portal account. Harriet will plan to meet with the QI team to discuss how to improve patient portal enrollment and to plan one or more tests of change with an aim to increase portal participation. Of those who received the email with the FCC questionnaire, 60% completed and returned the questionnaire via the secure email system, 10% faxed the form back prior to the appointment date and 10% brought the completed form to the visit.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan for next cycle: Need to increase patient portal enrollment and activation before conducting the next cycle.
For next cycle, Harriet will also ask parents/caregivers for feedback about the communication process and about the questionnaire.
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/1/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will routinely ask a set of questions to assess resilience of primary caregivers of our patients 0-3 yrs. old, as part of the well-child care (WCC) visit so we can better help them build their resilience and plan proactively how to respond to stressful parenting situations.
PLAN: QUESTIONS Can additional questions be integrated into the WCC visit?
How will they be documented in the patient’s record?
PREDICTIONS Questions will be verbally asked by Dr. Richards to at least 75% of the primary caregivers seen for a WCC visit tomorrow afternoon and documented in the patient records.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Completed Tasks: The 7 “Questions to ask” on the Strengthening Families’ “Parental Resilience: Action Sheet” (http://www.cssp.org/reform/strengtheningfamilies/about/body/ProtectiveFactorsActionSheets.pdf ) were reviewed by Parents/Caregivers who attended our June 15th Advisory Group meeting (PFAG). They reached consensus for Dr. Richards to test asking questions #4-6 at the initial visit. A smart set of those questions has been added to the EHR by Dr. Green. On Tuesday afternoon, Dr. Richards will test asking those questions to primary caregivers of patients 0-3 yrs. old being seen by him for a WCC visit.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of the afternoon, Joyce (MA) will tally the total # of patients 0-3 seen by Dr. Richards and the # of those with documentation that the “resilience” related questions were asked. The aggregate de-identified results also will be shared via email with the members of our PFAG.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/1/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will routinely ask a set of questions to assess resilience of primary caregivers of our patients 0-3 yrs. old, as part of the well-child care (WCC) visit so we can better help them build their resilience and plan proactively how to respond to stressful parenting situations.
PLAN: QUESTIONS Can additional questions be integrated into the WCC visit?
How will they be documented in the patient’s record?
PREDICTIONS Questions will be verbally asked by Dr. Richards to at least 75% of the primary caregivers seen for a WCC visit tomorrow afternoon and documented in the patient records .
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Completed Tasks: The 7 “Questions to ask” on the Strengthening Families’ “Parental Resilience: Action Sheet” (http://www.cssp.org/reform/strengtheningfamilies/about/body/ProtectiveFactorsActionSheets.pdf ) were reviewed by Parents/Caregivers who attended our June 15th Advisory Group meeting (PFAG). They reached consensus for Dr. Richards to test asking questions #4-6 at the initial visit. A smart set of those questions has been added to the EHR by Dr. Green. On Tuesday afternoon, Dr. Richards will test asking those questions to primary caregivers of patients 0-3 yrs. old being seen by him for a WCC visit.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE At the end of the afternoon, Joyce (MA) will tally the total # of patients 0-3 seen by Dr. Richards and the # of those with documentation that the “resilience” related questions were asked. The aggregate de-identified results also will be shared via email with the members of our PFAG.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Dr. Richards used the smart set questions as part of the appropriate WCC visits. He also took time to document the responses in the Notes section of the visit record. He felt it would be helpful information for future interactions with the family. He reported that the reaction from the parent of a 2-yrs. old was “why are you asking me these questions?” so he started prefacing his questions by saying that he is asking them to all parents/caregivers with a child 0-3 yrs. old.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED All 5 of the primary caregivers seen by Dr. Richards this afternoon were asked the resilience questions during the visit (except 1 grandmother who was not the primary caregiver) = 100%. Dr. Richards shared that the patients/families he saw this afternoon did not have any special needs so asking the questions did not blow his schedule out of the water but he expressed concern about taking the time when that is not the case. Can someone else ask those questions or should we consider sharing these questions with the family prior to the scheduled appointment and asking them to write down their answers?
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan for next cycle: PFAG members would like to get informal feedback from the primary caregivers at the end of the
visit. For Cycle 2, Alice (N Manager) will ask those parents/caregivers (before check-out) for feedback about those
questions they were asked and what else they may want/need (e.g., would they like information or help developing a plan in advance for how they will keep themselves calm and centered in these stressful circumstances).
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/25/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will invite at least 1 community-based organization (CBO) or state agency on our referral/resource list, such as Early Intervention (EI) to attend our monthly physician and staff meeting to help us better connect our families with appropriate supports and services, based on their needs.
PLAN: QUESTIONS Who should we invite first? Will a rep from the organization/agency be
willing/able to attend our meeting? Can we allot a half hour of our agenda for this purpose? Will it be useful for everyone or just physicians?
PREDICTIONS We can schedule a rep to attend our next meeting but it may be difficult because it is summer and people are on vacation. This opportunity to meet with a CBO or state agency we currently refer patients to will be useful for both physicians and staff members.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Our core team decided that Mary Jo (Nurse Manager) will contact the EI program tomorrow and invite someone to attend our monthly meeting in our office and give a brief 15-20 minute presentation about services and eligibility and be prepared to take 10-15 minutes of questions from the group.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE An evaluation form will be completed by each participant at the end of the meeting: Was it helpful/useful? Why or why not? How can we improve it next time? What organization/agency should be invited to our next meeting?
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/25/16
Objective for this PDSA Cycle (Aim): By July 31, 2016, our practice will invite at least 1 community-based organization (CBO) or state agency on our referral/resource list, such as Early Intervention (EI) to attend our monthly physician and staff meeting to help us better connect our families with appropriate supports and services, based on their needs.
PLAN: QUESTIONS Who should we invite first? Will a rep from the organization/agency be
willing/able to attend our meeting? Can we allot a half hour of our agenda for this purpose? Will it be useful for everyone or just physicians?
PREDICTIONS We can schedule a rep to attend our next meeting but it may be difficult because it is summer and people are on vacation. This opportunity to meet with a CBO or state agency we currently refer patients to will be useful for both physicians and staff members.
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Our core team decided that Mary Jo (Nurse Manager) will contact the EI program tomorrow and invite someone to attend our monthly meeting in our office and give a brief 15-20 minute presentation about services and eligibility and be prepared to take 10-15 minutes of questions from the group.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE An evaluation form will be completed by each participant at the end of the meeting: Was it helpful/useful? Why or why not? How can we improve it next time? What organization/agency should be invited to our next meeting?
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Two representatives from the EI program our staff meeting on July 25th. Good questions were asked. There was some confusion among the physicians about the referral process. A lengthy discussion followed about how communication and information sharing by EI with our practice needs to be improved. The program manager left her card and encouraged the physicians and staff to call her in the future with any questions or concerns related to these issues.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED All participants completed the evaluation form but it up took too much time. Overall, everyone thought the presentation and information shared was useful. The physicians especially liked the face-to-face interaction. Feedback included that next time 1 or more parents/caregivers who use or have used the services of the invited org/agency should be invited to attend that part of our meeting. Three physicians would like to learn more about the Family-to-Family Health Information Centers.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan for next cycle: There is no August meeting. Mary Jo will contact our state’s Family-to-Family Health Information
Center and invite them to attend our Sept. meeting. We will also identify 1 or more family(ies) who use the support and/or services that they offer and invite them to attend that portion of our meeting. Rather than collecting the evaluation/feedback on paper, we will test using Survey Monkey and send the URL via email to each meeting attendee after our next meeting.
Act Plan
Study Do
MODEL FOR IMPROVEMENT Team Name: ABC Pediatrics
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/1/16
Objective for this PDSA Cycle (Aim): By July 1, 2016, our practice will test a care plan that includes elements needed by healthcare professionals, patients and parents/caregivers to ensure seamless planned care.
PLAN: QUESTIONS What elements can currently be populated from our EHR?
What elements do the physicians and other clinicians in our practice want included? What elements do patients and parents/caregivers want/need?
PREDICTIONS This will require an iterative process but, over time, we will be able to create a balance between the practice and patient/family needs (and not be >4-pages).
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Tasks: By June 10th, Alice (N Manager) will export to Excel a list of all of the care plan elements included as possible choices in the NICHQ Care Plan Template which she downloaded from https://www.nichq.org/resource/nichqs-care-plan-template. She will cross-walk it with data fields currently in our EHR. She will also share the file via email with all of the physicians and clinicians, as well as the 15 members of our Parent/Family Advisory Group, asking them by June 17th to place an “X” in the appropriate column for each element which is a “must include” and for each element viewed as a “could include.” Alice will tally the results to share with our core QI team, including our parent partner, when they meet on June 24thto identify the initial care plan elements to be included and tested by Dr. Green. On July 1, this initial care plan template will be tested by Dr. Green with the last patient with special healthcare needs he is scheduled to see that day.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Feedback will be collected from Dr. Green about the ease in creating, sharing and reviewing the care plan with the patient/family. Feedback will also be collected from the patient and/or parent/caregiver about the usefulness of the information provided and ease in understanding the plan, based on format and organization. Both physician and parent/caregiver will be asked what else is needed or should be changed.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
Plan a Test of Change Cycle #:_1_Start Date: 7/1/16 End Date: 7/1/16
Objective for this PDSA Cycle (Aim): By July 1, 2016, our practice will test a care plan that includes elements needed by healthcare professionals, patients and parents/caregivers to ensure seamless planned care.
PLAN: QUESTIONS What elements can currently be populated from our EHR?
What elements do the physicians and other clinicians in our practice want included? What elements do patients and parents/caregivers want/need?
PREDICTIONS This will require an iterative process but, over time, we will be able to create a balance between the practice and patient/family needs (and not be >4-pages).
PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Tasks: By June 10th, Alice (N Manager) will export to Excel a list of all of the care plan elements included as possible choices in the NICHQ Care Plan Template which she downloaded from https://www.nichq.org/resource/nichqs-care-plan-template. She will cross-walk it with data fields currently in our EHR. She will also share the file via email with all of the physicians and clinicians, as well as the 15 members of our Parent/Family Advisory Group, asking them by June 17th to place an “X” in the appropriate column for each element which is a “must include” and for each element viewed as a “could include.” Alice will tally the results to share with our core QI team, including our parent partner, when they meet on June 24thto identify the initial care plan elements to be included and tested by Dr. Green. On July 1, this initial care plan template will be tested by Dr. Green with the last patient with special healthcare needs he is scheduled to see that day.
PLAN FOR COLLECTION OF DATA: WHO, WHAT, WHEN, WHERE Feedback will be collected from Dr. Green about the ease in creating, sharing and reviewing the care plan with the patient/family. Feedback will also be collected from the patient and/or parent/caregiver about the usefulness of the information provided and ease in understanding the plan, based on format and organization. Both physician and parent/caregiver will be asked what else is needed or should be changed.
DO: CARRY OUT THE CHANGE OR TEST; COLLECT DATA AND BEGIN ANALYSIS.
REPORT THE RESULTS OF YOUR TEST HERE. Describe observations, problems encountered, and special circumstances.
Tasks were completed as described in Plan. Dr. Green was able to create, print out, share and review the care plan with the last patient with special healthcare needs that he saw today. Many fields were populated with data from our EHR which was helpful but that did not include information recorded as a “Note.” It was “tested” with a 5 yrs. old child whose mom has been good advocate for her at her school. She reported that she likes the information about her child’s strengths and favorite activities but doesn’t like that it includes the fact that she has trouble paying for her daughter’s medications, since she shares this plan with the school nurse.
STUDY: COMPLETE ANALYSIS OF DATA; SUMMARIZE WHAT WAS LEARNED The feedback was shared with the QI team. Since the printed care plan was only 3 pages long, there is an opportunity to add some additional elements, preferably one or two “could include” that are already being collected in the EHR. The QI team is reconsidering including social risks which the physicians/clinicians wanted but not the parents/caregivers. Need to prioritize “must have” elements that currently require typing the information into the template, to see which could be created as data fields in the EHR that could then populate the care plan electronically.
ACT: ARE WE READY TO MAKE A CHANGE? Modifications or refinements to the test?
PLAN FOR THE NEXT CYCLE: Care plan template was tweaked, to remove social risks and add list of “primary”
school team members and community-based providers engaged with the child/youth (daycare, Early Intervention, Head Start, transportation providers, etc.), and contact information. Dr. Green will test the use, sharing and review of care plan with patients/families with CSHCNs seen tomorrow and will gather and give feedback to the QI team. Findings of these cycles will also be shared and discussed at the full staff meeting next week.
Family Engagement Quality Improvement Project December Monthly Progress Report
DATE DUE: December 30, 2016
The Monthly Progress Report (MPR) details the tests of change related to family engagement practice teams undertook during theaction period and any success stories or challenges they encountered.
1. Practice Name:*
Project Aim Statement: By January 2017, 10 pediatric primary care practices will work individually and collaboratively to test,implement, disseminate, and plan to sustain strategies that lead to improved family engagement in clinical practice through enhancedshared decision-making and connection of families to appropriate supports and services.
Instructions:
The purpose of this report is to obtain the following information from practice teams:
1. Describe tests of change and identify resources and tools utilized to test changes.
2. Identify successes and barriers in implementing tests of change.
3. Share what you learned this month.
4. Rate the impact of the project on patient/family communication and health care team experience in caring for patients andfamilies.
Click "Next" to begin:
Family Engagement Quality Improvement Project December Monthly Progress Report
2.
Did you meet as a team throughout the month of December to plan tests of change and discusschallenges/successes?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
3. How many times did you meet as a team?
4. Who attended the team meetings (for example, core improvement team members, additional practicestaff, parent/caregiver partners, other family members, Information Technology staff, etc)?
5. What did your team discuss during team meetings?
Family Engagement Quality Improvement Project December Monthly Progress Report
Family Engagement Tests of Change and Tools:
Please identify the changes you have tested within the past month. For each, describe changes, the impact/learning from this changeyou have made, and/or the tools you have tested.
6. Has your practice developed and/or modified one or more decision aid(s) in practice (modification couldinclude adding a practice name or logo to a decision aid)?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
7. If yes, please specify what decision aid was developed and/or modified in practice.*
Cincinnati Children's Hospital Decision Aids
Ottowa Family Decision Guide
Dartmouth-Hitchcock Decision Support Tools
Other (please specify)
8. Please describe how you developed/modified the decision aid in practice.*
Family Engagement Quality Improvement Project December Monthly Progress Report
9. Has your practice implemented one or more decision aid(s) in practice?*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
10. If yes, please specify what decision aid your practice implemented.*
11. Please describe how you implemented the decision aid(s) in your practice.*
Family Engagement Quality Improvement Project December Monthly Progress Report
12. Does your practices have a system in place for tracking and following up on referrals to appropriatesupports and services for patients/families/caregivers?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
13. If yes, please specify the system you have in place for tracking and following up on referrals toappropriate supports and services for patients/families/caregivers:
*
Checkbox in patient medical record
Referral fax back form
Requests for patient summary
Follow-up phone calls
Patient registry
Other (please specify)
14. Please describe how you implemented the system for tracking and following up on referrals toappropriate supports and services for patients/families/caregivers.
*
Family Engagement Quality Improvement Project December Monthly Progress Report
15. Does your practice have an engaged parent/caregiver partner that is a core member of theimprovement team?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
16. If yes, please provide one or more example(s) of how the parent/caregiver partner was engaged inimprovement team activities throughout this Action Period.
*
Family Engagement Quality Improvement Project December Monthly Progress Report
17. Does your practice have a system in place for obtaining feedback from families on patient/familyexperience?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
18. If yes (you have a system in place for obtaining feedback from families on patient/family experience),please select an example of what this system is:
*
Family advisory group/council
Post-visit family experience survey
Parent/family focus groups
Ask families for informal feedback at visits
Suggestion boxes
Other (please specify)
19. Please describe how you implemented the system(s) for obtaining feedback from families onpatient/family experiences.
*
Family Engagement Quality Improvement Project December Monthly Progress Report
20. Did your practice host a “lunch and learn” with a community-based organization that included practicestaff and/or family members?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
21. If yes, please describe what you learned at the “lunch and learn” and any changes you plan toimplement based on what you learned.
*
22. Please select the focus of the community-based organization:*
Child-Care
Housing Assistance
WIC
Nutrition
Title V
Local Family to Family Health Information Center (F2F HIC)
Other (please specify)
Family Engagement Quality Improvement Project December Monthly Progress Report
23. Did your improvement team share project results and progress with the rest of the practice/clinic staff(this can also include parents/caregivers)?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
24. If yes, please identify how project results/progress were shared with the rest of the practice/clinic staff.*
Discussing run charts during monthly team meetings
Sharing challenges and success during team huddles
Highlighting project results in practice newsletter
Showcasing project results on practice bulletin board
Other (please specify)
Family Engagement Quality Improvement Project December Monthly Progress Report
25. What other tests of change did your practice test/implement related to shared-decision making? Shareddecision making is a collaborative process that allows patients and their health care providers to makehealth care decisions together, taking into account the best scientific evidence available, as well as thepatient’s values and preferences.
A model for shared decision making includes: 1) Introducing choice; 2) describing options; 3) helpingpatients explore preferences and make decisions.
*
26. What other tests of change did your practice test/implement related to connecting families toappropriate supports and services?
*
Family Engagement Quality Improvement Project December Monthly Progress Report
27. Share something important, surprising, or successful your team learned/implemented this month.*
28. What was the biggest barrier/challenge your team encountered this month? Were you able toovercome it? If so, how?
*
Much less time (5) 4 No change (3) 2 Much more time (1)
29. Think about the changes your team has implemented as part of the “Family Engagement QualityImprovement Project.” Because of this project, the overall office visit time for patients and families has (Rate on a scale of 1-5, where 5=significantly decreased and 1=significantly increased)
*
Much more confident (5) 4 No change (3) 2 Much less confident (1)
30. Think about the changes your team has implemented as part of the “Family Engagement QualityImprovement Project.” Because of this project, the care team’s confidence about engaging families inshared decision-making has become: (Rate on a scale of 1-5, where 5=much more confident and 1=much less confident)
*
31. What issues or topics would you like to discuss on a monthly project team call or through the projectemail list?
*
Please click "Done" to submit your report.Thank you!
Family Engagement Quality Improvement Project December Monthly Progress Report
DATE DUE: December 30, 2016
The Monthly Progress Report (MPR) details the tests of change related to family engagement practice teams undertook during theaction period and any success stories or challenges they encountered.
1. Practice Name:*
Project Aim Statement: By January 2017, 10 pediatric primary care practices will work individually and collaboratively to test,implement, disseminate, and plan to sustain strategies that lead to improved family engagement in clinical practice through enhancedshared decision-making and connection of families to appropriate supports and services.
Instructions:
The purpose of this report is to obtain the following information from practice teams:
1. Describe tests of change and identify resources and tools utilized to test changes.
2. Identify successes and barriers in implementing tests of change.
3. Share what you learned this month.
4. Rate the impact of the project on patient/family communication and health care team experience in caring for patients andfamilies.
Click "Next" to begin:
Family Engagement Quality Improvement Project December Monthly Progress Report
2.
Did you meet as a team throughout the month of December to plan tests of change and discusschallenges/successes?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
3. How many times did you meet as a team?
4. Who attended the team meetings (for example, core improvement team members, additional practicestaff, parent/caregiver partners, other family members, Information Technology staff, etc)?
5. What did your team discuss during team meetings?
Family Engagement Quality Improvement Project December Monthly Progress Report
Family Engagement Tests of Change and Tools:
Please identify the changes you have tested within the past month. For each, describe changes, the impact/learning from this changeyou have made, and/or the tools you have tested.
6. Has your practice developed and/or modified one or more decision aid(s) in practice (modification couldinclude adding a practice name or logo to a decision aid)?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
7. If yes, please specify what decision aid was developed and/or modified in practice.*
Cincinnati Children's Hospital Decision Aids
Ottowa Family Decision Guide
Dartmouth-Hitchcock Decision Support Tools
Other (please specify)
8. Please describe how you developed/modified the decision aid in practice.*
Family Engagement Quality Improvement Project December Monthly Progress Report
9. Has your practice implemented one or more decision aid(s) in practice?*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
10. If yes, please specify what decision aid your practice implemented.*
11. Please describe how you implemented the decision aid(s) in your practice.*
Family Engagement Quality Improvement Project December Monthly Progress Report
12. Does your practices have a system in place for tracking and following up on referrals to appropriatesupports and services for patients/families/caregivers?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
13. If yes, please specify the system you have in place for tracking and following up on referrals toappropriate supports and services for patients/families/caregivers:
*
Checkbox in patient medical record
Referral fax back form
Requests for patient summary
Follow-up phone calls
Patient registry
Other (please specify)
14. Please describe how you implemented the system for tracking and following up on referrals toappropriate supports and services for patients/families/caregivers.
*
Family Engagement Quality Improvement Project December Monthly Progress Report
15. Does your practice have an engaged parent/caregiver partner that is a core member of theimprovement team?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
16. If yes, please provide one or more example(s) of how the parent/caregiver partner was engaged inimprovement team activities throughout this Action Period.
*
Family Engagement Quality Improvement Project December Monthly Progress Report
17. Does your practice have a system in place for obtaining feedback from families on patient/familyexperience?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
18. If yes (you have a system in place for obtaining feedback from families on patient/family experience),please select an example of what this system is:
*
Family advisory group/council
Post-visit family experience survey
Parent/family focus groups
Ask families for informal feedback at visits
Suggestion boxes
Other (please specify)
19. Please describe how you implemented the system(s) for obtaining feedback from families onpatient/family experiences.
*
Family Engagement Quality Improvement Project December Monthly Progress Report
20. Did your practice host a “lunch and learn” with a community-based organization that included practicestaff and/or family members?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
21. If yes, please describe what you learned at the “lunch and learn” and any changes you plan toimplement based on what you learned.
*
22. Please select the focus of the community-based organization:*
Child-Care
Housing Assistance
WIC
Nutrition
Title V
Local Family to Family Health Information Center (F2F HIC)
Other (please specify)
Family Engagement Quality Improvement Project December Monthly Progress Report
23. Did your improvement team share project results and progress with the rest of the practice/clinic staff(this can also include parents/caregivers)?
*
Yes
No
Family Engagement Quality Improvement Project December Monthly Progress Report
24. If yes, please identify how project results/progress were shared with the rest of the practice/clinic staff.*
Discussing run charts during monthly team meetings
Sharing challenges and success during team huddles
Highlighting project results in practice newsletter
Showcasing project results on practice bulletin board
Other (please specify)
Family Engagement Quality Improvement Project December Monthly Progress Report
25. What other tests of change did your practice test/implement related to shared-decision making? Shareddecision making is a collaborative process that allows patients and their health care providers to makehealth care decisions together, taking into account the best scientific evidence available, as well as thepatient’s values and preferences.
A model for shared decision making includes: 1) Introducing choice; 2) describing options; 3) helpingpatients explore preferences and make decisions.
*
26. What other tests of change did your practice test/implement related to connecting families toappropriate supports and services?
*
Family Engagement Quality Improvement Project December Monthly Progress Report
27. Share something important, surprising, or successful your team learned/implemented this month.*
28. What was the biggest barrier/challenge your team encountered this month? Were you able toovercome it? If so, how?
*
Much less time (5) 4 No change (3) 2 Much more time (1)
29. Think about the changes your team has implemented as part of the “Family Engagement QualityImprovement Project.” Because of this project, the overall office visit time for patients and families has (Rate on a scale of 1-5, where 5=significantly decreased and 1=significantly increased)
*
Much more confident (5) 4 No change (3) 2 Much less confident (1)
30. Think about the changes your team has implemented as part of the “Family Engagement QualityImprovement Project.” Because of this project, the care team’s confidence about engaging families inshared decision-making has become: (Rate on a scale of 1-5, where 5=much more confident and 1=much less confident)
*
31. What issues or topics would you like to discuss on a monthly project team call or through the projectemail list?
*
Please click "Done" to submit your report.Thank you!
Thank you for participating in the Family Engagement Quality Improvement Project!
We would like to find out some general information about the family engagement activities withinyour office setting. Please complete this post-implementation survey after the final action period. The survey will take no more than 15 minutes of your time. Only one survey is needed per practiceteam.
Your survey responses will be kept strictly confidential. We will never link your responses to yourname in reports or anywhere else.
If you have any questions, please contact Alex Kuznetsov, RD, at 847-434-7087 [email protected].
In order to progress through this survey, please use the following navigation buttons:
-Click the Next button to continue to the next page.
-Click the Previous button to return to the previous page.
-Click the Done button to submit your survey.
Family Engagment Quality Improvement Project Post-Implementation Survey
1. Please enter your practice name:*
We would like to know what types of family engagement activities you are currently involved with.
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
2. Which of the following methods for gathering patient and family feedback does your practice currentlyuse to support or inform its interactions with your patients and families? (select all that apply)
*
Family Advisory Council/Committee
Patient Suggestion Box
Patient/Family Focus Groups
Patient Satisfaction Surveys
Ask patients/families for informal feedback at visits
We have no system in place to obtain regular feedback from patients/families
Other (please specify)
3. For any of the methods you checked in the previous question, how does your practice use theinformation to support or inform its interactions with your patients and families? (select all that apply)
*
Review feedback to understand patient/family perspective and assess if patient/family needs are being met
We use the information to test/implement changes
Improvement teams review feedback, plan and test improvement ideas to incorporate patients’/families perspectives
We have not yet used the feedback from patients/families
Other (please specify)
4. In your direct interactions with your patients and families, describe your approach to identifying theirculture, beliefs, values, and practices (select all that apply):
*
Use of a patient/family history or demographic form
Use of open-ended questions
Use listening and other communication skills to assess
Use direct observation
We do not routinely obtain this information from patients
Other (please specify)
5. Do you provide a community resource list to your patients who may need it?*
Yes
No
Don't Know
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
6. If yes, please describe the types of information included on the community resource list (select all thatapply):
*
Education resources
Child Development/Behavior resources
Peer supports or Family-to-Family health information centers
Safety resources
Physical health resources
Teen resources
Other (please specify)
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
7. Do you have a system in place for tracking and following up on referrals to appropriate supports andservices for patients/families/caregivers (these supports could include community resources, peer-to-peersupports, medical specialists, etc)?
*
Yes
No
Don't Know
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
8. If yes, please specify the system you have in place for tracking and following up on referrals toappropriate supports and services for patients/families/caregivers:
*
Checkbox in patient medical record
Referral fax back form
Requests for patient summary
Follow-up phone calls
Patient registry
Other (please specify)
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
9. Does your practice create a post-visit medical summary or comprehensive care plan for patients/familiesat every visit? A comprehensive care plan includes an expanded medical summary, an emergencytreatment plan, and a dynamic, explicit plan of care, also known as an action plan. A post-visit medicalsummary is a history of medical information that includes the following:
Basic demographics and contact information
Patient and family, with guardianship identified, if applicableContact information for patient and family, including cell phone numbers and email addressesMedical HomeEmergency Contacts
Key medical, surgical, and injury historyCurrent medications, including medication reconciliationAllergiesImmunization recordInsurance informationSpecial instructions
*
Yes
No
Don't Know
10. Does your practice review and update the post-visit medical summary or comprehensive care plan withthe patient and family at each visit?
*
Yes
No
Don't Know
11. Does your practice have processes to communicate age-appropriate screening results and theirimplications to patients and families? Age-appropriate screenings include any/all listed in the Bright FuturesPeriodicity Schedule, as well as other screenings related to social determinants of health, as appropriateand necessary.
*
Yes
No
Don't Know
Part Two: Partnering with Patients and Families
Family Engagment Quality Improvement Project Post-Implementation Survey
12. "Shared decision making” is a collaborative process that allows patients and their health care providersto make health care decisions together, taking into account the best scientific evidence available, as well asthe patient’s values and preferences.
A model for shared decision making includes: 1) introducing choice; 2) describing options; and 3) helpingpatients explore preferences and make decisions.
Based on this definition, how often would you say you engage in shared decision making with the patientsand families in your care?
*
Never
Rarely
Occasionally
Frequently
Always
13. How do you implement shared decision making in your office (select all that apply):*
Discuss options with patients and families
Discuss the pros and cons of various treatments with patients and families
Use Motivational Interviewing (MI) techniques
Use existing knowledge of patient preferences
Use decision aids in practice
We do not use any shared decision making techniques
Other (please specify)
End of Survey
Family Engagment Quality Improvement Project Post-Implementation Survey
14. If you have any other information you would like to share, please enter it below:
15. How would you rate your current (right now) level of overall knowledge about family engagementactivities on a scale of 1 to 10, where 1 is the lowest and 10 is the highest?
*
1 2 3 4 5 6 7 8 9 10
16. Now, think back to immediately before this project began and rate your level of knowledge about familyengagement. If you feel your knowledge level has not changed, select the same number you chose in thequestion above.
*
1 2 3 4 5 6 7 8 9 10
Please click "Done" to submit your survey.Thank you!
Family Engagement Quality Improvement Project: Interview Script Page 1
Participant ID______________________
Family Engagement Quality Improvement Project
Post-Implementation Telephone Interview Script
(For Parent/Caregiver Partners Participating Individually on Interviews)
Thank you for agreeing to participate in the Family Engagement Quality Improvement Project
Interview. The purpose of this call is to learn about your experiences as participant(s) in the
project. Your feedback will be used to help us make improvements to our family engagement
initiatives and resources in the future.
I will be asking you a set of questions about your experiences during the project. There are no
right or wrong answers—your truthful responses are what count. The interview will take no
more than one hour to complete. You may choose to skip one or more questions or stop the
interview at any time.
The interview will be recorded while I take detailed notes about what was said during our
conversation. Everything you say is confidential. Your individual name(s) will not appear
anywhere on any publications resulting from this interview.
Do you have any questions or concerns before we get started? OK, I am going to start the
recording.
1. How long (how many weeks/months) did you participate as a member of the pediatric
practice quality improvement (QI) team (for clarification, the QI team includes the
Enhancing Family Engagement through Quality Improvement Lessons Learned from the Family Engagement Quality Improvement Project
Family engagement and family-centered care improves patient and family outcomes, increases family and clinician satisfaction, decreases health care costs, and improves effective use of health care resources. 2
The NCMHI Family Engagement Quality Improvement Project identified strategies to do the following:
For Clinical Practices, Title V programs, Family Organizations, and Others...Strategies for Implementing Family Engagement Quality Improvement Projects in Clinical Practices and/or through Multi-Site Learning Collaboratives
• IdentifyEntities(Practices,Individuals)ReadytoMakeaChange Conduct outreach to pediatric practices or individuals within a practice to gauge interest and capacity in implementing strategies to enhance family
• ConveneMultidisciplinaryCoreImprovementTeams Once a team leader or champion is identified, this individual can initiate the convening of a core improvement team. Core improvement teams facilitate
andleadqualityimprovementactivitieswithinaclinicalpractice.Multidisciplinarycoreimprovementteammembersshouldincludeprofessionalsin diverse roles such as physicians, non-physician clinicians, administrative support staff, and a parent/caregiver partner. Baseline knowledge and familiaritywithqualityimprovementmethodologyamongteammembersispreferred.
Improvement. Ensure all team members understand how to test changes in practice through Plan-Do-Study-Act (PDSA) cycles.
• TestSmallChanges Core improvement teams should be encouraged to plan and try out new ideas rather than implementation of large projects and initiatives. New ideas–
• MeasureProgress Determine what each practice and core improvement team wants to achieve. Develop a project aim and related project measures. Utilize additional
evaluation strategies such as a pre- and post- tests and monthly progress reports to collect information about what types of activities are being implemented within each practice.
• ProvideSupportandEducation Utilize the project aim and measures to identify tools and resources that can be used by participating core improvement teams to test changes.
Develop PDSA cycles to demonstrate how each tool and resource can be tested in practice. Additional support and education can be provided by formallytrainedqualityimprovementcoachesviatelephonecallsorin-personmeetingsandparticipationineducationalwebinarsand/orconferencecalls with other participating clinical practices (in multi-site collaboratives).
• FosterOpportunitiesforPeer-basedLearning For multi-site learning collaboratives, provide opportunities for peer-based learning. Offer in-person learning sessions or other meetings, interactive
• IntegrateSustainabilityandSpreadIntoallChangesthatResultinImprovement It is never too early to think about how improvements will be sustained. Communicate information about tests of change to all practice staff and
senior leadership, encourage buy-in and integration of successful changes into existing practice policies, procedures, and workflow.
Familyengagement is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. 1
1 Johnson, BH, Abraham, MR. Partnering with Patients, Residents, and Families: A Resource for Leaders of Hospitals, Ambulatory Care Settings, and Long-Term Care Communities. Bethesda, MD: Institute for Patient- and Family-Centered Care; 2012.
2 American Academy of Pediatrics, Committee on Hospital Care. Family-Centered Care and the Pediatrician’s Role. Pediatrics. 2003;112(3):691 – 696
For Practices and Health Care Organizations...Strategies to Meaningfully Engage Families in Clinical Practice
• StartwithStrengths Utilizing a strengths-based approach fosters trust and builds relationships between families, caregivers, patients, and pediatric professionals.
• ObtainandReviewFamilyFeedbacktoGuideImprovement Develop a system for obtaining family and caregiver feedback about their experience visiting your clinic. Some systems/strategies for gaining
feedback include family advisory groups, family surveys, focus groups, suggestion boxes, and virtual family groups via social media platforms.
• GoBeyondCarePlansandSummaries Most practices develop medical summaries, action plans, or care plans for families and patients. Enhance family engagement by developing these
documents in partnership with families. Utilize Teach Back, motivational interviewing, or the Ask-me-3 framework to actively engage families in this process. Share the final product with families and caregivers electronically and/or in hard copy.
• ConnecttoResourcesandServicesthatWork Connect families to necessary supports and services by developing community resource lists which can be used for referrals. Provide families
and caregivers an opportunity to review each resource and provide feedback on ease of referral and utility of each resource. This will facilitate the creation of a community resource list that only includes the most useful community resources for families and caregivers.
• KnowYourNeighbors Invite representatives from local organizations or community groups into your clinic to learn more about the services and programs they offer.
Keep these in mind as important referral resources for patients and families.
• DoNotReinventtheWheel—ConnectwithTitleVandFamily-to-FamilyHealthInformationCenters Every state has a Title V (Maternal and Child Health Block Grant) program and Family-to-Family Health Information Center. These organizations
are ready and available to assist pediatric practices in efforts related to family engagement and have already developed multiple tools and resources to help with family engagement efforts.
Tools and Resources• Family Engagement Quality Improvement Project Change Package and sample PDSA Cycles
• National Center for Medical Home Implementation Family Engagement Webinar Series
• Fostering Partnership and Teamwork in the Pediatric Medical Home: A “How-To” Video Series
• Introduction to the Model for Improvement
• Family Engagement Guide: The Role of Family Health Partners in Quality Improvement within a Pediatric Medical Home
• Strengthening Families Initiative: Identifying Family Strengths
• Care Mapping
• Achieving a Shared Plan of Care for Children and Youth with Special Health Care Needs
• Connect with your Family-to-Family Health Information Center
• Connect with your State Title V Program
For more information, visit www.medicalhomeinfo.org or email [email protected]
• Clearlyidentifyteammemberrolesand responsibilities at the beginning of the project.
• Communicateexpectationsforallteammembers, including parent/caregiver partners and other core improvement team members.
• ConsiderandnegotiatepotentialHIPAA/patient confidentiality issues prior to engaging a parent/caregiver partner and identifying roles and responsibilities.
• Offerincentivesforparticipation,suchasfinancial stipends, childcare services, food and support for transportation.
• Findtimeandinnovativestrategiestomeetas a team. Consider non-traditional meeting platforms such as Facebook, Skype, group texts, and emails.
• Ifparent/caregiverpartnersareunabletoparticipate in team meetings, continue to communicate regularly with parent/caregiver partners to keep them informed and engaged.
• Providetrainingonqualityimprovementmethodology specifically geared toward non-clinicians and individuals who may not be familiar with this methodology.
• Providepracticalexamplesofhowparent/caregiver partners can engage in planning and implementation of PDSA cycles.
• Foradditionaltipsandstrategiesonhowto identify and engage a parent/caregiver partner, visit the National Institute for Children’s Health Quality.
Tips for Engaging a Parent/Caregiver Partner in Practice-based Quality Improvement Projects
The NCMHI is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant number U43MC09134. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the US Government.
Thank you for participating in the Family Engagement Quality Improvement Project!
We would like to find out some general information about the family engagement activities withinyour office setting. Please complete this post-implementation survey after the final action period. The survey will take no more than 15 minutes of your time. Only one survey is needed per practiceteam.
Your survey responses will be kept strictly confidential. We will never link your responses to yourname in reports or anywhere else.
If you have any questions, please contact Alex Kuznetsov, RD, at 847-434-7087 [email protected].
In order to progress through this survey, please use the following navigation buttons:
-Click the Next button to continue to the next page.
-Click the Previous button to return to the previous page.
-Click the Done button to submit your survey.
Family Engagment Quality Improvement Project Post-Implementation Survey
1. Please enter your practice name:*
We would like to know what types of family engagement activities you are currently involved with.
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
2. Which of the following methods for gathering patient and family feedback does your practice currentlyuse to support or inform its interactions with your patients and families? (select all that apply)
*
Family Advisory Council/Committee
Patient Suggestion Box
Patient/Family Focus Groups
Patient Satisfaction Surveys
Ask patients/families for informal feedback at visits
We have no system in place to obtain regular feedback from patients/families
Other (please specify)
3. For any of the methods you checked in the previous question, how does your practice use theinformation to support or inform its interactions with your patients and families? (select all that apply)
*
Review feedback to understand patient/family perspective and assess if patient/family needs are being met
We use the information to test/implement changes
Improvement teams review feedback, plan and test improvement ideas to incorporate patients’/families perspectives
We have not yet used the feedback from patients/families
Other (please specify)
4. In your direct interactions with your patients and families, describe your approach to identifying theirculture, beliefs, values, and practices (select all that apply):
*
Use of a patient/family history or demographic form
Use of open-ended questions
Use listening and other communication skills to assess
Use direct observation
We do not routinely obtain this information from patients
Other (please specify)
5. Do you provide a community resource list to your patients who may need it?*
Yes
No
Don't Know
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
6. If yes, please describe the types of information included on the community resource list (select all thatapply):
*
Education resources
Child Development/Behavior resources
Peer supports or Family-to-Family health information centers
Safety resources
Physical health resources
Teen resources
Other (please specify)
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
7. Do you have a system in place for tracking and following up on referrals to appropriate supports andservices for patients/families/caregivers (these supports could include community resources, peer-to-peersupports, medical specialists, etc)?
*
Yes
No
Don't Know
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
8. If yes, please specify the system you have in place for tracking and following up on referrals toappropriate supports and services for patients/families/caregivers:
*
Checkbox in patient medical record
Referral fax back form
Requests for patient summary
Follow-up phone calls
Patient registry
Other (please specify)
Part One: Family Engagement Activities
Family Engagment Quality Improvement Project Post-Implementation Survey
9. Does your practice create a post-visit medical summary or comprehensive care plan for patients/familiesat every visit? A comprehensive care plan includes an expanded medical summary, an emergencytreatment plan, and a dynamic, explicit plan of care, also known as an action plan. A post-visit medicalsummary is a history of medical information that includes the following:
Basic demographics and contact information
Patient and family, with guardianship identified, if applicableContact information for patient and family, including cell phone numbers and email addressesMedical HomeEmergency Contacts
Key medical, surgical, and injury historyCurrent medications, including medication reconciliationAllergiesImmunization recordInsurance informationSpecial instructions
*
Yes
No
Don't Know
10. Does your practice review and update the post-visit medical summary or comprehensive care plan withthe patient and family at each visit?
*
Yes
No
Don't Know
11. Does your practice have processes to communicate age-appropriate screening results and theirimplications to patients and families? Age-appropriate screenings include any/all listed in the Bright FuturesPeriodicity Schedule, as well as other screenings related to social determinants of health, as appropriateand necessary.
*
Yes
No
Don't Know
Part Two: Partnering with Patients and Families
Family Engagment Quality Improvement Project Post-Implementation Survey
12. "Shared decision making” is a collaborative process that allows patients and their health care providersto make health care decisions together, taking into account the best scientific evidence available, as well asthe patient’s values and preferences.
A model for shared decision making includes: 1) introducing choice; 2) describing options; and 3) helpingpatients explore preferences and make decisions.
Based on this definition, how often would you say you engage in shared decision making with the patientsand families in your care?
*
Never
Rarely
Occasionally
Frequently
Always
13. How do you implement shared decision making in your office (select all that apply):*
Discuss options with patients and families
Discuss the pros and cons of various treatments with patients and families
Use Motivational Interviewing (MI) techniques
Use existing knowledge of patient preferences
Use decision aids in practice
We do not use any shared decision making techniques
Other (please specify)
End of Survey
Family Engagment Quality Improvement Project Post-Implementation Survey
14. If you have any other information you would like to share, please enter it below:
15. How would you rate your current (right now) level of overall knowledge about family engagementactivities on a scale of 1 to 10, where 1 is the lowest and 10 is the highest?
*
1 2 3 4 5 6 7 8 9 10
16. Now, think back to immediately before this project began and rate your level of knowledge about familyengagement. If you feel your knowledge level has not changed, select the same number you chose in thequestion above.
*
1 2 3 4 5 6 7 8 9 10
Please click "Done" to submit your survey.Thank you!
National Center for Medical Home Implementation (NCMHI) Family Engagement Quality Improvement Project (FEQIP) Summary of Key Findings May 30, 2017
Pam Kelley, Ph.D. Kelley Analytics, LLC
Overview The overarching goal of the FEQIP was to improve family engagement in pediatric primary care
practices by: 1) increasing knowledge of concepts and strategies related to family engagement among
participating practice teams; and 2) increasing the capacity of participating teams to make practice
improvements related to family engagement. The FEQIP intervention was based on the quality
improvement collaborative approach and included the following key components:
The FEQIP implementation period was ten months, lasting from May 2016 to February 2017. Eight
primary care pediatric practices from seven states in the Northeast, Southeast, West, and Midwest
regions of the United States participated.
The FEQIP evaluation employed a mixed methods design that included pre- and post- tests, chart
reviews, team surveys, patient surveys, and key informant interviews (see full report for methodology
details).
Key Findings
The project was successful in improving participating teams' knowledge of family
engagement. For the eight teams, the median rating of overall knowledge of family engagement
increased significantly from 4.5 (before the project) to 8.0 (after the project) on a scale of 1 to 10, a
total of 3.5 scale points. This translates to a 77.8% increase in knowledge. This finding was
supported by team interviews, in which participants expressed that the project was very helpful to
them in understanding the key concepts related to family engagement, particularly shared decision
making. In addition, all of the teams interviewed reported that participating in the project changed
FEQIP Components
Each participating practice site formed a multidisciplinary team including a pediatrician leader, practice staff, and a parent/caregiver (referred to as a Parent Partner) to participate in the project;
A group of clinical, quality improvement, and parent/family experts formed an expert work group to provide support for improvement by acting as project faculty;
Teams participated in collaborative/peer-based learning experiences on topics related to the Model for Improvement and family engagement via two in-person learning sessions (ie, collaborative meetings) and monthly interactive conference calls/webinars;
Teams were provided with additional resources including monthly email updates with notes from the QI Advisor and highlighted resources, a project listserv, and an electronic collaborative workspace;
Teams used Model for Improvement techniques (ie, setting aims, collecting data, and testing changes) to improve family engagement in their practice;
Teams tested changes in their practice using a predefined list (referred to as a "change package") of evidence-based strategies, tools, and other resources created for the project by the expert work group;
Teams participated in individualized, one-on-one coaching from a QI Advisor; and
Teams tracked their progress over time on a set of predefined project measures by maintaining monthly run charts and progress reports; key faculty members reviewed teams' monthly reports to assess the overall progress of the collaborative.
the way they think about family engagement. Some expressed feelings of raised awareness and
being "more tuned in," while others described their participation as "transformative" and
eye-opening.
All of the participants interviewed reported that they made clinical improvements as a result
of the project, with examples that included focusing on family strengths, communicating directly
with the patient rather than just the parent, incorporating shared decision making, and the use of the
Teach-back method for improving patient-provider communication.
Most participants interviewed reported that they had implemented practice-level
improvements as a result of the project, including developing policies and procedures for
referral tracking and follow-up; making their patient portal and website more parent-friendly;
adding front desk staff; creating handouts to help parents choose a specialist; and inviting parents
to speak at staff meetings.
Summary scores from pre-post assessments showed that overall, the teams made only slight
or no improvement on the project measures. Several issues may have contributed to these weak
results, in particular, teams scored at or near the ceiling of 100.0% at baseline on most measures,
making it difficult to demonstrate significant progress. This was the case with the Medical Record
Review Summary Score which increased slightly, from 92.5% to 94.6% and the Post-Visit Survey
Score, which remained constant at 100.0%.
Teams demonstrated significant improvement in pre-post self-ratings of provider-
patient/family partnerships at their practices. On a five-level Partnership Continuum that
includes Coexistence, Networking, Cooperation, Collaboration, and Partnership, the median level
of partnership for the eight teams increased from Networking (Level 2) to midway between
Cooperation (Level 3) and Collaboration (Level 4).
Most participants interviewed reported positive experiences with engaging a Parent Partner
on their team. For example, a representative from one team described the Parent Partner as "an
integral part" of the team; while another expressed that the project "opened my eyes to what a
Parent Partner is." Teams described Parent Partners as having made valuable contributions to their
practices, including reviewing and providing feedback on patient surveys and screening tools,
attending and providing feedback to staff during office meetings, and conducting home visits on
behalf of the office. However, the process of engaging a Parent Partner for the project involved
some challenges for most teams, especially with regard to defining the Parent Partner's role and
expectations; and finding time to meet as a team.
All of the teams interviewed reported plans to sustain, spread, or share what they learned
from the project and many expressed that they had already begun to do so, with examples that
included introducing project tools and resources to staff and colleagues, demonstrating shared
decision making and the use of decision tools to residents; incorporating family strengths and
resilience into health screens; and presenting Teach-back to colleagues using project slides.
Based on these findings, some considerations for improving future family engagement initiatives might
include addressing measurement issues and providing additional supports to practice teams for
working with Parent Partners. For example, continue to seek out valid and reliable measures of
family engagement that are feasible in practice settings. Further, since concepts related to family
engagement may not be fully understood by participants during the initial stages of a project,
consider the use of retrospective assessments as opposed to traditional pre-post designs to avoid
the potential for inflated pretest measurements. Finally, it may be worthwhile to explore additional
ways to support practice teams in engaging Parent Partners, including assistance with team-building,
clarifying roles and expectations, and continued attention to the specific needs of practices that