Noell Stone - National Association of Health Data Organizations

National Association of Health Data Organizations
Denver, CO
December 11, 2013
Noell Stone, MPH
Senior Research Scientist
University of New Mexico * Department of Pediatrics * Envision New Mexico
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Introduce
Envision NM
 Quality Improvement Through Practice Coaching
Our PCORI proposal:
 Controlling Asthma in Hispanic Children and Youth
Through Patient Centered Quality Improvement
Challenges and Successes when developing our project
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University of New Mexico * Department of Pediatrics
1/7/2013
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University of New Mexico * Department of Pediatrics * Envision New Mexico
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Envision New Mexico Staff Directory
Telephone 505-925-7600
www.EnvisionNM.org
Jane McGrath, MD, FAAP
Program Director
jmcgrath@salud.unm.edu
Kris Carrillo, LISW
Program Operations Director
kcarrillo@salud.unm.edu
Dan Rifkin, MD
Child and Adolescent Psychiatrist
drifkin@salud.unm.edu
Courtney Acklin
QI Training, Consultation and Outreach
cacklin@salud.unm.edu
Sara Anderson, MS
QI Training, Consultation and Outreach
sanders4@salud.unm.edu
Kirsten Bennett, MS, RD, LD
QI Training, Consultation and Outreach
kdbennett@salud.unm.edu
Terri Chauvet
Administrative Assistant III
tchauvet@salud.unm.edu
Carole Conley, LMSW
QI Training, Consultation and Outreach
cconley@salud.unm.edu
Paula LeSueur, CFNP
CHIPRA Manager
plesueur@salud.unm.edu
Kristine Lucero, MA
Accountant II
krisgonzales@salud.unm.edu
John Martinez
QI Training, Consultation and Outreach
johnLMartinez@salud.unm.edu
Janette Schluter
Program Data Specialist
jschluter@salud.unm.edu
McKane Sharff, MS
CHIPRA Program QI Specialist
msharff@salud.unm.edu
Jeanene Sisk
Administrative Assistant II
jsisk@salud.unm.edu
Noell Stone, MPH
Senior Research Scientist I
sstone@salud.unm.edu
Clancey Tarbox
Program Coordinator
ctarbox@salud.unm.edu
Nancy Vandenberg
CHIPRA Program Youth Specialist
nvandenberg@salud.unm.edu
Kevin Werling
Systems Analyst ll
kwerling@salud.unm.edu
Michelle Widener
Data Analyst
University of New Mexico * Department of Pediatrics * Envision New Mexico
miwidener@salud.unm.edu
12/7/2012
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We Provide:
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Clinical Services in 5 School Based Health
Centers
Practice Coaching for private and MCO
practices
Training in Quality Improvement and
Motivational Interviewing Techniques
Pediatric Telehealth Clinics
University of New Mexico * Department of Pediatrics
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Content Areas Include:
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Asthma
Pediatric Overweight
Patient Centered Medical Home
Adolescent and Child Behavioral Health
Immunizations
Billing/Medical Coding and Financial
Sustainability
University of New Mexico * Department of Pediatrics
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University of New Mexico * Department of Pediatrics
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Intervention
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One Site Visit (didactic and system change
curriculum)
Use of “Plan-Do-Study-Act”(PDSA) approach
Coaching calls with practice specialists as needed
Medical Record reviews at baseline and monthly for
9-12 months
University of New Mexico * Department of Pediatrics
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University of New Mexico * Department of Pediatrics
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Asthma affects nearly 38,000 children in
New Mexico yearly2
Distance to care and difficulties with treatment
adherence present challenges to asthma control
Adherence to evidence-based guidelines
remains poor
2NMDOH
Asthma Program
University of New Mexico * Department of Pediatrics
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Controlling Asthma in Hispanic Children and Youth
Through Patient Centered Quality Improvement
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Response to 1 time targeted funding announcement
3 year project
2.8 million dollars requested
3 PI’s:
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Nuestra Salud, LLC
Jane McGrath (UNM)
Gerry Faibrother (Academy Health)
University of New Mexico * Department of Pediatrics
1/7/2013
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“Does a patient-engaged quality
improvement program provide better
asthma outcomes for Hispanic Children
when compared to usual care?”
University of New Mexico * Department of Pediatrics
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Improve asthma control in Hispanic
asthma patients ages 5-18 years
Increase patient satisfaction with care and
QOL
Increase provider adherence to NHLBI
guidelines for assessment and treatment
University of New Mexico * Department of Pediatrics
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Integration of Asthma Best Practices into
primary care practice using
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Techniques Based on the Model for
Improvement1
Practice Coaching
Provision of Professional Education for
Maintenance of Certification (MOC)
Collect data to Evaluate Change
1 Langley
GL, Nolan KM,(2009). The Improvement Guide: A Practical Approach to Enhancing
Organizational Performance (2nd edition). San Francisco: Jossey-Bass
University of New Mexico * Department of Pediatrics
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Clinical: Lung Function, ACT Score, activity and
symptom change score, medication adherence
Patient: satisfaction and QOL
Provider: satisfaction and adherence to
guidelines
University of New Mexico * Department of Pediatrics
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PCORI
Asthma Research Flow Diagram
Phase I
Phase II
Create and Convene
Intervention
Hispanic Family
Network
Focus Groups
Create 20 patient
centered focus groups of
NM children ages 5 – 17
yrs old for patient/family
input approach
Provider Asthma Support Group
Meet, advise, participate in
intervention development and recruit
practices
Recruit practices
randomize
Patient consent and
survey completed
Conduct in-depth
interviews with 5 statewide
community providers
Design Patient
Engaged QI
Intervention
Baseline data
collection
Control Sites
Usual Care
Activity
developed by
Provider Asthma
Support Group
Intervention Sites
Learning collaborative:
· QI training
· Data
· Team formation
Coaching
begins
Site Visits and
Coaching calls
Final Data Collection and Reporting
University of New Mexico * Department of Pediatrics * Envision New Mexico
Provider education:
Motivational Interviewing,
Asthma Telehealth Clinic,
Asthma education,
Spirometry training
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Qualitative work with Families of Children
with Asthma
Create patient and provider advisory
networks
Create a model for “patient engaged quality
improvement in primary care practice”
University of New Mexico * Department of Pediatrics
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Randomized Controlled Trial Clustered On
Practice
10 practices receive usual care
10 practices receive “patient engaged
quality improvement” coaching
Total of 20 patients per practice selected
at baseline and after intervention
University of New Mexico * Department of Pediatrics
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“Intention to Treat” (by practice) approach
Compare nested patient outcomes, pre- and
post-intervention
Using adjusted and un-adjusted hierarchical
modeling to determine predictors of improved
control and guideline adherence
University of New Mexico * Department of Pediatrics
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Quality of care can be improved
A team-based approach can lead to system
change and adoption of best practices
Increased awareness of QI can support adoption
of best practices
Small changes can lead to large and sustained
improvement in care
University of New Mexico * Department of Pediatrics
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