# Presentation: 616856

## State and National Initiatives to Improve the Quality of Health Care for Children

- 13th Annual Maternal and Child Health Epidemiology  Conference
- December 12, 2007
- Doris Hanna, RN, CPNP, ScD

## About NICHQ

- Founded in 1999
- Mission: “To eliminate the gap between what is and what can be in health care for all children.”
- NICHQ is an action oriented organization dedicated exclusively to improving the quality of children’s health care
- NICHQ is a resource for health care and improvement  organizations, foundations, and government agencies seeking to improve care for children
- NICHQ is a national organization:
- Home Office – Cambridge, MA
- National cadre of key advisors
- Geographically distributed staff

## What we do:Change Practice to Improve Care and Outcomes

- Innovate
- Discover, invent, and share “good ideas—ready for use” in children’s health care
- Demonstrate
- Undertake targeted initiatives to demonstrate the feasibility of improving care and outcomes
- Accelerate Adoption
- Facilitate widespread adoption through policy change, capacity building, and partnership with high leverage systems (including state and federal government)

## NICHQ’s Bold Improvement Agenda

- Prevent Childhood **Obesity**
- Provide Seamless, Evidence Based, Family Centered Care for Children with **Chronic Conditions**
- Purge **Harm **from Children’s Health Care
- Promote **Equity **in Care

## Our Services

- Training and Transforming Care
- Learning Collaboratives: In person and across distance
- Action Networks and Spread Initiatives: Accelerating learning, spreading better care
- Annual Children’s Forum
- Toolkits
- Jump Start and Jump Ahead:  Introductory and Advanced QI Methods and Tools for Children’s Health Care
- Creating and Sustaining Improvement Resources
- Local, State, Regional and Federal programs to sustain change
- Setting the National Agenda for Change
- Federal and State Children’s Quality Policy
- Measurement
- Improvement
- Health Information Technology
- Payment

## Numerous potential state based resources to support improvement

- Professional society/medical association chapters
- Health Department
- MCH
- Children and Youth with Special Health Care Needs
- Medicaid Agencies
- State universities (medical and public health schools)
- State and local non-profits
- Combinations of the above

## The Breakthrough Series Learning Collaborative Model (IHI, 1995)

- A quality improvement method to refine and spread improvements and ideas throughout a system or set of systems
- Typically, a group of stakeholders working together to make improvements in a focused topic area (care delivery system)
- Links subject matter experts, application experts, and front line staff for mutual learning
- Short term (6-15 month) learning system
- Uses data to support improvement
- NICHQ always includes parents/families

## Medical Home Learning Collaboratives

- To improve care for children with special health care needs/youth by implementing the Medical Home concept
- To foster substantial relationships between Title V programs and their state’s primary care community, enabling Title V to:
- Support improvement in practices and
- Spread improvement across their State

**Notes:**
An example of the learning collaborative model to improve care

MHLC I
Connecticut
Colorado
Florida
Ohio
Oklahoma 
Louisiana 
Michigan 
North Carolina*
New York 
Utah
Virginia 
Wisconsin

MHLC II
DC
West Virginia*
Vermont
Illinois
Maine
Maryland
Minnesota
Texas
Pennsylvania*

## Hypothesis...

- Application of four key concepts
- Medical Home/Care Model for Child Health
- Collaborative Model
- Model for Improvement
- Model for Spread
- Together with support from a capable regional/state/local resource (Title V)
- Will result in acceleration of spread of Medical Home

## Medical Home Learning Collaborative IMedical Home Index Pre and Post Measures

## Results-MHLC II

## Broadening Beyond the Medical Home

- Vertical Coordination: Primary and Specialty Care
- Case example: Improving Access and Quality for Children with Epilepsy
- Horizontal Coordination: Community/Public Health Resources
- Case example: Strengthening handoffs between newborn hearing screening, specialty care, primary care, and early intervention

## Newborn Hearing:Collaborative Results

## Improve the health and well being of Children and Youth with Special Health Care Needs (CYSHCN) and their families through building the capacity of state Title V programs—in concert with other state based partners—to create and sustain effective community based systems of care...
CMS expressed interest in building state capacity to support improvement in perinatal care

- CMS expressed interest in building state capacity to support improvement in perinatal care

- Next Steps –Building Systems of Care

## Lessons Learned

- Health care is one contributor to child well being
- Direct
- Indirect (Health Behaviors)
- State based approaches have key advantages
- Numerous entities at state level can lead
- Works best if all participate
- Key role for real time, pragmatic data capacity as one key ingredient for improvement process

## Slide 16

## Slide 17

## Health Care for Children Different?

- Greater level of financial access than non elderly adults (if tenuous)
- Quasi-public health function, particularly 0-3 years
- Major focus on preventive health, health behaviors
- “Anticipatory Guidance”

## Relative Health and Safety of US Children

**Notes:**
Compared with children of other “developed” or wealthy nations, the children in the US fair poorly, as indicated by this particular UN ranking, itself based on infant mortality and low birth weight rates, as well immunization rates and deaths due to injury in the second decade of life.

## But the Quality of Children’s Health Care is No Better (and May Be Worse)

- Percent Receiving Recommended Care

- Source: McGlynn et al, NEJM 2003, 348;26:2635-45, and Mangione-Smith, et al, NEJM, 2007.

**Notes:**
Katie – Can you give me the RAND brief on Mangione-Smith’s work? I only have abstract. Thanks. 

## And Preventive Care is at the Bottom

- Mangione Smith et al, NEJM, 2007

## Role of Health Care in Health

- Schroeder SA, N Engl J Med 2007; 357:1222, from McGinnis Health Affairs 2002

## Why A State Role?

- Children’s Health Care is:
- Predominantly outpatient
- Locally delivered and organized
- State regulated
- Substantially funded through state programs
- Major state public health role (e.g., immunizations, newborn screening)

## Together we can make health care better for every child!

## Some Partnership Examples

- Partnership for Quality (ADHD)
- PA and CT EPIC programs
- NJ Immunization
- Medical Home, Epilepsy, Newborn Hearing 	Learning Collaboratives
- Neonatal Improvement Programs (OH, TN)
- Improvement Partnership (VCHIP, Envision 	NM)

**Notes:**
Partnership for Quality (ADHD)
PA and CT EPIC programs
Professional societies
NJ Immunization
Maternal and Child Health
Medical Home, Epilepsy, Newborn Hearing Learning 	Collaboratives 
Title V
Neonatal Improvement Programs (OH, TN)
Medicaid
Improvement Partnership (VCHIP, Envision NM)