Objective:
Patient-centered medical home (PCMH), a team-based model of practice involving patients, families, providers and care team members, focuses on high quality, efficient, and patient-centered care. The purpose of this project was to implement appropriate elements of the PCMH model in the care delivered by the Intermountain Hemophilia and Thrombosis Center (IHTC).
Methods:
The IHTC, as a medical home neighbor, participated in a 3 1⁄2 year (5/2011- 11/2014) Children’s Health Improvement Collaborative Medical Home Demonstration (MHD) that involved 3 specialty and 9 primary care practices in Utah. IHTC focused on both MHD- wide and practice-specific quality improvement (QI) goals. Our QI team included the IHTC core multidisciplinary team and a parent partner and medical home coordinator (MHC) who were funded by the MHD. The MHD led four sequential, 8-12 month projects: “Improving Collaboration Among Pediatric Generalists and Specialists,” “Implementing Care and Self- Care Plans for Children with Chronic Conditions,” “Improving Healthcare Transitions for Children with Special Health Care Needs,” and “Sustainability.” Practice-specific projects targeted goals established via a needs assessment and parent partner input. Plan-Do-Study- Act (PDSA) cycles were facilitated by the MHC and a practice coach from the MHD. Continuing education and peer support were provided via learning sessions, webinars, and ongoing mentorship.
Summary:
IHTC met all MHD-wide and practice-specific goals. Selected MHD-wide improvements included: completion of the patient history prior to new consultation (improved from ~15% to 95%); patient self-care plans (0% to 97%); and youth with an up-to-date transition tool (0% to 100%). To address “sustainability,” IHTC will continue using QI, implementing the PCMH model, and will maintain the MHC as a member of the care team. Practice-specific strategies resulted in improved efficiency and family-centered approach to the annual comprehensive clinic visit (31⁄2 hour visit decreased to 2 hours with reduced redundancy), reduced no-show/cancellations (~33% to 10%), established means for continuous individual patient/family feedback, and a formalized IHTC-specific emergency preparedness plan (currently in progress).
Conclusions:
Via participation in the MHD, the IHTC learned that QI is both realistic and rewarding. Essential components for ongoing improvement include: specific, defined and measurable goals; a QI leader; parent/consumer input; and participation by all clinical team members. The PCMH model provides a framework for meaningful change for patients, families, and clinical practice.
Acknowledgments:
Funded in part by a CHIPRA Quality Demonstrations grant: CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.