Illinois Medical Home Illinois Medical Home ProjectProject

Illinois Medical Home Illinois Medical Home ProjectProject

Presented by Kathy Sanabria, MBA, Presented by Kathy Sanabria, MBA, PMP Project DirectorPMP Project Director

Illinois Medical Home Project (IMHP) Evaluation Status

American Public Health Association 134th Annual Meeting and Exposition

November 7th, 2006Boston, MA

Principle Investigator: Charles Onufer, MDProject Director: Kathy Sanabria, MBA, PMP

Administering Organization: Illinois Chapter, American Academy of Pediatrics (ICAAP)

Evaluators: CADE Research Data Management Group University of Illinois Chicago (UIC) School of Public Health:

Kristin Rankin, MSPH (PhD Candidate)Andrew Cooper, MPH

Wendy Guo, BS

There’s No Place Like a “Medical Home”

A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.

Illinois Medical Home Project

In July 2004, the ICAAP was awarded a four-year $1,000,000 federal grant through the Division of Services for Children with Special Health Care Needs, Maternal and Child Health Bureau, to spread the medical home concept to primary care providers throughout Illinois. This presentation provides evaluation results for Phase I of the project, which occurred July 2004 through June 2006, and outlines Phase II of the project. The project is being administered by the Illinois Chapter of the AAP in collaboration with the Division of Specialized Care for Children (DSCC), Title V Program, University of Illinois.

IMHP Evaluation Subcommittee

• Charles Onufer, MD, Chair, Principle Investigator• Helen Binns, MD, MPH• Jenifer Cartland, PhD• Andrew Cooper, MPH • Colleen Monahan, DC, MPH• Kristin Rankin, MSPH• Kathy Sanabria, MBA

This project has received Institutional Review Board (IRB) approval through the University of Illinois at Chicago School of Public Health.

OUTLINE

• Phase I Evaluation Results

• Phase II Evaluation Plan

• Phase II Evaluation Baseline Results

Participating SitesDuring Phase I of the project, 6 core pediatric

primary care practices participated and received the following:

• Modest annual mini-grant stipends for 2 years• Quality Improvement (QI) teams at each site

participated in 3 Learning Sessions• Medical home resources from the AAP, NICHQ,

CMHI, ICAAP and DSCC• Access to trained facilitators to help organize

and guide the QI teams and hold monthly meetings

Phase I Evaluation Results

• Practice Assessment Checklist• Medical Home Index (MHI)• QI Team Evaluations• Family Surveys

Practice Assessment Checklist

• Developed for IMHP and piloted in Phase I• Administered on-site at baseline and 18 months

later at follow-up as an outcome measure (sites did not have access to the instrument or baseline results throughout the project)

• Inventories practice environment, resources, and characteristics of a medical home

• Will be useful to control for potential confounding factors affecting changes over time observed with other instruments

Phase I Evaluation Results

Practice Assessment Checklist

• All 6 Phase I sites (pediatric practices) completed baseline survey

• To date, 5 sites have completed follow up survey

Phase I Evaluation Results

Mean for All Phase I Practices, by Domain

0.0

0.2

0.4

0.6

0.8

1.0

AC

CE

SS

.

FA

MIL

Y.

CO

NT

IN.

CO

MP

R.

CO

OR

D.

CO

MP

AS

S.

CU

LTU

R.

QI

PH

YS

.

EN

VIR

ON

.

Sco

re

Baselinen=6 (2/2005-4/2005)

Followupn=5 (7/2006-9/2006)

Patient Care Other

Practice Assessment Checklist

Phase I Evaluation Results

Medical Home Index

• Completed by lead physician jointly with practice/clinic staff

• Defines and quantifies organization and delivery of primary care in 6 practice domains

Phase I Evaluation Results

Medical Home Index

Questions are grouped into 6 domains• Domain 1: Organizational Capacity • Domain 2: Chronic Condition

Management• Domain 3: Care Coordination• Domain 4: Community Outreach• Domain 5: Data Management• Domain 6: Quality Improvement/Change

Phase I Evaluation Results

Medical Home Index (Phase I)

Mean Score for All Practices, by Domain

1 .0

3 .0

5 .0

7 .0

OR

GA

NIZ

.

CO

ND

ITIO

NM

GM

T.

CA

RE

CO

OR

D.

CO

MM

.O

UT

RE

AC

H

DA

TA

MG

MT

.

QI

Le

ve

l

Baselinen=6 (2/2005-4/2005)

Follow-upn=6 (7/2006-9/2006)

Partial

Complete

Partial

Complete

Partial

Complete

Partial

Complete

4

3

2

1

Phase I Evaluation Results

Medical Home Index (Phase I)Distribution of Scores

For All Sites, Across All Domains21

%

21%

13% 18

%

10%

6%

12%

0%1% 2%

16%

16%

17%

17% 22

%

9%

0%

5%

10%

15%

20%

25%

30%

35%Pa

rtial

Com

plet

e

Parti

al

Com

plet

e

Parti

al

Com

plet

e

Parti

al

Com

plet

e

Per

cen

tag

e

Baseline (2/5-4/05) Follow Up (7/06-9/06)

Level 1 Level 2 Level 3 Level 4

Phase I Evaluation Results

Medical Home Index (Phase I)

Practice B

1

2

3

4

5

6

7

8

Question #

Lev

el

Baseline(3/2005)

Follow-Up(7/2006)

Partial

Complete

Partial

Complete

Partial

Complete

Partial

Complete

4

3

2

1

Phase I Evaluation Results

QI Team Evaluation

• QI Team members are surveyed• Elicit feedback on effectiveness of QI

Team meetings, facilitators, and success of QI Teams of achieving goals

• Administered twice for Phase I– At 6 months (February 2005)– At end of study (July/August 2006)

Phase I Evaluation Results

QI Team EvaluationNumber of QI Team Member Responses By Site

0

1

2

3

4

5

6

7

8

Site A Site B Site C Site D Site E Site F

Re

sp

on

se

s Baseline11/05

Followup7/06-9/06

For all sites, Baseline n=32 Follow-up n=25

Phase I Evaluation Results

QI Team Evaluation (Phase I)Sample Question: “I have a good understanding of the team’s goals and what next steps are needed to achieve them.”

Aggregated Response for All Respondents at All Sites

0%

10%

20%

30%

40%

50%

60%

Baseline 11/05 Follow-up 7/06-9/06

Pe

rce

nta

ge

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Phase I Evaluation Results

Family Surveys (Phase I)

• Medical Home Family Index (MHFI)

• Family/Caregiver Survey

Phase I Evaluation Results

Results pending completion of more follow up surveys.

Phase II Evaluation Plan Includes a Control Component

Updated Instruments• Practice Assessment Checklist• Medical Home Index (MHI)• QI Team Evaluations• Family Surveys Enrolled 10 demographically paired sites including pediatric

practices, family practices, and public health clinics: 5 sites will receive assigned “facilitators” and 5 sites will receive “technical assistance” to organize and implement their QI efforts. All sites will receive small mini-grants, three training sessions, and resources. The study attempts to determine what effect facilitators vs technical assistance brings to the process and outcomes.

Practice Assessment Checklist (Phase II)

• Updated slightly from version used in Phase I

• Checklist and baseline results are shared with Phase II sites to be used as a tool for them to select activities to work on to increase their level of “medical homeness”

• Fielded summer 2006

Phase II Evaluation Plan

Medical Home Index (Phase II)

• Same instrument as was used in Phase I

• Fielded summer 2006

Phase II Evaluation Plan

Family Surveys (Phase II)

• Modified instrument for Phase II– Combines two separate Family Surveys

used in Phase I• Medical Home Family Index (MHFI)• Family/Caregiver Survey

– Modified slightly to improve data quality– Updated for improved readability

• Letters distributed to sites September/October 2006, to be mailed same month (pending IRB approval for some sites)

Phase II Evaluation Plan

Future ActivitiesQI Team evaluations• Will be fielded to QI Teams twice• First round of evaluations will take place around April

2007

2-year follow up at conclusion of Phase II (June 2008)

• Practice Assessment Checklist• Medical Home Index (MHI)• Family Surveys

Phase II Evaluation Plan

Phase II Baseline Results• 9 of 10 sites have completed medical

home Practice Assessment Checklist baseline survey

• 9 of 10 sites have completed Medical Home Index (MHI) baseline survey

• Sites are in the process of mailing out family surveys (or receiving IRB approval to do so)

Mean for All Phase II Sites, by Domain

0.00.10.20.30.40.50.60.70.80.91.0

AC

CE

SS

.

FA

MIL

Y.

CO

NT

IN.

CO

MP

R.

CO

OR

D.

CU

LTU

R.

QI

PH

YS

.

EN

VIR

ON

.

Sco

re

Baselinen=9 (7/06-9/06)

Patient Care Other

Practice Assessment Checklist (Phase II Baseline)

Phase II Baseline Results

Medical Home Index (Phase II Baseline)

Mean Score for All Sites, by Domain

1 .0

3 .0

5 .0

7 .0

OR

GA

NIZ

.

CO

ND

ITIO

NM

GM

T.

CA

RE

CO

OR

D.

CO

MM

.O

UTR

EA

CH

DA

TAM

GM

T. QI

Lev

el Baselinen=9 (7/06-9/06)

Partial

Complete

PartialComplete

PartialComplete

PartialComplete

4

3

2

1

Phase II Baseline Results

Family Survey (Phase II Baseline)

Baseline results pending completion of more surveys

• Online responses have begun to come through

• Paper responses expected in coming weeks

Phase II Baseline Results

Illinois Medical Home Project

For more information about the project, please contact:

Kathy Sanabria, MBA, PMP, Project Director1358 West Randolph Street, Suite 2 EastChicago, IL 60607Phone: 312-733-1026, ext 208ksanabria@illinoisaap.net

Thank you for your interest!