The challenge of improving access to quality care for the populations served by the Maternal and Child Health Bureau (MCHB) calls for innovative solutions. By using the Learning Collaborative model developed by the Institute for Health Improvement (IHI), MCHB’s Division of Services for Children with Special Health Care Needs (DSCSHN) has supported activities to systematically improve access to care, especially through the medical home model, engaged families and enhanced community and state initiatives. Multi-stakeholder teams, working together over a period of time, test, share and implement evidence based strategies. Teams track their progress in meeting program measures by entering data in a password protected on-line website.
The successes in the following programs illustrate the potential value of applying the Learning Collaborative model to public health programs at the clinical and system levels:
- Improving Access to Care for Children and Youth Epilepsy: The epilepsy collaboratives include teams from 10 states working to improve access to primary and specialty care for children and youth with epilepsy living in rural and medically underserved areas. Success is evidenced by three key changes: 1) enhanced relationships between specialty and primary care physicians through the use of co-management tools (e.g. service agreements, faxback forms); 2) reduction in appointment wait time for neurology visits by redesigning appointment systems and using co-management tools and; and 3) improved quality of care through utilization of seizure action plans, care notebooks and empowering families.
- Early Hearing Detection and Intervention Program: The newborn hearing collaboratives include teams from 22 states working to improve timely follow-up to newborns not passing newborn screening. According to data from the Centers for Disease Control and Prevention(CDC), the percentage of infants in need of follow-up who were diagnosed with a hearing loss by 3 months of age improved from 55% in 2006 to 66% in 2007 (CDC). This improvement may be attributed to the nationwide spread of the following successful strategies employed in the collaboratives: 1) identifying the pediatric primary provider before the infant leaves the hospital; 2) making the next appointment for the infant before hospital discharge 3) scripting the message given parents when an infant fails the hospital screening and 4) obtaining a second point of contact for the family.
- Hemoglobinopathy Learning Collaborative: This learning collaborative includes grantees from the Sickle Cell Treatment Demonstration program, Sickle Cell Disease for Newborn Screening program, and the Comprehensive Medical Care for Cooley’s Anemia/Thalassemia. This collaborative is designed to support FQHCs, primary care clinics, community-based organizations and their network partners in quality improvement and the adoption of elements of the patient/family-centered medical home model for the co-management of individuals across the lifespan and their families living with hemoglobinopathies.
- Title V System of Services Infrastructure: Title V programs participate in Learning Collaborative activities to develop and support systemic strategies to improve the system of services for children and youth with special health care needs. Title V programs participated in (1) all medical home collaboratives including over 50 primary care practices from 20 states, (2) all epilepsy and newborn hearing screening collaboratives, and (3) developed an index which identifies domains and benchmarks for Title V Improvement. Over the next 6 months, teams from 18 states will also participating in a collaborative training on the application of quality improvement tools, such as the Title V Index, at the state and community level.
DSCSHN will continue expansion the Learning Collaborative model to other populations served by the Bureau. The Hemoglobinopathy Learning Collaborative has plans for another collaborative in the fall of 2010 and will focus on co-management and coordination of care of individuals living with hemoglobinopathies in various public health settings. A Learning Collaborative is planned in genetics and will focus on increasing the number of physicians who are competent and confident in providing information about newborns screening and common genetic disorders to patients and their families.
In addition to Quality Improvement activities in the DSCSHN, the Division of Healthy Start has launched a 27 month quality learning community involving 102 communities to translate the Select Panel on Preconception evidenced–based practices into the Healthy Start projects. Finally, the MCH Training program will use a collaborative peer learning process to support grantees in their efforts to increase racial and ethnic diversity of trainees and faculty in MCH Training Programs.