1. Bright Futures Ahead: Preventive Care Guidelines Update and Strategies for Implementation   Judy Shaw, EdD, MPH, RN, FAAP March 18, 2017

2. Judy Shaw, EdD, MPH, RN, FAAP
Bright Futures Ahead: Preventive Care Guidelines Update and Strategies for Implementation
Judy Shaw, EdD, MPH, RN, FAAP
Bright Futures Co-Editor
Executive Director, Vermont Child Health Improvement Program
Executive Director, National Improvement Partnership Network
Professor of Pediatrics & Nursing, The Robert Larner, M.D. College of Medicine at The University of Vermont

3. Disclosure
In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

4. Learning Objectives
Discuss changes to the Bright Futures guidelines and associated Periodicity Schedule
Understand the revision process and the evidence/reason for the changes
Review strategies for implementing the revised recommendations for preventive pediatric health care

5. Bright Futures Guidelines: History
1st Edition was published in 1994
2nd Edition was updated in 2000; revised in 2002
3rd Edition was revised and released in 2008
4th Edition was revised and released in 2017

7. Bright Futures/AAP Periodicity Schedule (2017)

8. Bright Futures Guidelines, 4th Edition
Part 1: Health Promotion Themes
12 chapters highlighting key health promotion themes
3 new themes
Part 2: Health Supervision Visits
Evidence and Rationale for screening recommendations
32 age-specific visits (including prenatal visit)
5 health supervision priorities for each visit
Designed to focus visit on most important issues for child that age
Includes: social determinants of health (risks and strengths and protective factors)

9. Bright Futures Guidelines, 4th Edition
Child Healthy Development
Family Support
Mental Health and Emotional Well-Being
Nutritional Health
Physical Activity
Healthy Weight
Promoting Lifelong Health for Families and Communities
Oral Health
Healthy Adolescent Development
Safety and Injury Prevention
Community Relationships and Resources
Promoting the Healthy and Safe Use of Social Media
Children and Youth with Special Health Care Needs

10. Components of a Bright Futures Visit
History
Surveillance
Physical examination
Screening
Immunizations
Anticipatory guidance

11. Priorities in the 4th Edition
12 Month Visit
15-17 Year Visit
Social determinants of health Risk Factors: living situation and food security; tobacco, alcohol and drugs Strengths & Protective Factors: social connections with family, friends, childcare and home visitation program staff, and others
Establishing routines
Feeding and appetite changes
Establishing a dental home
Safety
Social determinants of health Risk Factors: interpersonal violence; food security and living situation; family substance use Strengths & Protective Factors: connectedness with family and peers; connectedness with community; school performance; coping with stress and decision-making
Physical growth and development
Emotional well-being
Risk reduction
Safety

12. Priorities for the 12 Month Visit

13. Screening: 12 Month Visit

14. Priorities for the 15 Through 17 Year Visits

15. Screening for the 15 Through 17 Year Visits

16. Evidence and Rationale Chapter
Rigorous Guidelines Review
Evidence and Rationale Described
Evidence Consultant: Alex Kemper, MD, FAAP
Recommendations interpreted with caution
Based in science
Consensus based
What Evidence grounds our Recommendations?

17. Summary of Changes to Periodicity Schedule
Maternal Depression Screening
Oral Health
Fluoride Varnish
Fluoride Supplementation
Adolescent Hearing
Adolescent Depression Screening
Dyslipidemia
HIV
Tobacco, Alcohol, or Drug Use Assessment

18. Evidence and Rationale Example: Anemia

19. Integrated System Documentation Forms
Enables Provider to document all pertinent information and fulfill Quality Measure
Patient/Parent Education Handouts
Provides Parental Education all the Bright Future Priorities for the visit
Previsit Questionnaires
Allows healthcare provider to gather pertinent information without using valuable time asking questions

20. Examples: CHIPRA 2017 Core Measures
Adoption of the Bright Futures Guidelines can help to meet some of the CHIPRA Core Measures and MCH National Performance Measures related to pediatric preventive care.
Examples: Title V MCH Services Block Grant National Performance Measures
Examples: CHIPRA 2017 Core Measures
Percent of children with and without special health care needs having a medical home
Percent of infants placed to sleep on their backs
Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year.
Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool
Well-Child Visits in the First 15 Months of Life
Developmental Screening in the First Three Years of Life
Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life
Adolescent Well-Care Visit
Child & Adolescent Immunization Status
mchb.hrsa.gov/programs/titlevgrants/blockgrantguidance.pdf

21. Preventive Services Implementation State Spread Project (PreSIPS2)
Pediatric Practices
Approx. 10 per Chapter + residency program
Chapter Leadership Teams
Lead Physician, Project Mgr./QI Coach, State MCH rep, Family rep
AAP National Leadership Team & Staff
AAP Chapter Participants: Georgia
New Jersey
South Carolina
Virginia 21

22. Preventive Services Components
9 Month & 24 Month Visits
Elicit & Address Parental Concerns
Age Appropriate Medical Risk Assessment/Screening
Weight For Length or BMI
Developmental Screening/Follow-up
Autism Specific Screening/Follow-up
Addressing 3 Bright Futures Priorities in AG
Evaluation Of Parental Strengths
Oral Health Risk Assessment
Maternal Depression Screening
Plan Do
Study
Act

23. *Three of five Bright Futures priorities were used for anticipatory guidance delivery
**Bright Futures PSS is a summed score of all preventive services; each service is a value of 1 and each chart received a summative score of 0 to 7 for 9-mo visit and 0 to 8 for 24-mo visit at baseline and completion

24. Virginia: PreSIPS2 Why We Applied
Multidisciplinary and diverse team approach (clinical and non-clinical)
Monetary stipend (and TA) to kick start reconnection among partners
Family representative on leadership team was valued and integral
Reinforced value of data collection and improving the system(s)
Designed with clear and practical goals and objectives
PDSA cycles gave practices opportunity to fine tune improvements
Provided framework to build and strengthen – Practice team & Chapter leadership team
Opportunity to broaden perspectives and have community partners work directly with AAP Chapter
Added more bricks to foundation of the medical neighborhood
Opportunity to identify gaps in the system at all levels (clinical, public health, state, family)

25. EQIPP
The EQIPP Bright Futures courses, online learning programs, weave improvement principles and concepts with pediatric-specific clinical content to improve health outcomes. It is designed to identify and continuously close gaps in practice using practical tools.
EQIPP Bright Futures Infancy & Early Childhood is launched and the and Middle Childhood & Adolescence is expected to launch this year.
EQIPP participants simultaneously earn CME credit and meet MOC Program Part 4: Performance in Practice requirements.

26. brightfutures.aap.org

29. American Academy of Pediatrics Bright Future National Center
Jane Bassewitz, MA
Manager, Bright Futures National Center
Kathy Janies
Manager, Bright Futures Implementation
Phone
Web site brightfutures.aap.org