1. The Danis Pediatrics Experience Working with Bright Futures for bright futures for St Louis kids

2. The Danis Pediatrics Team Rachel Ervin, RN, BSN Director, Ambulatory Care Center M. Susan Heaney, MD, MPH Continuity Clinic Director Nancy Griffith, LPN Sean Fullan, MD Pediatric Resident

3. The Danis Pediatrics Experience Teaching Students Residents Parents and kids Hospital mission Caring, commitment, and excellence “Through our exceptional health care services, we reveal the healing presence of God.”

4. Danis Pediatrics Primary Care Pediatrics Clinic of the Division of General Academic Pediatrics (GAP), Department of Pediatrics, Saint Louis University School of Medicine Hospital-based at Cardinal Glennon Children’s Medical Center – urban St. Louis 43 Categorical Pediatric Residents, 14 Medicine/Pediatric Residents, 30 residents have on-site Continuity Clinic 10 full time faculty, 6 part-time faculty, 2 PNP’s 1 Practice Manager, 2 RN;s, 3 LPN’s, 4 MA’s 12,000 annual visits

5. Analysis from Initial Data Goal: improve all areas of weakness  Areas of Weakness 9 month visit  Parental Strengths Assessed  Oral Health Risk Assessment Completed 24 month visit  Age Appropriate Risk Assessment complete  Identified Risks Assess  BMI Charted  Autism Screen Completed  Positive Autism Screen Follow up  Parental Strengths Assessed  Oral Health Risk Assessed

6. Goal: improve all areas of weakness 9 month visit  Parental Strengths Assessed 0% to 60%  Oral Health Risk Assessment Completed 0% to70% 24 month visit  Age Appropriate Risk Assessment complete peak 30%, inconsistent  Identified Risks Assessed peak 100%, inconsistent  BMI Charted 0 to 100%  Autism Screen Completed 40% to 100%  Positive Autism Screen Follow up 40% to 100%  Parental Strengths Assessed 0% to peak 50%  Oral Health Risk Assessed 0% to peak 70%

9. Additional Progress  Maternal Depression Screening STRING Study on Infant Obesity (National Children’s Study) – select population, 2 year follow up  Community Resources for Parents Hospital Web site developed by residents  Motivational Interviewing Pediatric Grand Rounds

10. Interventions  Educational GAP Division Meetings Faculty Journal Club Resident Noon Conferences Resident Ambulatory Morning Conferences Monthly Webinars  EPIC implementations BMI, Parental Strengths and MCHAT on WCC visits  Medical Staff Quality Improvement Committee Reports

11. Innovation  Resident Continuity Clinic Billing Competition – Systems-based Practice Competency  National Data, Resident Data before and after educational intervention  “Ice Cream Social” for best practice

12. National versus GAP* Established Office Visits *according to SLU Compliance Office 2009

13. Billing by Doctor * Billed at least one new patient office visit There were no Level 5 bills in August “Goal” for Level 3“Goal” for Level 4

14. Billing by Doctor * Billed at least one new patient office visit There were no Level 5 bills in August “Goal” for Level 3“Goal” for Level 4

15. Challenges and Barriers  Personnel Changes Faculty, Clinic and Medical Directors, Nurses, Front Desk Staff  Use of Questionnaires – patient literacy, clinic flow, front desk efficiency  Conflicting Studies, e.g. Maternal Depression  EPIC changes implementation in a large hospital system

16. Next Steps  Implement future “resident Continuity Clinic team competitions” in quality improvement Satisfies Systems-based Practice Competency Requirement Fosters Resident participation in Quality Improvement in primary care Adds interest, fun and reward to Continuity Clinic experience

17. Greatest Change and Innovation  Education of staff, residents and faculty in Bright Futures  Improvement in all categories of weakness  Improved engagement in quality improvement process to improve patient care, office systems and patient satisfaction