1. What does the Future Have in Store? The Roadmap for Phase 2 of C4K Ruth S. Gubernick, MPH Quality Improvement Advisor Florida Pediatric Medical Home Demonstration Project Learning Session 2 April 27-28, 2012

2. Disclosure I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation.

3. Participating Organizations and Programs  American Academy of Pediatrics (AAP)  Florida Agency for Health Care Administration (AHCA)  Florida Children's Medical Services Network (CMS)  Health Management Associates  The Family Café  University of Florida Institute for Child Health Policy (ICHP)

4. Part I: AAP Quality Improvement Project Overview  Mission: To provide physicians and their staffs with strategies, tools, and resources necessary to strengthen medical homes’ capacity to provide high quality, family- centered care for all children and youth, including those with special health care needs (CYSHCN).  Overall Goal: To assess the effectiveness of systems of care and implement tools, strategies and measures designed to improve medical homeness, including enhancing access to care; providing family-centered care; providing and documenting planned, proactive, comprehensive care; and coordinating care across all settings.

5. AAP Quality Improvement Project Phase 2 - Aims and Measures  Between May 2012 and October 2012, participating practice teams will aim to improve preventive care at the 24 month visit so that: Appropriate risk assessments are performed at 95% of well-child visits for 24 month visit 95% of patients have documentation of 1completed standardized developmental screen at the 24 month health supervision visit. 90% of patients with a positive developmental screen have a follow-up plan in chart 95% of patients have documentation of a standardized autism-specific screen at the 24 month health supervision visit. 95% of patients with a positive autism screen have a follow-up plan in chart 95% of patients have documentation in chart that BMI was plotted on the percentile curves according to age and sex at the 24 month visit. 90% of patients have documentation in the chart that the patient’s medical summary or comprehensive care plan was created or updated/maintained at the visit. (The comprehensive care plan is developed and modified with input from the patient and family). 90% of patients have documentation in the chart that the patient’s current medical summary or comprehensive care plan was reviewed with the parent at the visit.

6. Phase 2 - Change Package Tools

7. AAP Quality Improvement Project Phase 2 - Aims and Measures  Between May 2012 and October 2012, the participating practice teams will aim to improve acute care so that: 90% of patients diagnosed with pharyngitis and dispensed an antibiotic receive a group A streptococcus test for the episode

8. Phase 2 - Change Package Tool

9. AAP Quality Improvement Project Phase 2 - Aims and Measures  Between May 2012 and October 2012 (action period 2), the participating practice teams will aim to improve chronic care so that: 90% of patients diagnosed with asthma receive an Asthma Control Test during their most recent visit 90% of patients diagnosed with asthma have an Asthma Action Plan created or updated/maintained, reviewed and shared with them during their most recent visit

10. Phase 2 - Change Package Tools

11. AAP Quality Improvement Project High Level Project Timeline

12. Questions/Comments?