The Quality Process in the Maternal Infant Health Program (MIHP) 2 - - PowerPoint PPT Presentation

The Quality Process in the Maternal Infant Health Program (MIHP)

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Presentation Obj ectives

• At the end of the presentation, participants will

be able to:

▫ Identify at least three metrics in the MIHP quality process. ▫ State two ways to utilize MIHP reports ▫ Identify at least two quality improvement initiatives that will impact the pregnant mother and infant

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“Implementing these changes won’t be easy. We’re pretty set in doing things the wrong way.” 3

MIHP Quality

Policy and Program Operation

Policy Quality Strategy Operation Guide

Evidenced Based Program

Annual MIHP Evaluation report Published Quasi- experimental Research

Data

State Aggregate and Legislative Reports Provider Specific Reports Certification Reports Surveys

Provider Oversight

Certification Reviews Administrative/ Billing Data Reviews

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DRAFT Diagram

Evidenced Based Program Research Update

• MIHP Participation has favorable effects on:

▫ Prenatal Care ▫ Birth Outcomes ▫ Maternal Postnatal Care ▫ Infant Health Care ▫ Infant Mortality

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Evidenced Based Program Research Publications

• Meghea CI, Raffo JE, Zhu Q, Roman LA. Medicaid home visitation and maternal and infant

healthcare utilization. Am J Prev Med. 2013;45(4):441-447

• Roman L, Raffo JE, Zhu Q, Meghea CI. A statewide Medicaid enhanced prenatal care program:

impact on birth outcomes. JAMA Pediatr. 2014 Mar;168(3):220-7.

• Meghea CI, You Z, , Raffo JE, Leach RE, Roman LA. Statewide Medicaid Enhanced Prenatal Care

Programs and Infant Mortality. Pediatrics. 2015. In Print.

• Peters C, McKane P, Meghea CI. Return on investment: cost savings to Medicaid from Maternal

and Infant Health Program due to reduction in preterm birth rate.” ROI Fact Sheet Series, Volume 1, (2015)

• Meghea CI, You Z, , Raffo JE, Leach RE, Roman LA. Statewide Medicaid Enhanced Prenatal Care

Programs and Infant Mortality Pediatrics peds.2015-0479; published ahead of print July 6, 2015, doi:10.1542/ peds.2015-0479

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Today’s Quality Focus

• Certification
• Data
• Quality Improvement at the program and agency

level

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4 0 38 26 25 25 22 17 11 11 10

Top 10 "Not Met" Indicators Novem ber 1, 20 14 - June 30 , 20 15 9

Critical Indicator #56

• #56 – Discharge Summary not complete

▫ The majority of “not mets” indicate that the closed charts do not reflect the POC2 and Professional Visit Progress Note Documentation. ▫ What does this mean?

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How does this happen?

• When reviewing MIHP records, the risk

identified is compared with the POC2 pulled and the achieved date next to the interventions

• Interventions in the progress notes are

compared to the risk score and POC2

• Discharge summary interventions are compared

to the risk score, POC2, and progress notes

Should Match

Risk Score

Should Match

POC2

Should Match

Progress Notes

Mom and Infant have received Care Coordination and Education

Discharge Summary

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What to do about the Un-Met indicator?

• A recommended way to improve this indicator in

your Agency

▫ Investigate the problem and address through:

 Agency Process Improvement  Staff Education  CHART REVIEW/ AUDIT!

 Choose a specific day to audit  Choose an amount of charts to audit  Ask MIHP Coordinator and/ or professional staff to audit each other’s charts

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Why Worry about Quality?

“ I’ m writing you a prescription. Do you want a longer life with less quality or vice versa? ”

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Because . . .

We want to provide the best and highest quality of care to our mothers and their infants and families.

W e need to m eet the clients' need s a nd exp ecta tions!

This happens through improving ▫ Quality at the state level ▫ Quality at the agency level

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Quality Monitoring

There are many ways to monitor quality

• Surveys
• Research and Evaluation
• Agency and Medical Record Review

(Certification visit)

• Adm inistrative Data

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Administrative DATA

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Quarterly Reports

• Why do I have all of this data and . . .

What do I do with it?????

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MRI S creener S ummary and Completion Time

Summary Frequency Percent Missing Medicaid ID

100 1.70

Missing Total Score

728 12.36

Missing Both

38 0.65

Completed

5,102 86.61

Total Number of Screenings Reported

5,891 100.00

Screener Completion Time Frequency Percent Not Completed Within 120 Days

0.00

Completed Within 120 Days

5,891 100.00

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MRI Marital S tatus and Race

Marital Status Frequency Percent Married

1,135 19.27

Unmarried

4,468 75.84

Refused

79 1.34

Separated

73 1.24

Divorced

127 2.16

Widowed

9 0.15

Race Frequency Percent Multi-Racial

211 3.58

Asian

79 1.34

American Indian/Alaskan Native

44 0.75

Black/African American

2,722 46.21

Hispanic/Latino

447 7.59

Native Hawaiian/other Pacific Islander

13 0.22

White/Caucasian

2,094 35.55

Arabic/Chaldean

225 3.82

Refused

56 0.95

Not Populated

0.00

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MRI Education Level and S creener Discipline

Education Level Frequency Percent Less than 8th

221 3.75

JR high/middle school

1,296 22.00

High school diploma/GED

3,160 53.64

Associate's degree

293 4.97

Bachelor's degree

149 2.53

Trade School

98 1.66

Graduate degree

18 0.31

Not Populated

656 11.14

Screener Discipline Frequency Percent Nurse

2,488 42.23

Social worker

2,721 46.19

Not Populated

682 11.58

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MRI Thoughts on Breastfeeding and Age at Time of S creening

Thoughts On Breastfeeding Frequency Percent I know I will breastfeed

2,758 46.82

I think I might breastfeed

1,227 20.83

I don't know what to do about breastfeeding

409 6.94

I know I will not breastfeed

811 13.77

Refused

10 0.17

Not Populated

676 11.48

Age Category At Time Of Screening Frequency Percent 08 - 11

0.00

12 - 14

9 0.15

15 - 19

791 13.43

20 - 29

3,813 64.73

30 - 39

1,181 20.05

40 - 44

90 1.53

45 - 49

6 0.10

Over 50

1 0.02

Not Populated

0.00

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MRI Race by Age Category

Race By Age Category Frequency Percent Row Percent Col Percent 08-11 12-14 15-19 20-29 30-39 40-44 45-49 Over 50 Not Pop Total Multi-Racial 0.00 0.00 0.00 1 0.02 0.47 0.02 54 0.92 25.59 0.92 125 2.12 59.24 3.28 29 0.49 0.49 2.46 2 0.03 0.03 2.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 211 3.58 Asian 0.00 0.00 0.00 0.00 0.00 0.00 5 0.08 6.33 0.08 44 0.75 55.70 1.15 26 0.44 0.44 2.20 4 0.07 0.07 4.44 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 79 1.34 American Indian/Alaskan Native 0.00 0.00 0.00 0.00 0.00 0.00 8 0.14 18.18 0.14 31 0.53 70.45 0.81 5 0.08 0.08 0.42 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 44 0.75 Black/African American 0.00 0.00 0.00 2 0.03 0.07 0.03 378 6.42 13.89 6.42 1,823 30.95 66.97 47.81 487 8.27 8.27 41.24 29 0.49 0.49 32.22 2 0.03 0.03 33.33 1 0.02 0.02 100.00 0.00 0.00 0.00 2,722 46.21 Hispanic/Latino 0.00 0.00 0.00 1 0.02 0.22 0.02 44 0.75 9.84 0.75 244 4.14 54.59 6.40 145 2.46 2.46 12.28 12 0.20 0.20 13.33 1 0.02 0.02 16.67 0.00 0.00 0.00 0.00 0.00 0.00 447 7.59 Native Hawaiian/other Pacific Islander 0.00 0.00 0.00 1 0.02 7.69 0.02 3 0.05 23.08 0.05 6 0.10 46.15 0.16 2 0.03 0.03 0.17 1 0.02 0.02 1.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13 0.22 White/Caucasian 0.00 0.00 0.00 4 0.07 0.19 0.07 287 4.87 13.71 4.87 1,376 23.36 65.71 36.09 394 6.69 6.69 33.36 31 0.53 0.53 34.44 2 0.03 0.03 33.33 0.00 0.00 0.00 0.00 0.00 0.00 2,094 35.55 Arabic/Chaldean 0.00 0.00 0.00 0.00 0.00 0.00 4 0.07 1.78 0.07 128 2.17 56.89 3.36 82 1.39 1.39 6.94 10 0.17 0.17 11.11 1 0.02 0.02 16.67 0.00 0.00 0.00 0.00 0.00 0.00 225 3.82 Refused 0.00 0.00 0.00 0.00 0.00 0.00 8 0.14 14.29 0.14 36 0.61 64.29 0.94 11 0.19 0.19 0.93 1 0.02 0.02 1.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 56 0.95 Total 0.00 9 0.15 791 13.43 3,813 64.73 1,181 20.05 90 1.53 6 0.10 1 0.02 0.00 5,891 100.00

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MRI Domain S cores

Domain Scores Frequency Percent No Low Moderate High Unknown Not Populated Total Family Planning

137 2.33 4,097 69.55 635 10.78 0.00 323 5.48 699 11.87 5,891

Pregnancy History

3,363 57.09 0.00 1,541 26.16 188 3.19 101 1.71 698 11.85 5,891

Food

4,735 80.38 0.00 458 7.77 0.00 0.00 698 11.85 5,891

Housing

3,444 58.46 0.00 1,476 25.06 273 4.63 0.00 698 11.85 5,891

Transportation

3,839 65.17 0.00 1,354 22.98 0.00 0.00 698 11.85 5,891

Nutrition

1,453 24.66 1,714 29.10 1,976 33.54 49 0.83 3 0.05 696 11.81 5,891

Social Support

4,598 78.05 0.00 246 4.18 0.00 0.00 1,047 17.77 5,891

Smoking

3,812 64.71 0.00 1,037 17.60 0.00 9 0.15 1,033 17.54 5,891

Alcohol

4,645 78.85 0.00 331 5.62 173 2.94 43 0.73 699 11.87 5,891

Drugs

4,337 73.62 0.00 505 8.57 317 5.38 33 0.56 699 11.87 5,891

Stress/Depression/MH

2,534 43.01 0.00 1,615 27.41 677 11.49 9 0.15 1,056 17.93 5,891

Abuse/Violence

3,034 51.50 0.00 1,015 17.23 1,106 18.77 35 0.59 701 11.90 5,891

Asthma

4,234 71.87 508 8.62 451 7.66 0.00 0.00 698 11.85 5,891

Diabetes

4,919 83.50 96 1.63 178 3.02 0.00 0.00 698 11.85 5,891

Hypertension

4,722 80.16 195 3.31 276 4.69 0.00 0.00 698 11.85 5,891

Overall

8 0.14 411 6.98 2,452 41.62 2,007 34.07 285 4.84 728 12.36 5,891

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Infant Risk Identifier Quarterly Report

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IRI S creening S ummary and Completion and Mother’s Marital S tatus

Summary Frequency Percent Missing Mother Medicaid ID 1,650 18.69 Missing Infant Medicaid ID 606 6.86 Missing Both Medicaid ID 139 1.57 Missing Total Score 581 6.58 Missing Mother Medicaid ID and Total Score 284 3.22 Missing Infant Medicaid ID and Total Score 49 0.55 Completed 7,692 87.11 Maternal Screens 4,372 49.51 Infant Screens 4,458 50.49 Total Number Of Screenings Reported 8,830 100.00 Screener Completion Time Frequency Percent Not Completed Within 120 Days 0.00 Completed Within 120 Days 7,692 87.11 Mother Marital Status Frequency Percent Married 1,148 26.26 Unmarried 3,072 70.27 Refused 15 0.34 Not Populated 137 3.13

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IRI Mother and Infant Race

Mother Race Frequency Percent Multi-Racial 171 3.91 Asian 67 1.53 American Indian/Alaskan Native 32 0.73 Black/African American 1,725 39.46 Hispanic/Latino 427 9.77 Native Hawaiian/other Pacific Islander 6 0.14 White/Caucasian 1,641 37.53 Arabic/Chaldean 222 5.08 Refused 17 0.39 Not Populated 64 1.46 Infant Race Frequency Percent Multi-Racial 36 0.81 Asian 7 0.16 American Indian/Alaskan Native 8 0.18 Black/African American 170 3.81 Hispanic/Latino 43 0.96 Native Hawaiian/other Pacific Islander 0.00 White/Caucasian 162 3.63 Arabic/Chaldean 18 0.40 Refused 2 0.04 Not Populated 4,012 90.00

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IRI – Education, Discipline, Feeding, and Gestational Data

Education Level Frequency Percent Junior High/Middle School 1,091 24.95 High School Diploma/GED 2,731 62.47 Associates Degree 223 5.10 Bachelors Degree 154 3.52 Refused 37 0.85 Not Populated 136 3.11 Screener Discipline Frequency Percent Social Worker 2,334 53.39 Nurse 1,823 41.70 Not Populated 215 4.92 Infant Feeding Status Frequency Percent Solid Foods 77 1.73 Breastfeeding 1,341 30.08 Other 4 0.09 Formula 2,779 62.34 Not populated 257 5.76 Gestation Period Frequency Percent Extremely Preterm - Less than 28 Weeks 72 1.62 Very Preterm - Between 28 and 31 Weeks 89 2.00 Moderate to Late Preterm - Between 32 and 36 Week 439 9.85 Early Term - Between 37 and 39 Weeks 1,966 44.10 Full Term - More than 39 Weeks 1,637 36.72 Not Populated 255 5.72

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IRI Mom and Baby Age at Time of S creening

Mother Age Category At Time Of Birth Frequency Percent 08 - 11 0.00 12 - 14 9 0.21 15 - 19 579 13.24 20 - 29 2,674 61.16 30 - 39 872 19.95 40 - 44 83 1.90 45 - 49 8 0.18 Over 50 8 0.18 Not Populated 139 3.18 Infant Age At Time Of Screening Frequency Percent LESS THAN 3 WEEKS 1,145 25.68 3 TO 4 WEEKS 534 11.98 1 MONTH 0 DAYS TO 2 MONTHS 30 DAYS 1,771 39.73 3 MONTH 0 DAYS TO 4 MONTHS 30 DAYS 461 10.34 5 MONTH 0 DAYS TO 7 MONTHS 30 DAYS 302 6.77 8 MONTH 0 DAYS TO 10 MONTHS 30 DAYS 182 4.08 11 MONTH 0 DAYS TO 12 MONTHS 30 DAYS 42 0.94 13 MONTH 0 DAYS TO 15 MONTHS 30 DAYS 21 0.47

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IRI Mother Race by Age Category

Mother Race By Age Category 08-11 12-14 15-19 20-29 30-39 40-44 45-49 Over 50 Not Pop Total Multi-Racial 2 34 101 28 1 5 171 Asian 5 34 23 4 1 67 American Indian/Alaska Native 4 20 7 1 32 Black/African American 5 252 1,081 309 25 3 3 47 1,725 Hispanic/Latino 1 59 215 133 16 2 1 427 Native Hawaiian/Other Pacific Islander 1 4 1 6 White/Caucasian 1 222 1,093 279 21 3 5 17 1,641 Arabic/Chaldean 1 117 86 14 4 222 Refused 1 8 5 1 2 17 Not Populated 1 1 62 64 Total 9 579 2,674 872 83 8 8 139 4,372

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IRI Infant Race by Age Category

Infant Race By Age Category < 3 Weeks 3 - 4 Weeks 1 - 2 Mths 3 - 4 Mths 5 - 7 Mths 8 - 10 Mths 11 - 12 Mths 13 - 15 Mths Not Pop Total Multi-Racial 17 4 10 2 2 1 36 Asian 2 1 4 7 American Indian/Alaska Native 1 1 5 1 8 Black/African American 46 18 65 22 10 6 1 2 170 Hispanic/Latino 14 5 18 4 2 43 White/Caucasian 53 22 51 18 10 7 1 162 Arabic/Chaldean 4 1 7 4 1 1 18 Refused 1 1 2 Not Populated 1,008 482 1,610 411 278 165 39 19 4,012 Total 1,145 534 1,771 461 302 182 42 21 4,458

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IRI Maternal Domains

Maternal Domain Scores Frequency Percent No Low Moderate High Unknown Not Populated Total Overall 534 12.21 289 6.61 1,661 37.99 1,574 36.00 65 1.49 249 5.70 4,372 Family Planning 2,076 47.48 1,004 22.96 1,053 24.09 0.00 0.00 239 5.47 4,372 Smoking 3,111 71.16 0.00 1,026 23.47 0.00 9 0.21 226 5.17 4,372 Alcohol 3,936 90.03 0.00 143 3.27 56 1.28 13 0.30 224 5.12 4,372 Drugs Use 3,720 85.09 0.00 44 1.01 372 8.51 14 0.32 222 5.08 4,372 Stress/Depression/MH 2,370 54.21 0.00 1,357 31.04 423 9.68 0.00 222 5.08 4,372 Abuse/Violence 2,641 60.41 0.00 250 5.72 1,189 27.20 69 1.58 223 5.10 4,372 Housing 2,858 65.37 0.00 1,233 28.20 59 1.35 0.00 222 5.08 4,372 Food 3,870 88.52 0.00 280 6.40 0.00 0.00 222 5.08 4,372

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IRI Infant Domains

Infant Domain Scores Frequency Percent No Low Moderate High Unknown Not Populated Total Infant Overall 0.00 594 13.32 591 13.26 2,911 65.30 30 0.67 332 7.45 4,458 Infant Health 4,145 92.98 0.00 0.00 0.00 40 0.90 273 6.12 4,458 Infant Safety 1,497 33.58 0.00 0.00 2,668 59.85 21 0.47 272 6.10 4,458 Feeding/Nutrition 2,919 65.48 0.00 686 15.39 581 13.03 0.00 272 6.10 4,458 Infant Development 3,966 88.96 0.00 221 4.96 0.00 0.00 271 6.08 4,458 Family Support 1,951 43.76 0.00 1,340 30.06 838 18.80 41 0.92 288 6.46 4,458 Infant Health Care 2,481 55.65 431 9.67 862 19.34 396 8.88 16 0.36 272 6.10 4,458

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Maternal Discharge S ummary

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MDS Completed D/ C and S napshot

Summary of Completed Discharge Summaries Frequency Percent Total Number of Discharge Summaries Completed 3,445 100.00 Number of Infants followed in MIHP 2,286 66.36 Maternal Services Completed Prior to Birth 1,176 34.14 Maternal Services Completed After Birth 2,269 65.86 Enrolled in WIC 3,264 94.75 Medicaid Health Plan Contacted When Enrolled in MIHP 3,354 97.36 Medical Care Provider Notified at Enrollment and at Discharge 3,142 91.20 Snapshot of Activity for this Quarter Frequency Total Discharge Summaries Started During Quarter 3,844 Total Discharge Summaries Completed During Quarter - Regardless of Start Date 3,445 Total Discharge Summaries Incomplete at End of Quarter 418

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MDS Birth Outcomes, Average Visits, Gestational Age, Currently Breastfeeding

Birth Outcomes Frequency Percent Live Birth 2,523 73.24 Still Birth 15 0.44 Miscarriage 107 3.11 Elective Abortion 10 0.29 Other 790 22.93 Average Visits Total Visits Average Average Number of Prenatal Visits 13,398 3.89 Average Number of Postpartum Visits 4,976 1.44 Gestational Age Frequency Percent <= 37 WEEKS 432 12.54 > 37 WEEKS 2,090 60.67 Not Populated 923 26.79 Currently Breastfeeding Frequency Percent Yes 901 0.00 No 1,307 0.00 Unknown 312 0.00 Not Populated 925 0.00

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MDS Immunization and Race

Immunization Schedule Frequency Percent Education Provided 2,124 0.00 Referred 346 0.00 Refused 53 0.00 Not Populated 922 0.00 Race Frequency Percent Multi-Racial 159 4.62 Asian 62 1.80 American Indian/Alaskan Native 35 1.02 Black/African American 1,196 34.72 Hispanic/Latino 270 7.84 Native Hawaiian or other Pacific Islander 2 0.06 White/Caucasian 1,541 44.73 Arabic/Chaldean 149 4.33 Refused 11 0.32 Not Populated 20 0.58

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MDS Referrals

Referrals Frequency Percent Family Planning 1,059 30.91 Plan First 235 6.86 Immunization 522 15.24 Medical 566 16.52 Dental 451 13.16 Counseling 441 12.87 Basic Needs 990 28.90 Infant Mental Health 77 2.25 Substance Abuse 70 2.04 Child Protective Services 14 0.41 Domestic Violence 141 4.12 WIC 1,176 34.33 Child Care 52 1.52 Baby Items 1,417 41.36 Education 426 12.43 Employment 65 1.90 Other Referral 1,597 46.61 Home Visit Support 342 9.98 Multiple Referrals 2,203 64.30 Not Complete 0.00

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MDS Domain S cores

Domain Scores Frequency Percent No Low Moderate High Total Family Planning 1,276 37.04 1,828 53.06 341 9.90 0.00 3,445 Pregnancy History 2,711 78.69 0.00 586 17.01 148 4.30 3,445 Food 3,066 89.00 0.00 379 11.00 0.00 3,445 Housing 2,653 77.01 0.00 720 20.90 72 2.09 3,445 Transportation 2,841 82.47 0.00 604 17.53 0.00 3,445 Social Support 3,327 96.57 0.00 118 3.43 0.00 3,445 Smoking 2,739 79.51 0.00 706 20.49 0.00 3,445 Alcohol 3,283 95.30 0.00 125 3.63 37 1.07 3,445 Drugs 3,095 89.84 0.00 229 6.65 121 3.51 3,445 Stress/Depression/MH 2,261 65.63 0.00 865 25.11 319 9.26 3,445 Abuse/Violence 2,610 75.76 0.00 489 14.19 346 10.04 3,445 Asthma 3,070 89.11 226 6.56 149 4.33 0.00 3,445 Diabetes 3,279 95.18 90 2.61 76 2.21 0.00 3,445 Hypertension 3,231 93.79 113 3.28 101 2.93 0.00 3,445

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Infant Discharge S ummary

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IDS Completed D/ C, S napshot and Average Visits

Summary of Completed Discharge Summaries Frequency Percent Total Number of Discharge Summaries Completed 2,291 100.00 Substance Exposed Infant 109 4.76 Enrolled in WIC 2,230 97.34 Medicaid Health Plan Contacted When Enrolled in MIHP 2,256 98.47 Medical Care Provider Notified at Enrollment and at Discharge 2,179 95.11 Snapshot of Activity for this Quarter Frequency Percent Total Discharge Summaries Started During Quarter 2,749 1.09 Total Discharge Summaries Completed During Quarter - Regardless of Start Date 2,291 0.94 Total Discharge Summaries Incomplete at End of Quarter 467 0.29 Average Visits Total Visits Average Average Number of Visits 16,380 7.15

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IDS S ervice S tatus, Breastfeeding

Infant Service Status Frequency Percent Completed 1,366 59.62 Infant Deceased 5 0.22 Cannot be Located 568 24.79 Parent/Guardian Declined Services 352 15.36 Currently Breastfeeding Frequency Percent No 1,817 79.31 Yes 247 10.78 Unknown 227 9.91 Ever Breastfed Frequency Percent Yes 475 0.32 No 414 0.26 Not Populated 1,402 0.75 Breastfeeding Duration Frequency Percent Days 30 0.33 Weeks 104 0.63 Months 341 1.24

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IDS Immunization and Well Child

Immunization Schedule Frequency Percent Education Provided 2,074 90.53 Refused 43 1.88 Referred 854 37.28 Well Child Schedule Frequency Percent Education Provided 2,067 90.22 Refused 31 1.35 Referred 825 36.01

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IDS Maternal and Infant Race

Maternal Race Frequency Percent Multi-Racial 99 4.32 Asian 44 1.92 American Indian/Alaskan Native 26 1.13 Black/African American 745 32.52 Hispanic/Latino 201 8.77 Native Hawaiian/other Pacific Islander 4 0.17 White/Caucasian 1,052 45.92 Arabic/Chaldean 107 4.67 Refused 11 0.48 Not Populated 2 0.09 Infant Race Frequency Percent Multi-Racial 242 10.56 Asian 42 1.83 American Indian/Alaskan Native 22 0.96 Black/African American 754 32.91 Hispanic/Latino 186 8.12 Native Hawaiian/other Pacific Islander 6 0.26 White/Caucasian 926 40.42 Arabic/Chaldean 110 4.80 Refused 3 0.13 Not Populated 0.00

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IDS Referrals

Referrals N=2291 Frequency Percent Family Planning 639 27.89 Plan First 207 9.04 Immunization 429 18.73 Medical 425 18.55 Dental 207 9.04 Counseling 275 12.00 Infant Mental Health 75 3.27 Parenting 403 17.59 Child Care 138 6.02 WIC 669 29.20 Substance Abuse 43 1.88 Child Protective Services 27 1.18 Domestic Violence 88 3.84 Home Visit Support 294 12.83 Other Referral 1,428 62.33 Multiple Referrals 1,138 49.67 Not Populated 16 0.70

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IDS Maternal Domain

Maternal Domain Scores Frequency Percent No Low Moderate High Unknown Not Populated Total Family Planning 1,554 67.83 408 17.81 329 14.36 0.00

0.00 0.00 2,291

Smoking 1,707 74.51 0.00 584 25.49 0.00

0.00 0.00 2,291

Alcohol 2,213 96.60 0.00 55 2.40 23 1.00

0.00 0.00 2,291

Drugs 2,106 91.92 0.00 48 2.10 137 5.98

0.00 0.00 2,291

Depression 1,505 65.69 0.00 641 27.98 145 6.33

0.00 0.00 2,291

Abuse/Violence 1,800 78.57 0.00 164 7.16 327 14.27

0.00 0.00 2,291

Housing 1,825 79.66 0.00 438 19.12 28 1.22

0.00 0.00 2,291

Food 2,205 96.25 0.00 86 3.75 0.00

0.00 0.00 2,291

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IDS Infant Domain

Substance Exposed Infant Domain Scores Frequency Percent No Low Moderate High Unknown Not Populated Total Positive At Birth 65 59.63 9 8.26 8 7.34 27 24.77 0.00 0.00 109 Primary Caregiver Use 60 55.05 17 15.60 8 7.34 24 22.02 0.00 0.00 109 Environment 62 56.88 19 17.43 6 5.50 22 20.18 0.00 0.00 109 Infant Domain Scores Frequency Percent No Low Moderate High Unknown Not Populated Total Infant Health 1,647 71.89 205 8.95 335 14.62 104 4.54 0.00 0.00 2,291 Infant Safety 1,259 54.95 0.00 0.00 1,032 45.05 0.00 0.00 2,291 Feeding/Nutrition 1,778 77.61 0.00 365 15.93 148 6.46 0.00 0.00 2,291 Infant Development 2,081 90.83 0.00 210 9.17 0.00 0.00 0.00 2,291 Parenting And Child Care 1,512 66.00 0.00 469 20.47 310 13.53 0.00 0.00 2,291

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MIHP Quality PDCA

Modified from Demming’s PDS A

• Plan –

Recognize and analyze the problem needing improvement

• Do –

Develop and Test the solution

• Check –

Review the test and study the results

• Act –

Take action based on what you learned in the study step: Adopt, adapt, or abandon

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PDCA - Wikipedia, the free encyclopedia Accessed at https:/ / en.wikipedia.org/ wiki/ PDCA

Quality PDCA at the S tate Level

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DCA

• Plan –

Recognize and analyze the problem needing improvement

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DCA

• Problem, 13%
• f the Risk Identifiers

in the state data base are

• incomplete. The largest percent

(12.3% ) is due to no total score.

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DCA

▫ Why is this a problem?

 No risk score thus no POC for the mom;  Agency can’ t bill until it’s complete; or  Agency is “ holding” the risk identifier in

the data base thus preventing another agency from seeing mom

 Limits services to a high risk population  Based on the data, it doesn’ t appear

agencies are doing outreach

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“Great. . . Just what we need: another quality improvement campaign! 53

P CA

• Do –

develop and implement an improvement you think will work.

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P CA

▫ S

tate receives reports listing incomplete risk identifiers by NPI number

▫ Add new indicator to recertification that

assesses percentage of incomplete MRI/ IRIs

▫ Use state average of less than 13%

incomplete MRI/ IRIs as not-met thresh hold

▫ Inform agencies of this change ▫ Implement indicator in the next Cert Cycle

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PD A

• Check –

Review the intervention results ▫ Of 50 agencies reviewed over a one year period,

20%

• f the agencies received a “ not-met” for this

indicator

▫ After one year of implementation, the state

average decreased to 10% incomplete screeners in the database

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PDC

• Act –

Take action based on what you learned in the study

• Next step: Adopt, adapt, or abandon

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PDC

What do you think we should do?

Adapt!

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PDC

• WHY?

▫ Although the state average decreased to

10% , the goal is to have all screeners complete

▫ Change the indicator percentage to

receive a “ met” to below the state average of 10% incomplete

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Questions?

• Would you do anything different?

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Do you feel like this now?

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Togetherness

Let’s do a PDCA together using the quarterly report!

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Quarterly Report

• Lists the domains
• Lists the number and percentage of women who

score No, Low, Moderate, High, Unknown or Not Populated

• Lists the Referrals
• SO WHAT?

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Let’s look at Depression

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Let’s look at referrals

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DCA

Plan – Recognize and analyze the problem needing improvement What do you think the problem is? What additional information would help?

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P CA

Do – develop and implement an improvement you think will work.

• What would you try?

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PD A

Check – Review the intervention results

• What do you want to see to show you that the

intervention worked?

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PDC

• Act –

Take action based on what you learned in the study

• Next step: Adopt, adapt, or abandon

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REMEMBER

You aren’t alone. . . Don’t assume you know what the problem is - - Do the PLANNING

• Check data and every available

resource you have to help you discover the true problem

• Ask staff to help figure it out
• Ask your clients what they think

DO the Intervention - - brainstorm with staff to plan the intervention that will work best in your agency Pick a timeline to CHECK on the results

• f the intervention

Decide what your ACTion will be and your next steps . . . Adopt, Adapt, or Abandon

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Questions? 71

Break Questions for the MIHP State Staff Panel

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