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

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

2 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

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

4 MIHP Quality Policy and Evidenced Provider Data Program Based Oversight Operation Program State Aggregate and Legislative Reports Policy Annual MIHP Certification Evaluation report Reviews Provider Specific Reports Quality Strategy Certification Reports Published Quasi- Administrative/ experimental Billing Data Reviews Research Operation Guide Surveys DRAFT Diagram

5 Evidenced Based Program Research Update • MIHP Participation has favorable effects on: ▫ Prenatal Care ▫ Birth Outcomes ▫ Maternal Postnatal Care ▫ Infant Health Care ▫ Infant Mortality

6 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

7 Today’s Quality Focus • Certification • Data • Quality Improvement at the program and agency level

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9 Top 10 "Not Met" Indicators Novem ber 1, 20 14 - June 30 , 20 15 4 0 38 26 25 25 22 17 11 11 10

10 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?

11 How does this happen? Mom and Infant have Risk Progress Discharge Should received Care POC2 Should Should Match Summary Notes Coordination Score Match Match and Education • 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

12 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

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

14 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

15 Quality Monitoring There are many ways to monitor quality • Surveys • Research and Evaluation • Agency and Medical Record Review (Certification visit) • Adm inistrative Data

16 Administrative DATA

17 Quarterly Reports • Why do I have all of this data and . . . What do I do with it?????

18 MRI S creener S ummary and Completion Time Summary Frequency Percent 100 1.70 Missing Medicaid ID 728 12.36 Missing Total Score 38 0.65 Missing Both 5,102 86.61 Completed Total Number of Screenings Reported 5,891 100.00 Screener Completion Time Frequency Percent 0.00 Not Completed Within 120 Days 0 100.00 5,891 Completed Within 120 Days

19 MRI Marital S tatus and Race Marital Status Frequency Percent 1,135 19.27 Married Unmarried 4,468 75.84 Refused 79 1.34 Separated 73 1.24 Race 127 2.16 Divorced Frequency Percent 9 0.15 Widowed 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 0.00

20 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

21 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 Age Category At Time Of Screening Not Populated 676 11.48 Frequency Percent 08 - 11 0 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 0.00

22 MRI Race by Age Category Race By Age Category Frequency Percent Row Percent Not Over Col Percent Pop 08-11 12-14 15-19 20-29 30-39 40-44 45-49 50 Total 0 1 54 125 29 2 0 0 0 211 Multi-Racial 0.00 0.02 0.92 2.12 0.49 0.03 0.00 0.00 0.00 3.58 0.00 0.47 25.59 59.24 0.49 0.03 0.00 0.00 0.00 0.00 0.02 0.92 3.28 2.46 2.22 0.00 0.00 0.00 5 Asian 0 0 44 26 4 0 0 0 79 0.00 0.00 0.08 0.75 0.44 0.07 0.00 0.00 0.00 1.34 0.00 0.00 6.33 55.70 0.44 0.07 0.00 0.00 0.00 0.00 0.00 0.08 1.15 2.20 0.00 0.00 0.00 4.44 8 American Indian/Alaskan Native 0 0 31 5 0 0 0 0 44 0.00 0.00 0.14 0.53 0.08 0.00 0.00 0.00 0.00 0.75 0.00 0.00 18.18 70.45 0.08 0.00 0.00 0.00 0.00 0.00 0.00 0.14 0.81 0.42 0.00 0.00 0.00 0.00 0 2 378 1,823 487 29 2 1 0 2,722 Black/African American 0.00 0.03 6.42 30.95 8.27 0.49 0.03 0.02 0.00 46.21 0.00 0.07 13.89 66.97 8.27 0.03 0.02 0.00 0.49 0.00 0.03 6.42 47.81 41.24 32.22 33.33 100.00 0.00 44 Hispanic/Latino 0 1 244 145 12 1 0 0 447 0.00 0.02 0.75 4.14 2.46 0.20 0.02 0.00 0.00 7.59 0.00 0.22 9.84 54.59 2.46 0.20 0.02 0.00 0.00 0.00 0.02 0.75 6.40 12.28 13.33 16.67 0.00 0.00 3 0 1 6 2 1 0 0 0 13 Native Hawaiian/other Pacific Islander 0.00 0.02 0.05 0.10 0.03 0.02 0.00 0.00 0.00 0.22 0.00 7.69 23.08 46.15 0.03 0.00 0.00 0.00 0.02 0.00 0.02 0.05 0.16 0.17 1.11 0.00 0.00 0.00 0 4 287 1,376 394 31 2 0 0 2,094 White/Caucasian 0.00 0.07 4.87 23.36 6.69 0.53 0.03 0.00 0.00 35.55 0.00 0.19 13.71 65.71 6.69 0.03 0.00 0.00 0.53 0.00 0.07 4.87 36.09 33.36 34.44 33.33 0.00 0.00 0 0 4 128 82 10 1 0 0 225 Arabic/Chaldean 0.00 0.00 0.07 2.17 1.39 0.17 0.02 0.00 0.00 3.82 0.00 0.00 1.78 56.89 1.39 0.17 0.02 0.00 0.00 0.00 0.00 0.07 3.36 6.94 11.11 16.67 0.00 0.00 8 Refused 0 0 36 11 1 0 0 0 56 0.00 0.00 0.14 0.61 0.19 0.02 0.00 0.00 0.00 0.95 0.00 0.00 14.29 64.29 0.19 0.02 0.00 0.00 0.00 0.00 0.00 0.14 0.94 0.93 0.00 0.00 0.00 1.11 Total 0 9 791 3,813 1,181 90 6 1 0 5,891 0.00 0.15 13.43 64.73 20.05 1.53 0.10 0.02 0.00 100.00