DC PICHQ
Partnership to Improve Children's Healthcare Quality

Transforming Community Health in the District of Columbia

Are we making a difference? Are there outcomes measures for primary care?

For children enrolled in Medicaid – a key outcome measure of primary care is successful delivery of EPSDT services. CMS requires each state Medicaid program, such as DC’s Medical Assistance Administration (MAA), to provide a comprehensive program of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services to its Medicaid enrollees. These EPSDT services are based on “best practice” recommendations and clinical guidelines from the American Academy of Pediatrics and Bright Futures developmental screening and counseling.

Progress and Accomplishments

Late in 2005, the Goldberg Center received start-up funding from the Commonwealth Fund, National Initiative for Children’s Healthcare Quality, and Children’s National Medical Center to formally establish the DC Partnership for Children’s Healthcare Quality (DC PICHQ) – with the EPSDT improvement as its initial quality improvement initiative. DC PICHQ has engaged an unprecedented collaboration of public health, managed care organizations, academic health centers, community pediatric providers, and parent advocates.

DC PIHCQ Collaborative Partners American Academy of Pediatrics – DC Chapter AmeriGroup, Inc. Bright Futures at Georgetown University Chartered Health Plan, Inc. Chartered Family Health Center Children’s National Medical Center District of Columbia Department of Health DC DOH – Medical Assistance Administration (Medicaid) George Washington University School of Medicine MEDSTAR – Georgetown University Medical Center HealthRight, Inc. Howard University Health Services for Children with Special Needs, Inc. Unity Health Care, Inc.

This past year has seen remarkable progress and national recognition for the DC PICHQ and its city-wide improvement activities. In 2006, the DC PICHQ presented at key national forums – including the American Academy of Pediatrics’ National Legislative Conference, the AAP Council on Federal and Government Affairs, and the NICHQ 6th Annual Forum. DC PICHQ has leveraged its quality improvement expertise and infrastructure to facilitate and mentor DC DOH-provider team participation in national quality improvement learning collaboratives (Medical Home for Children with Special Health Care Needs and Improving Awareness and Access to Care for Children and Youth with Epilepsy).

DC PICHQ has contracted with all four DC Medicaid plans to support on-going EPSDT improvement activities (practice recruitment and provider training; annual EPSDT providers updates at local DC AAP and MCO meetings). The PICHQ has collaborated with DOH and MAA to pilot and launch the DC HealthCheck Registry to capture EPSDT documentation. By the end of 2006, over 20,000 completed EPSDT visits had been entered into the new DC HealthCheck child health data registry. Preliminary data demonstrates:

• DC PICHQ has recruited, trained, and implemented EPSDT SMRFs in more than 60% of DC Medicaid’s provider community – representing close to 75% of DC Medicaid patient enrollees
• Complete and comprehensive EPSDT documentation for well-child visits has improved from an initial 30% chart audit benchmark (2002) to > 90% (2006)
• Children in DC’s Medicaid program are now documented as receiving the nation’s most comprehensive EPSDT visits

DC PICHQ efforts in 2007 will focus on expanding city-wide practice implementation, registry functionality, and further improving provider documentation through P4P report cards.

Community Health Improvement: Looking Forward

The future for data-driven community health improvement looks even more exciting. Early data “snapshots” from the registry reveal significantly more detailed health information and the opportunity to target and measure key child health issues, populations and outcomes longitudinally over time. For example, while there is widespread recognition that childhood obesity is epidemic, increasing and disproportionately represented in poor and minority populations – detailed obesity information for children in Washington, DC is limited to small surveys. The DC PICHQ and DOH Medicaid were able to look at BMI data for an initial cohort of registry submissions – providing confirmation in much greater detail that 40% of DC’s children in Medicaid are overweight (18% with BMI > 85th percentile) or obese (22% with BMI > 95th percentile).

This successfully demonstrates how key child health data can be captured and shared (at the provider and community level) to guide targeted improvement and improve community health. The DC PICHQ looks forward with great anticipation to expanding its city-wide practice-based collaboration quality improvement model, infrastructure, and expertise to a city-wide obesity initiative to be launched in 2007.