Abstract
This brief highlights the major strategies, lessons learned, and outcomes from Colorado’s experience in the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).
Colorado’s Goals: Work with school-based health centers to improve care for adolescents by 1) implementing new quality improvement process 2) implementing an electronic screening tool 3) engaging youth in care 4) promoting the patient-centered medical home
Insights Results
Overview of model
Colorado hired quality improvement coaches to help school-based health centers (SBHCs) improve the delivery and documentation of preventative services recommended by the Early and Periodic Screening Diagnosis Treatment (EPSDT) standards and to improve other QI topics (e.g. pediatric obesity, depression and anxiety, sexual health and immunization)
The percent age of adolescents in SBHCs with all EPSDT-recommended services documented increased from 33% to 72% during the demonstration
Electronic questionnaires were used to screen adolescents for social and behavioral risk factors; students responded more positively to electronic rather than previous paper surveys and results were used to identify risk factors that required follow up
All participating SBHCs became recognized medical homes by completing the Medical Home Index form and by creating a tracking system for referrals, coordinating with local hospitals and developing a list of community resources for families
Key takeaways/implications
Partnerships: Colorado partnered with New Mexico to design and implement demonstration across both states
Challenges: 1) SBHCs’ EHR problems (ex. poor internet connection); 2) A general lack of familiarity with QI; 3) Staff turnover, competing priorities for staff time; and 4) Limited financial resources made processes to monitor and improve quality more complicated
