Abstract
This brief highlights the major strategies, lessons learned, and outcomes from North Carolina’s experience during the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) from February 2010 to February 2016.
North Carolina’s Goals: Improve quality of care for children by 1) calculating, reporting and using quality measures 2) helping practices strengthen the medical home model for children with special healthcare needs 3) testing the Children’s Electronic Health Record format
Insights Results
Overview of model
North Carolina improved reporting on Child Core Set measures and helped more than 200 practices improve care quality by hiring pediatric quality improvement specialists and enhancing practice-level quality reports
The state made modest but meaningful improvements on several quality measures over the 15-month period (e.g., body mass index screening, autism screening, adolescent screening and dental varnishing)
Practices participated in learning collaboratives to strengthen their medical home characteristics for special needs children
Key takeaways/implications
Many practices instituted: 1) The use of validated, state recommended mental health and developmental screening questionnaires; 2) Regular measurement and recording of children’s body mass index; 3) The use of motivational interviewing to help families improve nutrition and increase physical activity for obese children; and 4) the use of dental fluoride varnish for children
As a result, practices reported high levels of developmental screenings for infants and young children (90% or greater)
Challenges: Efforts to improve practices’ electronic health records (EHR) features to better capture information about children were hindered because EHRs were often too slow to build new requirements into their products
