WIAAP GOALS – FY 2005-6 by goodbaby

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									WIAAP strategic plan 05-08

WISCONSIN CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS

STRATEGIC PLAN 2005-2008

Wisconsin Chapter of AAP

Thursday, July 27, 2006

Mission The Wisconsin Chapter of the American Academy of Pediatrics works to 1) assure optimal health and safety for Wisconsin’s children and their families through advocacy and collaboration with other child interest groups 2) give support and education to Wisconsin pediatricians enabling them to continue to be the most effective providers of healthcare to children. Values The WIAAP believes: 1. All children in our state should have access to adequate medical and dental home a. Leadership and advocacy on behalf of children b. Promoting excellence in patient care c. Collaboration with professional organizations, community service groups, and government agencies 2. All children in our state deserve high quality, accessible, and affordable healthcare a. Leadership and advocacy on behalf of children b. Collaboration with other professional organizations and government agencies 3. All pediatricians in our state should receive appropriate compensation for their services a. Provider and patient education b. Collaboration with other professional organizations and government agencies Vision Working together, and with other child interest groups, we will insure that children of our state will have a bright and healthy future and that our members will experience satisfaction and pride in their profession. The overall principle for our chapter is to eliminate disparities in healthcare for children in our state through advocacy, education, and collaboration Priorities WIAAP aims to improve quality of care and eliminate racial/ethnic and socioeconomic disparities in the following priority areas:  Overweight  Infant mortality  Mental health  Asthma o Continue our efforts directed at improving the care of children o Areas of additional emphasis  Injury prevention

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Wisconsin Chapter of AAP
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Thursday, July 27, 2006

Dental health Health insurance coverage Language barriers to care for limited English proficient children and their families Advocate for pediatric-specific best practice measurement Advocate for the adoption of pediatric-specific evidence based practice Develop chapter and regional leadership in quality improvement and patient safety

Process o o o o o o o o o o Set priorities Develop outcome measures for each goal Identify appropriate committees Consider the foundation role Define membership roles Align community partners Engage national organization Analyze fiscal implication Consider funding sources Disseminate information to the general membership, public, media, and others Operational plan o o o o o o o o Needs assessment Assign champions for each priority Gather existing benchmarks from other organizations Identify ongoing projects in our state Allocate financial resources Support the efforts of the pediatric council Invite experts in quality improvement and patient safety to participate Disseminate information  Teleconference  Regional group meetings

Key question Given the fact that there are other organizations and government agencies working on the same priorities we should focus our efforts on:  What changes can we make that will benefit our members and is usueful in their practice

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Wisconsin Chapter of AAP Goals Matrix Goal Obesity: 1. Reduce the prevalence of childhood and adolescents obesity 2. Improve the quality of care and eliminate disparities. Reduce Infant mortality Champions 1. Frank Greer 2. Joe Tzougros 3. Barb Kolb 4. Jeff Lamont 5, David Bernhardt Target 1. Physicians 2. Schools 3. Community

Thursday, July 27, 2006

Measurement Obesity down because of global change at home, school based and WIC programs

1. Kyle Mount 2. Glenn Flores 2. Paul Wegehaupt

Mental health

1. Murray Katcher 2. Jim Meyer 3. Kyle Mount 4. Russell Scheffer

Asthma

1. John Meurer

1. Address immediate causes of infant mortality 2. Address regionalization issues 1. Access to pediatric mental health specialists improves across the state 2. Early diagnosis and screening 3. Education 1. Increase use of controller medication 2. Reduce exposure to smoking in public places 3. Increase cigarette taxes 4. Education

1. Annual disparities report card for state. 2. Survey results 3. Public education 1. Activity to improve communication 2. Meetings with mental health providers

1. Education 2. Communication with insurer

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Wisconsin Chapter of AAP

Thursday, July 27, 2006

Appendix A: Plan for reducing obesity in Wisconsin Due to alarming trend in childhood overweight, the Wisconsin Chapter of the American Academy of Pediatrics (WIAAP) has chosen as one of its key priorities Childhood Obesity.

Goals:  Positively impact the prevalence and incidence of childhood and adolescent overweight in the state of Wisconsin.  Improve the quality of care and eliminate disparities in the treatment of childhood overweight in the state of Wisconsin. Priority Recommendations: 1. Healthcare: Increase Physician awareness of childhood overweight and its association with long-term medical complications with emphasis on prevention.     Support breast feeding and prenatal health Increase use of BMI as a screening tool in the primary care setting Increase early anticipatory guidance for healthy activity and nutrition in infants and preschool children Increase primary care screening for metabolic sequelae of overweight (early insulin resistance, type 2 diabetes, hyperlipidemias, hypertension, liver disease)

2. Schools: Increase schools’ awareness of childhood overweight and their role in education, nutrition and physical activity to positively affect health.        Encourage members of the AAP to serve on school wellness committees Maximize activity and physical education in schools Lectures to students, parent & teacher organizations, school nurses Reduce food marketing in elementary schools Eliminate soda sales on campuses K-8 Adopt minimum nutrition standards for ala carte and vending offerings which would be endorsed by our chapter Adopt minimum physical activity standards endorsed by our chapter based on Healthy Active Living statement published by AAP this year

3. Community: Promote healthy lifestyles and environments that could help combat this trend.

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Wisconsin Chapter of AAP    

Thursday, July 27, 2006

Support legislation that increases activity within the community (biking & hiking trails, safe parks, side walks) Support research for cause and treatment of Obesity Encourage insurance companies to reimburse for Obesity counseling and treatment list of available experts to interact with media related to news releases, publications, etc in the field of pediatric obesity

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Wisconsin Chapter of AAP

Thursday, July 27, 2006

Appendix B; To reduce infant mortality by addressing the immediate causes and regionalization of neonatal services Goal: Decrease infant mortality Aim: To reduce infant mortality by addressing the immediate causes and regionalization of neonatal services A: Immediate causes of infant mortality

The major immediate causes of infant mortality are prematurity/low birthweight, congenital malformations, and SIDS/SUDI. For the period 2002-2004 disorders related to preterm birth and low birthweight accounted for 20.9% of all infant deaths in Wisconsin. During the same period congenital malformations and SIDS/SUDI accounted for 19.9% and 10.0%, respectively. Prematurity Addressing prematurity remains difficult. There is an increasing body of evidence that suggests that a significant cause of premature labor and delivery is rooted in the effects of the psychosocial environment on the woman’s hypothalamic-pituitary-adrenal axis. The disparity in outcomes is explained, at least in part, by the chronic differential exposure to stress of the HPA axis and its subsequent adverse effects on the reproductive capabilities of the woman. From this perspective, reducing the rate of premature delivery will depend on changing the societal context in which women live. Congenital malformations Some congenital malformations are preventable. The use of folic acid has decreased the incidence of neural tube defects significantly. SIDS/SUDI The area in which pediatricians can probably play the greatest role in reducing infant mortality is in the area of SIDS/SUDI prevention. In 1992 the AAP released its recommendations on sleep positioning identifying any non-prone position as being optimal for reducing SIDS risk. Subsequent studies showed that side sleeping was associated with a higher risk than supine sleeping. Since that time there has been a significant decrease in infant deaths associated with sleep position. Other factors are probably also important in the sleep environment. These include soft sleep surfaces and loose bedding, overheating, smoking, and bed sharing. Objectives: 1. Sleep environment a. Conduct a survey of pediatricians’ attitudes and understanding of the 2005 policy statement “The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the

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Wisconsin Chapter of AAP

Thursday, July 27, 2006

2.

3.

Sleeping Environment, and New Variables to Consider in Reducing Risk” by March 31, 2007. b. Convene a focus group of pediatricians to evaluate the survey and develop a web-based powerpoint presentation on sleep environment by August 31, 2007. c. Identify other community stakeholders and coordinate efforts (with the chapter’s Committees on Injury and Poison Prevention, Medical Student Education, and School Health) on consumer education to increase awareness of appropriate sleep environment (FIMR, Infant Death Center, middle and high schools, etc.) beginning September 2006. (Specific methods would be determined by the group.) Tobacco cessation a. Work with the Tobacco Free coordinator, John Meurer, and other stakeholders to continue to advocate for smoking cessation. Prematurity a. Coordinate efforts with Maternal and Child Health to increase awareness of factors influencing premature labor and delivery by producing two articles for the WIsper and one for the WMJ. The articles would summarize current and developing understanding of the important pathways to premature delivery. b. Formalize relationships with the MOD, Wisconsin Association for Perinatal Care, ACOG, and other professional organizations by October 31, 2006. Assess the capacity of each of the partners c. Meet with representatives of the state by January 31, 2006 to discuss the state’s Framework for Action to Eliminate Racial and Ethnic Disparities in Birth Outcomes. Identify specific action steps from the framework that could be adopted by the AAP primarily (with support from the organizations identified in 4.b), or secondarily (as a supporter/resource for the organizations listed). Regionalization

B:

Regionalization of perinatal services During the 1970s regionalization of neonatal and perinatal services was advocated to improve pregnancy outcomes. According to the Committee on Perinatal Health, since 1993 financial and marketing pressures, as well as community demands, have encouraged some hospitals to raise their perinatal care service level designation, primarily with regard to patient care activities without attention to regional coordination concerns. This imbalance or lack of coordination in the provision of services may be a product of a growing competitive health care market and prepaid health plans with overlapping geographic areas. Such competitive forces frequently have led to the unnecessary duplication of services within a single community or geographic region with the potential to result in decreased complex patient care, increased patient morbidity and mortality, and increased cost.

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Wisconsin Chapter of AAP

Thursday, July 27, 2006

In November of 2004 the AAP released the policy statement “Levels of Neonatal Care”. In this document the levels of care were defined in terms of a more comprehensive assessment of patient needs and distinction among low, moderate, and high levels of complexity and risk. The document concludes with recommendations: 1. Regionalized systems of perinatal care are recommended to ensure that each newborn infant is delivered and cared for in a facility appropriate for his or her health care needs and to facilitate the achievement of optimal outcomes. 2. Population-based data on patient outcomes, including mortality, specific morbidities, and long-term outcomes, should be obtained to provide level-specific standards for volume of patients requiring various categories of specialized care, including surgery. The number of Neonatal Intensive Care Units in Wisconsin has increased over the last 15 years. Some of these units may duplicate services and increase cost without offering clear benefits to problems like infant mortality. On the other hand patient satisfaction may be met by having an NICU that is closer to home, facilitating transportation to and from the hospital. Increased numbers of NICUs also can make the units more accessible to outlying hospitals. Underlying many of the issues relating to assessing NICU need is a basic lack of information. Insufficient information is available in Wisconsin to perform cost-benefit, cost-utility, and cost-efficiency analyses. In addition, outcome and quality indicators are needed. Conclusions According to Johnson and Little, in the past decade, with the transformation of the health care system and the emergence of managed care, there has been a resurgence of interest in public, professional, and governmental interest in quality measurement and accountability. Regional perinatal systems have been implemented in all states with varying levels of involvement by state health agencies and the public sector. State efforts in quality improvement have four arenas of activity: 1. policy development and implementation, 2. definition and measurement of quality, 3. data collection and analysis, and 4. communication to affect change Few state health agencies (through their MCH programs and perinatal staff) are taking action in all four arenas. This analysis concludes that there are improvements MCH programs could implement without significant expansion in their authority or resources and points out that there is an opportunity for states to be more proactive as they have the legal authority and responsibility for assuring MCH outcomes. With these thoughts in mind the following objectives are recommended: Objectives: 1. Convene a group to define quality and desired outcomes in neonatal intensive care by February 28, 2007. The group would be comprised of neonatologists,

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Wisconsin Chapter of AAP

Thursday, July 27, 2006

2.

3.

pediatricians, and representatives from the WIAAP chapter’s Quality Committee. Convene a group to develop policy and accountability of Neonatal Intensive Care implementation and oversight by June 30, 2007. The group would be comprised of representatives from the WIAAP, Wisconsin chapter of ACOG, Wisconsin Association for Perinatal Care, DHFS (Division of Children and Family Services, Division of Public Health, and Division of Health Care Financing), AHA, and private and public insurers. Appoint one member of the WIAAP to serve on the Wisconsin Association for Perinatal Care’s Perinatal Data Committee. This member would attend committee meetings and report back to the Committee on Fetus and Newborn. The member would also serve as a consultant as the Perinatal Data Committee begins to develop a Neonatal Module for PeriData.

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Wisconsin Chapter of AAP

Thursday, July 27, 2006

APPENDIX C: Improve access to mental health 1. Need assessment: A. The group has developed a survey of needs for pediatricians throughout the state. B. Previous surveys have indicated the following needs: a. Assistance with Diagnosis b. User friendly treatment guidelines c. CME training on diagnostic states and medications d. Phone support e. Additional support: Telemedicine C. Medical College of Wisconsin and Children’s Hospital of Wisconsin have developed the Evaluation Clinic model. This model targets ADHD, Anxiety Disorders and Depression. Primary care clinicians who desire this assistance refer patients who they agree to treat. (#a and b) a. Provides diagnostic assessment, either face to face or potentially via telepsychiatry b. User friendly treatment guidelines for Depression, Anxiety Disorders and ADHD have been developed. D. CME programs through MCW/CHW, Wisconsin AAP, Wisconsin Family Medicine have been developed. (#c) E. In discussions with State representatives in regard to a crisis in care for the states youth with psychiatric illness a proposal to develop a center in Milwaukee metro area is being proposed. It would include all of bullet B. above. a. Phone support, at the time of call or within 30 minutes for short 5-15 minute consultations would be supported. b. Telepsychiatry support for more in depth consultations would also be included. F. The State of Wisconsin is looking into adding a billable fee for the originating end of a telepsychiatry consultation. This is to ensure the safety of patients. G. The Mental Health Association in conjunction with the State of Wisconsin have been examining how primary care and psychiatry can collaborate with care. They are also helping to look into telepsychiatry issues. There next meeting is 3 October in Wisconsin Dells. Goal: Pilot this project in the Milwaukee area. The hope is to expand to other areas if the original pilot is successful. Member support to the state would be helpful.

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Wisconsin Chapter of AAP Appendix D; Improve asthma care

Thursday, July 27, 2006

Background  Asthma is one of top 5 priority topics for WIAAP and AAP strategic plans.  WI Asthma Coalition (WAC) is led by State of WI Division of Public Health and primarily funded by CDC.  Fight Asthma Milwaukee (FAM) Allies is led by Children’s Hospital and Health System and primarily funded by MCW Healthier WI Partnership Program.  County coalitions funded by CDC/State WAC: Chippewa, Fond du Lac, LaCrosse, Marathon, and Milwaukee (FAM Allies) Goals and objectives: follow WAC Committees and goals 1. Clinical care: increase the use of evidence-based, best practice asthma guidelines for the diagnosis and management of asthma by all health care providers in order to optimize the quality of health care to individuals with asthma 2. Education: to expand and improve the quality of asthma education to be consistent with the National Asthma Education and Prevention Program guidelines and to be culturally and linguistically appropriate 3. Enhanced covered services: managed care, self-insured, Medicaid and Medicare will fund reasonable, measurable, and achievable disease management for persons with asthma 4. Environment: reduce or control environmental factors in WI associated with asthma 5. Disparities: reduce disparities in asthma diagnosis, treatment, and outcome among racial or ethnic minority and low-income populations 6. Public policy: improve asthma care and decrease health disparities through policy change 7. Surveillance and evaluation 8. Work-related: reduce the burden of work-related asthma in WI Potential WIAAP Committees to be most involved: Children with Special Health Care Needs, Minorities and Native American Health, Emergency Medicine, Administration and Practice Management, Tobacco Free Coordinator, Environment, Psychosocial Aspects of Child & Family Health, School Health, Electronic Communications, Access, Legislative, Medical Student Education, Pediatric Research

Potential activities  Recruit more WIAAP members to join WAC, FAM Allies and other local coalitions as active members  Participate in and promote Allergist Outreach Asthma Education for Primary Care Practices  Provide education with WAC or FAM Allies materials to teachers, childcare providers, coaches, families and community members  Write asthma disparities article for WI Medical Journal; John Meurer will be lead author

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Wisconsin Chapter of AAP      

Thursday, July 27, 2006

Participate in AAP online Education in Quality Improvement for Pediatric Practices (eQuipp) asthma program Join American Lung Asso. of WI Legislative Network Advocate for asthma inhaler bill (AB 1132) for children in private and choice schools Promote WI Legislative Council study on asthma Advocate for appropriate respiratory medication coverage by Medicaid Prior Authorization Advisory Committee (Carl Eisenberg and John Meurer did so in 2005) John Meurer will promote asthma benefits in State of WI Medicaid, BadgerCare Plus, and Tobacco Advisory Committees

State and Milwaukee outcome measures  WI DHFS monitors asthma prevalence, hospital stays, emergency department visits, health care costs, and mortality; analyses stratified by age 0-4, 5-10, and 11-17 years, gender, and race/ethnicity  WI DHCF reports Medicaid annual asthma ED and ambulatory visits and medication use among children by county to FAM Allies  CHW reports annual asthma hospitalizations by zip code to FAM Allies Funding  WI Academy of Pediatrics Foundation received $180,000 grant from GlaxoSmithKline from 2004-07 for the Allergist Outreach Asthma Education program; Todd Mahr will negotiate continued funding of $20,000-$40,000;  CHAW received grant from AstraZeneca for CHAW and MCW program management and evaluation in 2006; CHAW will apply for continued funding from AstraZeneca in 2007  WIAAP might budget for specific activities based on Committee requests

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Wisconsin Chapter of AAP

Thursday, July 27, 2006

Appendix E: Wisconsin Chapter of the American Academy of Pediatrics 2005 Goals identified by Executive Committee members (N = 19) Average Access Topics Legislative Topics Nutrition Topics Chapter Activities Psychosocial Topics Immunization Topics Sports Medicine Topics Injury/Poison Prevention Topics CSHCN Topics School Health Topics Breastfeeding Topics Senior Pediatrician Topics Subspecialty Topics Electronic Topics 4.9 4.2 4.2 4.0 4.0 3.9 3.9 3.8 3.7 3.3 3.3 3.3 2.8 2.8 Std Dev 0.3 0.9 1.1 0.7 1.0 0.9 1.0 0.9 1.2 1.1 1.1 1.1 0.8 1.0

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