• Type of Practice: State chapter of the American Academy of Pediatrics (local non-profit organization)
  
• Location: Chicago, IL
  
• Population Served: 10 pediatric practices participated in the quality improvement initiative, serving approximately 2,000 families
  

• Identify existing initiatives, projects, or demonstrations in your state upon which to build or expand.
• Identify partners and stakeholders who may be able to collaborate with your organization in implementing a pediatric medical home project. These partners may include the following:
• State Children with Special Health Care Needs program (Title V)
• State Medicaid
• Family-to-Family Health Information Center
• State chapter of the American Academy of Family Physicians
• State chapter of the American Academy of Pediatrics
• Early Intervention programs
• Convene a multisdisciplinary planning group of partners and stakeholders.
  
• Identify a variety of clinics within a health care system that will participate in a quality improvement project; look for variety in geographic location and population served (insurance status, socioeconomic status, demographics).
• Recruit multidisciplinary teams in each practice to participate in the quality improvement project. Team members may include the following:
• Physicians
• Nursing staff
• Medical assistants
• Administrative staff
• Clinic directors
  
• Parent partners
  
• Identify a champion among each quality improvement practice team.
• Facilitate a four day in-person learning session.
• Offer incentives for participation including the following:
• Continuing Medical Education (CME) credit
  
• Maintenance of Certification points
• Assistance with meeting national medical home recognition or certification standards
  
• Assign a quality improvement facilitator to each clinic/practice team in order to provide support and technical assistance to each practice team throughout the duration of the project.
• Support practice teams in implementing Plan-Do-Study-Act (PDSA) cycles by organizing meetings between teams and quality improvement facilitators monthly over two years.
• Facilitate in-person meetings at each clinic with quality improvement facilitators. 
• Encourage facilitation of referrals between clinicians, practices, and community resources to enhance care coordination.
• Work with adult and pediatric clinicians to develop written policies for clinicians and patients to facilitate transitioning youth to adult health care.
• Work with an independent evaluator to implement a rigorous evaluation plan. The plan may include the following components:
• Disseminating the Medical Home Index at baseline and at the end of the project for clinics to conduct a self-assessment of their own medical home implementation.
• Disseminating the Medical Home Family Index at baseline and at the end of the project to allow families/caregivers to rate their satisfaction levels.
• Utilize baseline results of both surveys to identify changes and improvements for PDSA cycles.
  
• Track process measures and other quality improvement data.
  
• Utilize national resources and technical assistance centers including the following:
• National Center for Medical Home Implementation
• Got Transition
• Center for Medical Home Improvement
• Local chapters of the American Academy of Pediatrics
• Communicate accomplishments to stakeholders through e-Newsletters, emails, and the project Web site. 
  

• Staff turnover at both the leadership and clinic staff level was a challenge in project implementation. The project leadership recommends implementing a quality improvement training program for new staff to ensure understanding of medical home and quality improvement science.
  

• The project identified the following areas for continued improvement:
  
• Communication strategies that clinicians and practices can utilize to explain complex medical conditions to families.
• On-going training and professional development for staff to support culture change.
  
• Inclusion of parent partners as active and engaged members of quality improvement teams.
  

• For more information, contact Kathy Sanabria, MBA, PMP, Associate Executive Director of the Illinois Chapter of the American Academy of Pediatrics: ksanabria@illinoisaap.com.
• Visit the Illinois Chapter of the American Academy of Pediatrics Medical Homes in Cook County Web site.
• Visit the National Center for Medical Home Implementation "For Practices" Web page to download copies of the Medical Home Index and Medical Home Family Index.