Supported by the Massachusetts Children's Health Insurance Program Reauthorication Act (CHIPRA) Quality Demonstration Grant, this statewide quality improvement project utilized Practice Transformation Facilitators to implement components of the pediatric medical home and improve care for children and families.

Implementation Insights:

  • Identify a motivated individual currently employed within a practice to manage day-to-day implementation of pediatric medical home transformation.
  • Create opportunities for collaborative learning and problem solving among participating practices.
  • Develop a detailed evaluation methodology at the start of the project.

    Updated: February 2016

 Background Information
  • Type of Practice: Non-profit organization
  • Location: Boston, Massachusetts
  • Population Served: Approximately 239,000 children were served through the Massachusetts CHIPRA medical home learning collaborative through 13 participating pediatric practices.

 Pediatric Medical Home Implementation Strategies
  • Recruit pediatric practices to participate in a statewide quality improvement project.
  • Identify internal Practice Transformation Facilitators (PTFs) that will function as change agents for medical home transformation within each practice. Characteristics and advantages of PTFs include the following:
      • Co-located and employed by the clinic.
      • Understand the clinic's culture and contextual factors.
      • Understand the local community.
      • Use data to understand whether changes resulted in improvement.
      • Use a disciplined approach to making changes including the Model for Improvement and Plan-Do-Study-Act cycles.
  • Provide training and support to PTFs using a quality improvement curriculum.
      • Utilize trainings to facilitate collaborative learning, brainstorming, and strategies to address challenges. Additional training for PTFs includes the following:
          • Monthly conference calls with all PTFs.
          • Quarterly PTF in-person trainings.
          • In-person trainings during learning sessions, facilitated by project staff and quality improvement advisor.
  • Partner with local organizations including the following:
      • Children's Hospitals
      • Universities
      • Health Care Plans
      • Non-profit Organization
  • Develop a detailed evaluation methodology at the start of the project.
  • Use validated tools to measure medical home such as the Medical Home Index.

 Challenges
  • Challenges encountered throughout this project included the following:
      • Resistance to change in practice culture
      • Limited resources for medical home transformation within a particular practice
      • Achieving buy-in from practice staff
  • To overcome these challenges, Practice Transformation Facilitators (PTFs) engaged in collaborative learning and problem solving through monthly calls and quarterly in-person meetings.

 More Information
  • For more information, contact Emma Smizik, MPH, Senior Project Manager at the National Institute for Children's Health Quality at esmizik@nichq.org.
  • Visit the CHIPRA Massachusetts Medical Home Initiative Web site to view the following:
      • Care Plan Templates
      • Family Engagement Guide
      • Care Coordination Paper
      • Care Team Role Builder
      • Creating a Patient and Family Advisory Council:  A Toolkit for Pediatric Practices
      • Medical Home Transformation Crosswalk