Partnerships: As part of the Improving Health Outcomes for Children (IHOC) project in Maine and Vermont, funded with Child Health Insurance Program Reauthorization Act (CHIPRA) funds, the Maine Child Health Improvement Partnership (ME CHIP) was started in 2010 and is run by Maine Quality Counts. ME CHIP's mission is to improve the health of the state's children using public and private partnerships to initiate and support measurement-based efforts to enhance child health care.
ME CHIP has public and private partners including the state's Medicaid agency (MaineCare), the Muskie School of Public Service at the University of Southern Maine, the Maine Center for Disease Control and Prevention, local health systems and practices, the Maine American Academy of Pediatrics Chapter, and parents. IHOC and ME CHIP projects have focused on updating the state Medicaid forms to align with Bright Futures recommendations and developing the First STEPS (Strengthening Together Early Preventive Services) 4-year quality improvement project. First STEPS offered training sessions and 6- and 8-month learning collaboratives for primary care practices to improve developmental and autism screenings in 2012 and 2014, respectively.
Adaptation: Throughout the state, the standardized form to be completed for all Medicaid children and families was updated and revised to be consistent with the Bright Futures Guidelines, 3rd Edition. In collaboration with Vermont health professionals, the state applied for and received a CHIPRA demonstration grant, which provided funding to improve health care quality and delivery systems for children enrolled in Medicaid. As part of the state's CHIPRA demonstration grant, IHOC staff from Maine Quality Counts implemented the new Bright Futures Toolkit in the state. An institutional license was purchased and the toolkit was made available electronically to all practices that serve children enrolled in MaineCare. Staff at Maine Quality Counts and the Muskie School worked with MaineCare staff to review the Visit Documentation Forms and Parent/Patient Education Handouts and toolkit. Staff compared the Bright Futures visit form to the forms used in Maine that were based on the Bright Futures Guidelines, 1st Edition. Working with physicians and other stakeholders, the group used the Bright Futures forms as a template, adding Maine-specific fields, including required child health metrics and more space for notes and results of the physical exam.
Maine Quality Counts staff worked with a team at MaineHealth, which is one of the state's largest health systems, to reformat the Paarent/Patient Education Handouts because the health literacy level on the Bright Future forms were too high, according to MaineCare requirements. With permission from the American Academy of Pediatrics, all family education handouts were revised to meet 5th-grade reading requirements, reviewed by MaineCare communications and member services personnel, and posted on MaineCare's Web site.
Learning collaboratives: Maine Quality Counts initiated the 4-phase First STEPS learning initiative. The first phase focused on increasing immunizations and ran from September 2011 to April 2012; 24 pediatric and family practices that serve a high volume of children insured by MaineCare participated in this phase. The second phase focused on improving developmental, autism, and lead screening rates for children younger than age 3; it ran from May to December 2012 with 12 pediatric and family practices, which included 45 physicians who serve an estimated 20,000 children with MaineCare coverage. MaineCare saw an increase in developmental screening rates in children ages 1–3 from 1% to 6% in 2011 and from 12% to 17% in 2013. The third phase focused on healthy weight and oral health in 2013. The final phase in 2014 focuses on developmental and autism screenings and disseminating the lessons learned in 2012 to an additional 31 practices with both regional trainings and a full learning collaborative. In each phase, the collaboratives typically lasted 8 months and included 2 full-day training conferences, monthly training Webinars, and data collection.