P1086 - Improving HealthySteps Patient Follow-up Process in a Military Setting

Background: HealthySteps (HS), a program of Zero to Three, is a unique evidence based, pediatric primary care-based program that promotes positive parenting and healthy development by interweaving the medical support of the physician’s office with the resources and services of a HealthySteps Specialist (HSS). A HSS is an additional member of the medical team, trained to help families identify, understand, and manage parenting challenges, provide support before, during, and after well-child visits, and coordinate connections to community resources. This best practice program has proven sustained positive effects in the civilian setting but has not been implemented into the military setting until recently. In January 2018, Madigan Army Medical Center Pediatrics was one of two pilot sites chosen to implement HS in the military health system. In September 2018, after months of enrolling patients into the HealthySteps program, we identified a problem in the low number of face-to-face follow-up visits.

Program Goals: We developed a process improvement project that focused on improving the number of HSS face-to-face follow-up at subsequent well-child visits.

Evaluation:

Methods: Our team used a FOCUS-PDCA process improvement methodology to create an improvement plan, which helped to decrease the complexity of the follow-up process. We provided additional training for the HSS to access RevenueCycle (the electronic appointment system of MHS Genesis) in order for them to view future well-child visit appointments. We then created an excel spreadsheet tracking system that automatically prompted the HSS to look for an appointment in RevenueCycle if the child’s age was within 1 month of an anticipated well-child visit. We compared pre-intervention and post-intervention cumulative total face-to-face follow-up visits and average total face-to-face encounters per month (initial encounters + follow-ups). We also evaluated sustainment in average face-to-face follow-up visits per month, and average total face-to-face encounters per month 12 months post-intervention.

Results: Over a 3 month period, the total face-to-face follow-up visits increased from 4 to 52 in 3 months (0.8/month to 16/month), and the average total face-to-face encounters per month increased from 15 to 52 (Figure 1). After 12 months post-intervention, the average face-to-face follow-up visits per month was sustained at 20, and average total face-to-face encounters per month was sustained at 45 (Figure 2).

Discussion: The significant increase in total and monthly face-to-face follow-up visits is reflective of the implementation of the care-coordination spreadsheet tracking system and increased visibility of patient appointments through RevenueCycle access. Currently, this is the best method to reliably track patients in the HS military system. Looking ahead, we hope to automate the process even further. The increased support provided by HSS during follow-ups have made them valued members of the medical team.