July 21, 2015 | Tags: Blog | Tags: Adolescent Well Visit , Pediatrics , Adolescents , CCO Metric , Portland
Adolescent Well Visit rates are traditionally low, particularly in Oregon where averages have been below the national benchmark for both Commercial and Medicaid populations. What has Westside Pediatrics done to get adolescents in for these visits?
We made it a priority to send reminders and communicate with parents on the importance of this visit for their teens. When the patient or their parent calls our office with an inquiry or for advice, and especially when they come in for appointments, we remind them about the need for a well care visit. We aim to discuss this at every point of contact, and continue to remind them. We document when the last well check was performed in the patient’s chart, and it is also written in red on their superbill, so they are reminded anytime they check-in. Persistence has been the biggest driver of our success.
It sounds as though a lot of your success you credit to communication?
Yes, definitely. Automated reminder calls were not enough; we needed to remind the patients face-to-face or on the phone and really impress how important it is to do this. We found that patients don’t really check their voicemails and call back anymore - no one ever responds.
It is clear that staff being on board was also an important part of this effort. Was there staff training that went along with this? It sounds like many staff members have a role in this process – from the front desk, to the medical assistants and providers. How did you train staff to communicate with patients about Adolescent Well Visits? Did you use any specific training resources?
We didn’t use any specific training resources, but we had a staff meeting and got all the clinic staff on board with the why; everyone needed to understand why this is so important. Once we began discussing it and putting it in practice in the clinic, suggestions for improving the process came from the staff, and over time many were implemented. It was clear early on that we had plenty of opportunities to remind the patients, so we just needed to take advantage of those opportunities.
It seem your work to see more teens for these visits has been very successful. Can you speak a little about any challenges you faced during the implementation?
There were not any staff issues, but engaging the patient and their parents was a little difficult. Until a few years ago it was standard practice after the age of five for children to only need to be seen every 2 years, so parents were not prioritizing scheduling well-care visits. The recommendation changed to every year, and we had to explain that change to the parents and get them to understand. This was the biggest challenge because it was ingrained in them already that these visits were unnecessary. It was a challenge helping them see why the recommendation changed, and why it was important.
So, in your opinion, what have been the best practices you have found to implement this well within a clinic?
Staff meetings are the best way we found. The frontline staff have ideas clinic administrators may not think of because they work so closely with all of this every day. For example, it was their idea to start giving reminders to parents during the shot clinic hours. This is normally a very quick encounter, so we hadn’t considered doing it then, but it has been very effective.
It has also been beneficial that this is incentivized by the Medicaid programs. The insurance carriers generate lists they send to us and we can work down them and remind the patients. The insurance carriers are also informing the patients on their side, and letting them know there is an incentive for them to get these visits done. The dual approach really helps raise awareness and underscore the importance of the well care visits. We do a bigger push during the summer months because it is usually a good time for families to come in, and it tends to be easier for these patients to come in and get seen before it’s necessary for them to do so for sports.
Lisa Weida is the Practice Administrator at Westside Pediatrics, an independent practice with four physicians in Portland, Oregon. In 2013 Westside Pediatrics participated in a Patient-Centered Primary Care Institute Learning Collaborative to enhance their quality improvement skills and further development as a Patient-Centered Primary Care Home (PCPCH).
Looking to improve your Adolescent Well Visits? Access these recorded webinars through the Institute website:
- Enhancing Adolescent Well-Visits
- Depression Screening & SBIRT for Adolescents: Practical Considerations for Implementing the CCO Incentive Metrics
Each year the Oregon Health Care Quality Corporation (Q Corp) produces Information for a Healthy Oregon a statewide report on health care quality and utilization. The report analyzes claims data across populations to identify opportunities for improving the quality, affordability and patient experience of care for all Oregonians. Information for a Healthy Oregon includes information about chronic disease care, preventive care, and ambulatory and hospital resource use. For this year’s report we interviewed top performing practices to learn what they have done to achieve high screening rates. Stay tuned for the release of this year’s report later this summer; it will be available for download on the Q Corp website.