Partners For Kids would like to highlight the work of United Methodist Children’s Home (UMCH) Family Services, one of our contracted behavioral health organizations, which is actively engaged in our Quality Improvement (QI) Coaching Program. In December 2022, UMCH launched an initiative to ensure that children prescribed antipsychotics receive compliant metabolic lab monitoring. Atypical (second generation) antipsychotic medications carry known metabolic risks, including weight gain, glucose intolerance, dyslipidemia, and hypertension. The American Diabetes Association (ADA) and The Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) recommend baseline and follow-up metabolic monitoring at regular intervals, including annual metabolic lab monitoring of glucose and lipids.[1] Michael Sivey, Clinical Director at UMCH, said that engaging in this QI initiative has “encouraged our team to be more intentional with our lab orders, meaning educating our clients, helping remove barriers and ensuring prompt results. The more we talked about labs and their importance, the more we saw the needle move in a more positive direction. We took the mystery out of the equation and updated our policies to ensure compliance.”

UMCH’s success can be partly attributed to its adherence to the Institute for Healthcare Improvement’s (IHI) Model for Improvement, which emphasizes three key elements:

1. Right People Engaged: UMCH has made a concerted effort to include voices from various steps of the process in their quality improvement initiative. Support from leadership, input from prescribers, and feedback from administrative staff have been integral to developing and implementing their roadmap for change.
2. Right Questions Asked: UMCH asked, “What will we measure?” and “How will we know our changes lead to improvement?” To supplement the claims data provided by the Partners For Kids Quality Improvement Coaching Program, UMCH is developing a tracking tool to better follow the process from ordering labs to receiving and uploading them to the EHR. This in-house capability allows UMCH to answer these questions more accurately and adjust their roadmap for change accordingly.
3. Right Interventions Tested: UMCH has completed multiple PDSA (Plan-Do-Study-Act) cycles to test their intervention ideas in real-world settings. Through these cycles, they have collaboratively identified pain points in the process and brainstormed solutions. Successful interventions include developing patient-facing education, connecting patients to pediatric-friendly lab locations, implementing policies that require lab completion prior to subsequent antipsychotic medication orders by providers, educating prescribers on handling irregular lab results, and regularly outreaching to patients overdue for labs with reminders and support.

The key elements implemented by UMCH have led to two notable improvements in their outcomes: surpassing previous performance levels and marking significant organizational transformation. UMCH stands as a testament to the integration of QI as a fundamental aspect of their mission fulfillment. Michael Sivey advocates for all organizations to adopt QI methodologies, emphasizing that “no matter what kind of agency you are, or who you serve, QI is essential to allow for change and growth.”  Partners For Kids offers a QI program that can aid organizations in the development and execution of QI initiatives. With over five years of collaboration on QI initiatives with Partners For Kids, Michael notes that Partners For Kids’ attention to detail, customer service, data reporting, and readiness to go the extra mile for children on Ohio Medicaid has helped them integrate the QI methodology into their organization.

Partners For Kids is incredibly proud of UMCH’s devotion to creating a system of care that promotes best outcomes in child health. They have truly gone the above and beyond to integrate high value and innovative care approaches into their operational workflows.

If you would like to learn more or get involved in the Partners For Kids Quality Improvement Coaching Program, please contact pfkqicoaching@NationwideChildrens.org.

References:

[1] 2024-Antipsychotic-QI-Project-One-Pager_FINAL_1.22.24.pdf (partnersforkids.org)