CARE TRANSFORMATION COLLABORATIVE OF RI

RI ADULT IMMUNIZATION QUALITY IMPROVEMENT INITIATIVE:RI DEPARTMENT OF HEALTH CONTRACTED WITH THE CARE TRANSFORMATION COLLABORATIVE OF RHODE TO PROVIDE PROJECT MANAGEMENT AND QUALITY IMPROVEMENT SUPPORT FOR A NINE-MONTH QUALITY IMPROVEMENT INITIATIVE TO IMPROVE ADULT IMMUNIZATION RATES USING EVIDENCE-BASED TOOLS OF THE PRACTICE CHOOSING WITH THE SHARED GOALS OF A) ENSURING THAT NEARLY ALL PATIENTS WERE COUNSELED AND RECEIVE RECOMMENDED VACCINES AND B) TO UTILIZE AND PROVIDE FEEDBACK ON THE RHODE ISLAND CHILD AND ADULT IMMUNIZATION REGISTRY (RICAIR) WHICH HAD BEEN IMPLEMENTED DURING COVID (2020). POPULATIONS OF FOCUS INCLUDED PATIENTS WITH DIABETES THAT FACE A HIGHER RISK OF COMPLICATIONS FROM VACCINE-PREVENTABLE ILLNESSES INCLUDING COVID-19, INFLUENZA, PNEUMONIA AND INFECTIONS CAUSED BY DIPHTHERIA, TETANUS AND PERTUSSIS AND PREGNANT PEOPLE AND THEIR BABIES WHO ARE ESPECIALLY VULNERABLE TO COVID-19 AND INFLUENZA. PARTICIPATING PRACTICES INCLUDED SIX PRACTICE SITES THAT FOCUSED ON PATIENTS WITH DIABETES AND THREE PRACTICES THAT FOCUSED ON PRENATAL PATIENTS. OVER THE COURSE THE QUALITY IMPROVEMENT INITIATIVE, PRACTICES IDENTIFIED A QUALITY IMPROVEMENT TEAM, COMPLETED PRE AND POST BEST PRACTICES READINESS ASSESSMENT TOOLS, PROVIDED BASELINE, MID-POINT AND FINAL VACCINE PERFORMANCE RATES ON SELECTED VACCINES, MET MONTHLY WITH A PRACTICE FACILITATOR TO IDENTIFY AND IMPLEMENT PERFORMANCE IMPROVEMENT PLANS AND PRESENT FINDINGS INCLUDING CHALLENGES AND SUCCESSES AT THREE PEER LEARNING SESSIONS. PRACTICES IMPROVED THEIR PERFORMANCE WITH UTILIZING BEST PRACTICE STRATEGIES WITH GREATEST IMPROVEMENT NOTED IN KEEPING STAFF UP TO DATE ON CURRENT RECOMMENDATIONS, MAINTAINING COMPLETE UP-TO-DATE REGISTRIES, ASSESSING NEED FOR VACCINES AT EVERY VISIT, PROVIDING PATIENTS WITH ROUTINE REMINDERS, IDENTIFYING AN IMMUNIZATION CHAMPION AND EVALUATING AND IMPROVING PRACTICE PERFORMANCE. VACCINE PERFORMANCE RATES IMPROVED FOR ALL VACCINES. FOR PATIENTS WITH DIABETES: PERFORMANCE RATES FOR TD IMPROVED FROM BASELINE OF 56% TO 62%; PNEUMOCOCCAL IMPROVED FROM 52% TO 58%; INFLUENZA IMPROVED FROM 39% TO 52% AND COVID IMPROVED FROM 20% TO 26%. FOR PREGNANT PEOPLE: PERFORMANCE RATES FOR TD OR TDAP IMPROVED FROM BASELINE OF 73% TO 77% INFLUENZA IMPROVED FROM 56% TO 69% AND COVID IMPROVED FROM 0% TO 9% THIS QUALITY IMPROVEMENT INITIATIVE IS IMPORTANT BECAUSE IT DEMONSTRATED THAT EVEN WITH VACCINE HESITANCY AND RAMPANT MISINFORMATION, PRIMARY CARE PROVIDER RECOMMENDATIONS, IMPROVED PRACTICE WORKFLOWS AND PATIENT REMINDERS, TAILORING AND CUSTOMIZING PATIENT EDUCATION (INCLUDING OUTREACH TO FATHERS), OFFERING VACCINE CLINICS, MEASURING IMMUNIZATION PERFORMANCE RATES AND INVOLVING STAFF IN PERFORMANCE IMPROVEMENT EFFORTS RESULTS IN IMPROVED VACCINE PERFORMANCE THAT HAS SIGNIFICANT IMPACT ON KEEPING PATIENTS THAT ARE HIGHER RISK PROTECTED FROM PREVENTABLE ILLNESSES. TRAINING PEDIATRIC & FAMILY MEDICINE PROVIDERS TO DIAGNOSE AUTISM IN YOUNG CHILDRENTHE CARE TRANSFORMATION COLLABORATIVE OF RHODE ISLAND (CTC-RI), IN PARTNERSHIP WITH THE RHODE ISLAND DEPARTMENT OF HEALTH (RIDOH) AND WITH FUNDING FROM UNITEDHEALTHCARE, LAUNCHED A TRAINING INITIATIVE FOR PRIMARY CARE PROVIDERS TO IMPROVE TIMELY DIAGNOSIS OF AUTISM AND DEVELOPMENTAL DELAYS. THE PROGRAM ADDRESSES LONG WAIT TIMES FOR SPECIALTY EVALUATIONS, WHICH PARENTS OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS IDENTIFIED AS A MAJOR BARRIER TO ACCESSING DIAGNOSTIC SERVICES. BY EQUIPPING PRIMARY CARE PROVIDERS TO DIAGNOSE CLEAR CASES, CHILDREN CAN BEGIN TAILORED INTERVENTIONS SOONER.FOLLOWING AN ENVIRONMENTAL SCAN, CTC-RI PARTNERED WITH VANDERBILT UNIVERSITY TO ADOPT ITS EVIDENCE-BASED ASD-PEDS ASSESSMENT AND TRAINING MODEL. THREE RHODE ISLAND-BASED CONSULTANTS WERE TRAINED TO SERVE AS TRAINERS AND RESOURCES FOR PROVIDERS, SUPPORTED BY A PRACTICE FACILITATOR FOR IMPLEMENTATION AND BILLING GUIDANCE. FIFTEEN PEDIATRIC PROVIDERS AND FOUR INTEGRATED BEHAVIORAL HEALTH CLINICIANS ENROLLED IN THE PROGRAM. TRAINING INCLUDED A TWO-DAY IN-PERSON SESSION, FOLLOWED BY VIRTUAL SESSIONS, A COMMUNITY OF PRACTICE, AND ONGOING IMPLEMENTATION SUPPORT WHICH WILL CONTINUE THROUGH DEC 2026.RIDOH PRIMARY CARE TRAINING SITES PROGRAMCTC-RI, IN PARTNERSHIP WITH RHODE ISLAND DEPARTMENT OF HEALTH OFFICE OF PRIMARY CARE AND RURAL HEALTH LAUNCHED THE RIDOH PRIMARY CARE PRIMARY CARE TRAINING SITES PROGRAM. THE PROGRAM, WHICH RECEIVED $2.7 M IN STATE FUNDING FOR ITS INAUGURAL YEAR, AIMS TO INCREASE THE CAPACITY FOR TRAINING STUDENTS IN PRIMARY CARE SETTINGS BY PROVIDING FUNDING TO PRIMARY CARE SITES THAT PRECEPT MEDICAL, NURSE PRACTITIONER AND PHYSICIAN ASSISTANT STUDENTS, MEDICAL RESIDENTS AND FELLOWS. CTC-RI CONVENED SUBJECT MATTER EXPERTS TO CREATE A CURRICULUM FOR THE PROGRAM THAT ENSURES TRAINEES LEARN ABOUT THE PATIENT-CENTERED MEDICAL HOME MODEL AND ADVANCED PRIMARY CARE PROVIDED AT THE TRAINING SITES. AS PART OF THE PROGRAM, CTC-RI HOSTS QUARTERLY COLLABORATIVE LEARNING SESSIONS AND MONTHLY DROP-IN SUPPORT FOR PRECEPTORS TO CREATE A COMMUNITY OF PRIMARY CARE PRECEPTORS AND PROVIDE EDUCATION ON TEACHING SKILLS, PROGRAM OPERATIONS AND OTHER TOPICS OF INTEREST. CURRENTLY THERE ARE 34 PATIENT-CENTERED MEDICAL HOME PRIMARY CARE SITES WITH OVER 130 PRECEPTORS ENROLLED IN THE PROGRAM REPRESENTING A 68% INCREASE IN CAPACITY.