189 - Complex Care Program Communication with Families of Children with Medical Complexity, a Quality Improvement Study

Poster Number: 189

Jennifer T. Lemke, Medical College of Wisconsin, Wauwatosa, WI, United States; Sarah Johaningsmeir, Medical College of Wisconsin, Milwaukee, WI, United States; Jessica L. Schnell, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Children with medical complexity (CMC) receive care across inpatient and outpatient settings and have multiple specialists involved in their care. The Complex Care Program (CCP) at Children’s Wisconsin provides medical co-management and care coordination for CMC in both settings. Regular communication between families and CCP is essential for proactive care coordination. The CCP strives to have meaningful communication with all patient families each month, known as reciprocal contact.

Objective: Increase the percentage of patients with reciprocal contact each month to a goal of 94%.

Design/Methods: A key driver diagram identified areas for potential process improvement. A Pareto chart was created using two months of baseline reciprocal data collected via a retrospective chart review. The quality improvement team implemented PDSA cycles and collected qualitative and quantitative data from CMC caregivers, CCP staff and patient electronic medical records. The percentage of patients with successful reciprocal contact was calculated monthly over a twelve-month period.

Results: A Pareto chart categorized areas of failed reciprocal contact into six categories: no response with < 3 attempts (43%), no reply to MyChart (16%), reciprocal contact documented but not billed (15%), late response with < 3 attempts (11%), patient graduated/discharged (8%), and no response despite >3 attempts (6%). Interventions focused on eliminating waste in CCP workflow, increasing caregiver response rates, and further standardizing the reciprocal contact tracking and documentation process. Over a twelve-month intervention period, the percentage of patients with monthly reciprocal contact increased from a baseline of 84% to 91%. Internal month-to-month variability also decreased.Conclusion(s): Successful monthly reciprocal contact depends on both CCP staff and CMC caregivers. Caregiver-related failures were most frequently due to caregivers not having questions or needs at the time of contact. Staff-related failures were most frequently due to time constraints and inadequate attempts at communication. Successful interventions targeted these pitfalls by finding ways to make reciprocal contact more valuable to families and less-time consuming for staff. Next steps include sustaining interventions and collecting data on patient-reported outcomes impacted by familiarity between the CCP team and families.