Spotlight on Excellence – Valley Children’s Clinic Elevated as a Top Performer in HQI’s Practice Transformation Network with Quality Measurement Improvement

March 13, 2019

Valley Children’s Clinic, an independent pediatric practice in Harrisonburg, VA with six providers who serve about 4,000 patients each year, is in February’s “Spotlight on Excellence.” We are recognizing the practice for their success with improving patient and family engagement, implementing shared-decision making, improving access to behavioral health services, and reducing unnecessary testing of patients. The practice, located in the Shenandoah Valley area since 1979, serves about 58 percent of Medicaid-eligible patients and the majority have limited English proficiency. Valley Children’s Clinic said being a member of Health Quality Innovators’ (HQI) Practice Transformation Network (PTN) participating in the Transformation Clinical Practice Initiative (TCPI) helped them overcome these potential barriers to address their patients’ needs.

  1. How did you increase engagement with your patients and their families?
    We set aggressive targets for improvement in this area and a key factor to our success was increasing the use of our online patient portal. We created a tutorial video on Facebook showing users how to register for access and get started with basic features. Use of the portal for registration and appointment scheduling has improved, which allows our administrative staff more time to perform other jobs.
    We also increased engagement by training our clinicians to improve their motivational interviewing technique, which gives them better communication tools to empower our patients with making healthy lifestyle changes. This is particularly important when addressing sensitive topics such as weight management and nutrition. We improved our weight assessment and nutrition counseling quality measure from a baseline of 29 percent in 2015 to 45 percent in 2018. Other factors that increase patient engagement include hiring multilingual staff, offering same-day appointments, and making changes in response to feedback from patient surveys.
  2. How are you successful making positive connections with patients and their family through shared-decision making?
    We offer patients and families potential alternatives and provide information about the benefits and risks for their options. We don’t want to necessarily convince our patients and their families to change their minds, but rather ensure that accurate information is provided so they can make an informed decision. We’ve found this collaborative approach strengthens our relationship with family members and builds a foundation of trust going forward.
  3. You say that receiving behavioral health care in the Harrisonburg area is challenging because there are a limited number of providers offering this service. What have you done to help your patients receive this type of care?
    We recently partnered with a telepsychiatry service to help connect patients with the resources they need. Information about this service was incorporated into our resources sheet and our clinicians refer families who would benefit. This partnership makes behavioral health visits more convenient for our patients and ensures they receive services in a timely manner.
  4. Valley Children’s improved their Merit-based Incentive Payment System (MIPS) quality measure of appropriate testing for children with pharyngitis from a baseline of 74.4 percent in 2015 to 93.8 percent in October 2018, making them a top performer in HQI’s PTN. How did you achieve this accomplishment?
    This MIPS quality measure assesses appropriate testing for children between the ages of 2 and 18 who are diagnosed with pharyngitis, prescribed an antibiotic, and received a group A streptococcus test. As a pediatric provider, we really wanted to improve the rate of appropriate testing for our patients. Our staff meets every three weeks to review the status of this measure and other quality measures. We review the need for changes, update our workflow with evidence-based protocols for testing and treatment, and implement guidelines as needed. We are very pleased with our results because reaching 93.8 percent on this measure exceeded the 2018 MIPS 7th decile range registry benchmark.
  5. What lies at the core of Valley Children’s success?
    Ultimately, the most vital component of our success comes down to having a high level of collaboration and communication between all team members. This builds the foundation of our practice and allows us to focus on what’s most important, serving our patients. It can’t be one individual. Leaders in the practice must be willing to work together and try new things. If you do meet resistance from anyone in the practice, get them on board by identifying barriers as well as solutions to overcome those barriers. Make them part of the change process.
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