Background: Continually improving the care we deliver is an obligation for all clinicians. Delivery of sub-optimal health care has been documented in every setting studied, including pediatric primary care. Mangione-Smith, et al. reported in 2007 that children in the U.S. receive less than half of the recommended preventive, acute and chronic care.1 This is not because clinicians don’t try to provide the best care possible – providing high quality, evidence-based, primary care is difficult, requiring that physicians incorporate ever-expanding scientific knowledge, evolving screening tools, and current treatment guidelines into their daily practices. They must provide care for children with routine needs, as well as for children with specialized and complicated needs, like those with cerebral palsy, depression, Down syndrome, celiac disease, Tourette syndrome, and many more. They must also guide patients and parents through a complex healthcare system, coordinate the care provided by specialists, and advocate for their patients with insurers and schools, all while adapting to a rapidly changing healthcare environment and responding to myriad demands from payers, government, and credentialing organizations. All this with limited resources and little training in quality improvement.
The Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ), established in 2003, is a collaborative effort of organizations and individuals with a common interest in promoting evidence-based best practices and assisting physicians in implementing quality improvement at the practice level. UPIQ provides education, guidance, tools, measurement, and ongoing support to help bridge the gap between knowing best practices and consistently implementing them in practice. Led by the University of Utah Department of Pediatrics, the Utah Chapter of the American Academy of Pediatrics, and the Utah Department of Health, UPIQ is a public-private partnership supported by grants, foundations, state programs, and generous in-kind contributions from its member organizations.
Mission: To engage, lead and support practices in transforming the delivery of children’s healthcare.
Goals: 1. To foster innovation and the use of evidence in clinical practice and delivery systems to provide accessible, coordinated, and family-centered healthcare for Utah’s children.
- To champion, facilitate, and support practice change that improves the quality of care.
Approaches: UPIQ is a pioneer in applying quality improvement (QI) principles and collaborative learning to primary care practice at the state level. Our Learning Collaboratives bring together practice teams (physician, nurse or MA, office manager, and, often, a family partner) for “learning sessions” where relevant scientific evidence is presented, QI techniques are taught, and teams are assisted in developing goals and strategies for improvement. Practices receive ongoing support and technical assistance from UPIQ staff (and each other) through conference calls, site visits, and repeated practice assessments over 9-12 months. Topics have included: preventive services delivery, asthma, ADHD, screening for developmental, social-emotional problems maternal depression, and toxic stress, obesity prevention, motivational interviewing, mental health, and providing comprehensive care for children with special health care needs (Medical Home). For their participation in our Learning Collaboratives, UPIQ offers pediatricians and, for some projects, family physicians credit toward part 4 of their specialty board’s Maintenance of Certification programs.
Looking Forward: As of June 2014, UPIQ’s Learning Collaboratives have involved over 260 clinicians from over 90 practices statewide, including close to 50% of the state’s pediatricians and a growing number of family physicians and mid-level providers. To make a substantial difference in the health of Utah’s children, UPIQ aims to reach more practices, to help clinicians implement sustained QI processes and systems, and to support and to integrate our efforts with health system reform. We will also continue to identify collaborators, needs, and opportunities to help medical practices and to build a broad base of support for ongoing improvements in children’s healthcare.
1 Mangione-Smith R, DeCristofaro AH, Setodji CM, Keesey J, Klein DJ, Adams JL, et al. The quality of ambulatory care delivered to children in the United States. NEJM. 2007 Oct 11;357(15):1515-23.
Previous and current funding (since inception in 2003) – in addition to the generous in-kind and institutional support of the Partner organizations:
- Primary Children’s Medical Center Foundation
- American Academy of Pediatrics (AAP) Community Access to Child Health (CATCH) grant
- Commonwealth Fund Assuring Better Child Development (ABCD2) grant / Utah Medicaid
- AAP Partnerships for Quality grants
- Church of Jesus Christ of Latter-Day Saints Foundation
- Asthma Program, Utah Department of Health (UDOH)
- Health Resources and Services Administration/Maternal & Child Health Bureau, through UDOH
- Centers for Disease Control & Prevention / Utah County Early Head Start and Medicaid
- Immunization Program, Utah Department of Health
- Sanofi Pasteur (immunization manufacturer) • Utah Medical Association Foundation
- Marriner S. Eccles Foundation • Abbott Laboratories
- CHIPRA Quality Demonstration grant / Utah and Idaho Medicaid/CHIP programs
Comments from Participants in UPIQ Learning Collaboratives
I participated in 2 UPIQ learning collaboratives, one on developmental screening tools and the other
on ADHD. They were both extremely informative and practical allowing me to implement new tools
and approaches into my practice. We now use the ASQ screening questionnaire routinely in our well
visits and have a more thorough and consistent way of tracking development. I am sure that I have
made more referrals to up-to-3 programs than I did in the past. Parents also seem more clued into
what their children should be capable of doing at various ages.
Nina Jorgenson, MD
Participating in the UPIQ developmental collaborative helped me edit the CHC’s (Community Health
Centers) well-child forms to make them more practical … In the two years since I made those
changes, I have seen a sharp reduction in calls from family practitioners asking me what to do with
their 2 year old patient who only says single words. It was also useful for me to review the validated
developmental tests, even though we can’t afford to use them. I am now turning again to that
knowledge as I push CHC to institute some form of routine testing for autism at the 18 month visit.
UPIQ participation was very useful for me.
Carole Stipelman, MD
Salt Lake City, UT
I have been involved with the ADHD and Medical Home learning collaboratives. They were valuable
to me & my patients. Our chronic patients have especially been pleased with the changes we’ve made
because of the Medical Home Project.
Marty Nygaard, MD
St. George, UT
The learning session in December was my first … I was very impressed with the presentations on
Mental Health, Attention deficit, Autism and behavior issues. The young man who was the keynote
speaker was excellent. I was impressed with all the presenters and the fact that they all provided the
names of agencies, phone numbers and contact people. I think learning sessions are the key to
providing opportunities and educating caregivers of people who have special needs
Nancy Johnson, Parent Partner
The recent learning session was very informative … the break out group [was] struggling with the
issue of keeping the medical home alive after the grant is up, which totally surprised me as I feel as
though it is not a huge deal to sustain this way of care. I really feel if you want to keep this idea alive
and in action you need to educate the public to this way of care so they in turn can demand it for
themselves and their loved ones who benefit the most from it.
Liz Wall, Parent Partner
Summit County, UT
I found the asthma UPIQ very useful despite my resistance to the request to include my medical
assistant and center manager. I ultimately included both employees and I believe they had a better
understanding for the asthma education process. However, the only person who adopted or needed
the kick in the butt to change her ways was me and I have given out “tons” more asthma education
with asthma control tests and asthma action plans since the UPIQ meeting.
Mindy Boehm, MD
change their practices. UPIQ is much more important to me than Grand Rounds, Common Problems
and most articles/textbooks I read because the collaborative style gives me time to process my own
ideas. It encourages (requires) me to synthesize hypotheses, test them and rethink the whole
process again and again. Active learning! They didn’t teach me that in medical school… Seriously, I
would not have thought possible what I am doing now with the CATCH grant and reforming how my
community thinks about medical homes for the uninsured without the direction UPIQ has given me.
Kathy Ostler, MD
Summit County, UT
I have found UPIQ to be an important organization for the overall goal of all pediatricians – the
improvement of the quality of healthcare given to children. I participated in the Learning Collaborative
to improve screening for developmental disorders in the first two years of life. I am positive that my
participation did in fact improve my screening ability which, of course, translates to better care for my
patients. I must also say how impressed I have been with the UPIQ organization in general. One very
important point in specific has been the willingness to work with each participant to make minor
changes that meet the needs of a particular provider and that provider’s staff. That effort to
individualize when possible absolutely makes each Learning Collaborative more likely to bring about a
positive change in the practice of pediatrics in Utah.
Joseph Jopling, MD
Salt Lake City, UT
Just let me take a minute to say thanks for all your efforts. Your work really has made a difference in
our practice and in the lives of our patients. The difference can’t be easily quantified but I am certain
that it is substantial. I use the UPIQ project information every day. Thanks so much for all your hours
of teaching and the ongoing contribution you make to our careers. We appreciate you very much.
John Bennett, MD
Spanish Fork, UT
Although I was rather distant on participating following the in-house conferences, using the
information at my clinic is a different story. I am very upbeat and encouraged by how easy it is to
address childhood obesity with parents. Based on the project and things we have utilized here in my
clinic, our whole clinic has decided to do a quality improvement project dealing with Childhood
Tricia Ferrin, DO