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EHDI Answers to VA EHDI
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Zika Virus Updates

Zika Update #6
S. Hughes Melton, MD, MBA, FAAFP, FABAM
Chief Deputy Commissioner

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Letter from Marissa Levine, Virginia State Health Commissioner

Telemedicine Grant

We are pleased to announce that our grant funded Telemedicine Program – “My Medical Home IN My Home!” is well underway. We are working on implementing telemedicine in pediatric practices across the state.  The goal of the grant is to help pediatric practices expand the medical home using telemedicine to enhance the delivery of care.  We are interested in whether or not telemedicine can expand a pediatrician’s ability to care for their own patients, in particular children with chronic care conditions and/or special needs.  Using telemedicine provides more access to care coordination services and helps to overcome barriers such as transportation issues.

Preventive Services Improvement State Spread Project (PreSIPS2)

As you know Bright Futures, a national health promotion and disease prevention initiative, addresses children’s health needs in the context of family and community. Commonly used in pediatric practice, many states also incorporate Bright Futures principles, guidelines and tools to strengthen the connections between state and local programs, pediatric primary care, families, and local communities.

As part of ongoing efforts to enhance Bright Futures implementation at the practice, family, community, and state levels, the American Academy of Pediatrics is leading a new initiative – the Preventive Services Improvement State Spread (PreSIPS2) project. A groundbreaking collaboration between AAP National and AAP chapters, PreSIPS2 is a quality improvement (QI) state-based learning collaborative to create sustainable state to local improvement infrastructure to achieve awareness and improvement in the preventive health outcomes of children based on Bright Futures. PreSIPS2 aims to:

1) Encourage enduring partnerships and collect lessons learned between and among 5 AAP Chapters and their affiliated state agencies/organizations and selected practices (including parent leaders) to create a system to support and enhance Bright Futures implementation and spread at the state level.

2) Facilitate a quality improvement collaborative in 5 states with 10-15 participating practices with each state-based chapter and implement the Bright Futures Guidelines for health supervision visits birth to age 3 in each practice.

3) Facilitate practice teams achieving measurable improvements in health supervision care with participating practices based on the Bright Futures measures.

Health Care for Children and Youth in Foster Care Chapter Project

This grant proposes to take the described model of care established in Virginia Beach and expand it to the other cities in Tidewater. This will require significant administrative support and training.

  1. Strengthen and support the new collaboration between CHKD CMG and VBDSS. Use this collaboration as a model for foster care in the region and the Commonwealth of Virginia.

The collaboration described above requires on going administrative support to continue the process. The caseworker access to the EMR Patient portal requires staff resources to create the electronic relationships between caseworkers, supervisors, and the children in their custody. This includes verifying that the necessary authorization to treat is available in the EMR. As new children are placed in custody and staff are hired or leave, these electronic relationships require constant attention.

  • Establish a formal collaboration between CHKD CMG and the department of social services in each of the cities in Tidewater.

We wish to approach each of the cities in Tidewater with the goal of standardizing this approach to the care of foster children for the entire region. This will require support staff to approach the city DSS, arrange meetings and coordinate those meetings. The proposed budget includes salary support for Dr. Mitchell to conduct those meetings. There are at least six cities in this region to approach and establish collaboration between CHKD CMG and their DSS.

  • Provide training for this collaboration of care for the remaining physicians in CHKD CMG.

Seven CHKD CMG practices in and near VB have been trained in the implementation of this program. As the program expands to the other six cities, the other 11 CHKD CMG practices must also be trained. We have budgeted to accomplish the first five training sessions during this funding year.

  • Provide training for this collaboration of care for the DSS in each of the cities in the region.

Each new collaboration between CHKD CMG and the city DSS will require training of caseworkers in each DSS.

  • Demonstrate the success of this model of care at the state level.

We must begin to demonstrate our success at the state level. The budget includes travel reimbursement for meetings with VA AAP and state leaders in the Richmond area. (100 miles from Norfolk)

  • Formalize collaboration between CHKD CMG and third party Medicaid payors for the care of the children in their system.

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HPV Quality Improvement Project

Each year, 27, 000 US citizens are diagnosed with HPV related cancers. Unfortunately, although HPV vaccination can help prevent these cancers, vaccination rates fall far below national goals. HPV vaccination averages 50% for initiation of eligible people and only 33 % for completion. The percentages are actually lower in the Southern part of the US, where HPV related cancers occur at an increased frequency. The CDC has made HPV vaccination a health care priority and has given AAP chapters grant money for a quality improvement project to increase these rates. The Virginia AAP chapter will be working collaboratively with the North Carolina chapter towards improving these rates. We will be working with a quality improvement coordinator and using the QIDA system for data collection and measurement. The goal of the work will be to improve implementation and completion rates over the next year. The work will involve 4-5 practices in each state. Once completed, the plan will be to provide outreach to other practices in NC and VA, with the intent of sharing sustainable processes that will help all interested practices reach these same goals.

VA AAP 2014 Legislative Wrap Up/Looking Ahead to 2015/Special Budget Session Update

The 2014 regular General Assembly session came to a close on Saturday, March 8. However, they adjourned without a budget and returned for a special legislative session regarding the budget on March 24. The new fiscal year starts July 1, so a new budget needs to be approved and in place by June 30.

The biggest issue in regards to the budget remains: Medicaid expansion. The Senate and House could not agree on how to address the hundreds of thousands of uninsured Virginians. The Senate proposed a plan called “Marketplace Virginia,” which will use federal Medicaid funds to provide private insurance for up to 400,000 uninsured Virginians. The House is strongly opposed to Medicaid expansion in any form and has rejected this proposal. We are hopeful the House and Senate will find a compromise and agree on a budget before July 1!

We had a very successful session and are pleased that many of our top priorities passed the legislature. One of our biggest priorities, our pulse ox legislation, passed both houses and has already been signed by Governor McAuliffe. HB 387 (Comstock) and SB 183 (McWaters) will require all hospitals to administer a pulse oximetry screening for newborns.

We were pleased to see legislation this year to ban e-cigarettes for minors. HB 218 (Albo) and SB 96 (Reeves) will now prohibit minors from purchasing vapor products by adding them to the definition of tobacco products. We were thrilled to see both bills pass the General Assembly unanimously.

We supported HB 720 (McClellan), which passed both the House and Senate. This bill will require school boards to develop a policy to set aside a non-restroom location that is shielded from public view to be designated as an area in which any mother who is employed by the school board or enrolled as a student may take breaks during the school day to express milk until her child reaches the age of 1.

We also worked on legislation regarding concussion policy and are pleased to see these bills pass both the House and Senate. HB 410 (Anderson) and SB 172 (Stuart) will require every non-interscholastic youth sports program utilizing public school property to establish policies regarding identifying and handling suspected concussions. Both bills have been signed by Governor McAuliffe.

We closely followed legislation regarding diabetes care in public schools. Delegate Cole and Senator Stuart put in bills at the request of a concerned constituent in their districts.The original legislation was very problematic and we had many concerns, as did other groups. We worked with the patrons and relevant stakeholders to find language that appeased everyone. The final versions of SB 532 and HB 134 will now allow children who are diagnosed with diabetes and have parental consent and written approval from their prescriber, to carry their diabetes supplies and self-check their own glucose levels at school, on the school bus or at a school-sponsored activity.

Unfortunately, we did have two disappointments this year. We supported HB 1023 (Kilgore), which would have banned smoking in cars with children under the age of 8. The bill was successfully reported out of subcommittee for the first time, but then was tabled in the full House Militia, Police and Public Safety committee.

We also supported legislation this year regarding indoor tanning and children under 18. Senator Barker and Delegate Brink carried legislation for the Joint Commission on Health Care that would have prohibited indoor tanning for children 14 and under and required parental notification for children 15, 16 and 17 years old. Delegate Yost carried legislation that would have prohibited indoor tanning for all children under 18. Sadly, all three bills were tabled in the House Commerce and Labor committee. However, a few Republican members of the committee expressed interest to us about moving forward with a full ban next year.

While we are dismayed with the outcomes of the smoking in cars and tanning bills, we are encouraged by the progress they made this year and are hopeful for better outcomes next year.

Overall, it was a very successful session for us. Thank you to everyone who came out for our annual “White Coats on Call” day and advocated on behalf of pediatric medicine.