Chapter Quality Network (CQN) Practice Improvement to Address Adolescent Substance Use Project Chapter Application

Transcription

1 Chapter Quality Network (CQN) Practice Improvement to Address Adolescent Substance Use Project Chapter Application Chapter Name Names of Chapter Leadership President: Vice President: Executive Director: Identification of your chapter project leadership team The Physician Project Leader will be expected to: Provide overall leadership for the implementation of the CQN PIAASU project Participate in monthly chapter calls with other chapter leaders to share progress and strategies Contribute to learning session curriculum development Host conference calls/webinars for participating practices and provide coaching and support for project quality improvement activities Present practice improvement content at learning sessions (both in state and webinar) Review and analyze project improvement data and provide feedback and encouragement to participating practices Attest to physician participation for American Board of Pediatrics Maintenance of Certification (ABP MOC) Part 4 Please provide the name, and telephone number of the Physician Project Leader: Name: Phone: Please describe why this person s skill set makes him or her an appropriate choice for this chapter project leadership role in the CQN PIAASU project. 1

2 The Chapter Project Manager will be expected to: Create meeting agendas and following up on action items Facilitate and participating in online meetings and conference calls Contribute to learning session curriculum development Create PowerPoint presentations Facilitate in state learning sessions and organizing speakers and facilities Act as primary chapter liaison to practices for all project activities Act as primary chapter liaison to national AAP. Please provide the name, and telephone number of the Chapter Project Manager: Name: Phone: Please describe this person s capacity to manage and lead the day to day activities of the CQN PIAASU project, including his or her experience with managing chapter projects, organizing meetings, accounting for grant funds and working with member practices. The Local Substance Use or Mental Health Expert will be expected to provide the following throughout the project: Substance use and mental health education (presentations) during learning sessions, webinars and monthly conference calls Responses to questions and guidance for clinical questions from participating practices Please provide name, and telephone number of the Local Substance Use or Mental Health Expert: Name: Phone: Please describe why this person is an appropriate choice for this role in the CQN PIAASU project. 2

3 Chapter Infrastructure for Quality Improvement (QI) Please check the box that best describes your chapter s infrastructure for QI. Does your chapter: 1. Have a QI committee? Yes Not at this time, but planning within the next year No 2. Have a strategic plan that involves QI activities at the practice and/or state level? Yes Not at this time, but planning within the next year No Experience With QI in Practice Please complete the following questions pertaining to your chapter s experience with QI in practice. QI in practice refers to activities that use data based methods to create rapid improvements in health care delivery. 3. Does your chapter have experience (current or past) leading a QI project that is focused on improving children s health outcomes and also provides credit for ABP MOC Part 4 (Improving Performance in Practice)? Yes No 3a. If yes, please describe the specific focus, length of the project, and successes and challenges (no more than 3 examples). Please make note of any payer engagement in projects. 3b. Please describe the sustainability of your chapter s QI projects. 4. Please describe your chapter s experience with meeting practice recruitment goals for member practices. Describe the successes and challenges when recruiting member practices and, if you have experienced challenges, describe how you overcame them. 3

4 Communication Between Chapter Leadership and Members Please describe your chapter s communication processes. 5. How often does the leadership of your chapter (President, Vice President and/or Executive Director) communicate with chapter members (by phone or )? Quarterly Once a month Multiple times per month 6. What has been your most successful method for communicating with chapter members? If you have experienced barriers, describe how you addressed them. CME Experience 7. Please describe your chapter s experience with offering CME programs. In your description, share what plans you have to offer CME programs in 2016 and, on average, how many people attend your chapter meetings that provide CME. Practice Recruitment 8. Briefly describe the practice composition within your state (eg, estimate the percentage of small practices, large group practices, integrated care networks, academic centers, etc). 9. Please explain how you plan to recruit 10 to 15 practices to participate in the CQN PIAASU project. In your description, please explain which types of practices you plan to recruit (eg, small practices, large group practices, physician networks, academic centers, etc). In addition, identify the number and names of practices that have already expressed interest in participating. 10. Please tell us about your chapter s ability to include in this project practices that serve minority children and/or children living in poverty. 4

5 Evidence of Partnership(s) With State and Private Partners 11. Please check the boxes next to the types of organizations with which your chapter has productive working relationships in which the agency calls upon the chapter leadership and/or membership to participate in activities aimed at improving children s health care quality. Medicaid Insurers or Private Payers Children s Hospitals ACOs or Integrated Delivery Systems Public Health (local or state departments/agencies) Health Foundations Medical Schools or Universities Other major initiatives Our chapter currently does not partner with any state or private partners 11a. Provide no more than 3 specific examples of how the chapter and organization(s) have worked together. 11b. Describe your relationship with family consumer groups around children s behavioral health (ie, Family Voices, National Alliance for Mental Illness, Federation of Families for Children s Mental Health, etc). Chapter Goals and Expectations 12. What does your chapter expect to gain from participating in this project? 13. How does the CQN PIAASU project align with your chapter s overall plan to support your members in QI? 5

6 Evidence of Financial Controls 14. Does your chapter have a written policy/procedure in place for financial grant management? Yes No 6

7 Application Submission Applications are due to the AAP by Wednesday, July 15, 2015, at 5:00PM CST. Please send your application, with signatures (electronic signatures are acceptable), to: Stephanie Domain, Manager, Mental Health Initiatives Fax: 847/ Late applications will not be accepted. The physician project lead and chapter project manager will receive an acknowledgement of receipt via within one business day. Please follow up with Stephanie Domain (847/ ) if you believe you have submitted your application and have not received an acknowledgement. Signatures Chapter President: Physician Project Leader: Chapter Project Manager: Local Substance Use or Mental Health Expert: 7