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Quality Counts
This column is coordinated by April Buchanan, M.D., Vice Chair of Quality at Children’s Hospital of Greenville Hospital System
(GHS). The article highlights the QTIP (Quality, Technology, Innovation and Pediatrics) program at GHS Children’s Hospital’s
Center for Pediatric Medicine. Dr. Buchanan serves on the Oversight Committee for the state grant supporting QTIP.
QTIP Project Boosts Quality
The Center for Pediatric Medicine (CPM) is one of
18 primary care practices taking part in a statewide
demonstration grant called QTIP, aimed at
improving pediatric health care through measures
in quality, promotion of health information
technology and evaluation of provider-based
models. The $9.2-million grant, funded by the
Centers for Medicare and Medicaid Services,
involves the S.C. Department of Health and Human
Services, S.C. Chapter of the American Academy
of Pediatrics, University of South Carolina’s Office
of Research and Statistics, CareEvolution, and
Thomson Reuters.
Four key foci make up the project:
1. Quality: demonstrate that newly developed
quality indicators can be successfully used in
pediatric practices
2. Technology: share key clinical data through
a statewide electronic quality-improvement
network
3. Innovation: develop a physician-led, peer-to-peer
quality-improvement network
4. Pediatrics: expand use of pediatric medical
homes to address children’s mental health
challenges
This grant represents a unique opportunity for
our state’s pediatricians to help develop qualityimprovement
tools. The first learning collaborative
took place January 2011; the program will continue
for 4.5 years.
QTIP focuses on 25 quality measures in
the Children’s Health Insurance Program
Reauthorization Act; CPM is working on several
measures. The first is to decrease ER use among
its patients by improving access through evening
and weekend clinic hours.
CPM also launched an alert system that provides
names of patients who visit a GHS emergency
department. Follow-up phone calls then are made
to these patients to determine why they went to the
ER and remind them of clinic hours and after-hours
phone triage.
Another focus is improved well-child care within
the first 15 months of life. Initially, 94 percent of
patients reviewed had five well-child visits within
this time, with the 12-month visit being the most
frequently missed. To continue to improve, the
clinic began automated reminder calls. There are
plans to initiate financial counseling at the 9-month
visit to explain the Medicaid redetermination
process to parents and help ensure the child has
coverage for the 12-month visit.
CPM also started oral health screenings and
fluoride varnishes. In late February 2012, the
baseline rate for oral health discussion was 36
percent before implementation; with education and
automated reminders within the electronic medical
record (EMR) template, that number reached
92 percent.
Within one month, 239 fluoride varnishes were
performed. As part of the process, caregivers
receive a list of dental providers within the
community who accept Medicaid, and children
receive “goodie bags” with a dental instruction
sheet, toothbrush and book that encourages
brushing.
Other projects address ADHD and improved
developmental screening.
QTIP’s leadership
team has engaged
participation from
office staff, nurses,
residents and
attendings, in
addition to tracking
outcomes. (l-r)
Sabrena O’Connor,
Physician Practice
Specialist; Doreen
Patterson, M.D.;
Cindy Garnett,
EMR Support Tech;
Katy Smathers,
Office Manager;
and Tammy
Gladson, R.N.,
Clinical Supervisor.
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