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Next Steps: A Practitioner's Guide For Themed Follow-up Visits For Their Patients to Achieve a Healthy Weight
Next Steps: A Practitioner's Guide For Themed Follow-up
Visits For Their Patients to Achieve a Healthy Weight

Managing the White Space: Quality Improvement at a New Level of Innovation and Partnership

A Message from Charlie Homer, NICHQ's President and CEOApril 2011

Personal change is challenging. Organizational change is really challenging. What about community and broad system change? How challenging is that!

Things at NICHQ are buzzing and humming as never before. Our staff has grown significantly, we’re building new technologies, and our reach is wider than ever. It’s a very exciting time for me personally and for the organization as a whole.

What is most exciting is that we are now tackling challenging topics through innovative strategies that involve not only managing what happens within organizations, but also the areas between organizations – the white space that has confounded us all – so that children and families can lead healthier and fuller lives.

It’s a thrilling and daunting agenda. We’ve entered a whole new domain of ambition and it has created a renewed sense of invention and aspiration for NICHQ. I couldn’t be more excited to be part of this extraordinary team rising to this level and ready to take on these new challenges.

Here are some examples of this amazing work:

• In our ongoing work to improve care for children with autistic spectrum disorder, we are now focused on care across community resources, linking specialty and primary care sites and developing shared approaches to co-management. We have had the great pleasure of working with the Autism Treatment Network for the past three years, helping to develop care pathways for children with associated medical problems such as constipation and sleep disorder and implementing these pathways within the specialty treatment sites. But this new agenda is even more ambitious. By enabling coordination between sectors, this work has the potential to dramatically improve access and efficiency, and enhance family centeredness for these patients. We had our expert meeting in March to define the core change concepts and the measures teams can use to track their success. It has been an honor to partner with MGH, Autism Speaks, and HRSA throughout this important project.

• NICHQ is now the national coordinating center for the Sickle Cell Disease Treatment Demonstration Program, with support from HRSA. In this program we seek to catalyze and accelerate the efforts and activities of community-based networks committed to improving access, quality, and outcomes of care for individuals with Sickle Cell Disease (SCD) across the lifespan. (The challenges these individuals confront and their general experiences with the health care system were poignantly described recently in the New York Times Patient Voices series.) Each of the SCD networks includes a comprehensive treatment center, one or more primary care/federally qualified health centers, and one or more community based organizations. In this program, then, in addition to optimizing the care and within each delivery organization in each network and reducing cost overall, we seek to maximize integration and coordination across the organizations—with the individual and family at the core. And perhaps most importantly, in improving care for this population, we will be inherently addressing the critical topic of health equity. Talk about challenging and rewarding!

• While the Autism and Sickle Cell programs focus on the white space between organizations clearly engaged in health care, the Prevention Center, a HRSA-funded initiative focused on promoting healthy weight in communities across the country, pushes the boundaries of quality improvement even further. This program will apply our improvement methods to address prevention and treatment of obesity at the community level, engaging all three sectors critical to changing the trajectory of the obesity epidemic: primary care, public health, and community organizations. Multi-sectoral teams will be asked – perhaps for the first time – to work together for a common aim, using common metrics to track their progress. We’re just starting to get this program off the ground, and we’re extremely energized about the enormous potential gains from this unique and innovative approach.

• Another example of a novel approach is our work to improve follow-up from newborn hearing screening, making sure that children with abnormal hearing screens during their newborn hospitalization receive timely and accurate diagnosis and, if abnormal, treatment and integration into the medical home and early intervention services. This project, too, spans the white space, this time building bridges between hospitals doing the screening, state laboratories gathering and reporting data, clinical care sites (both primary and specialty care), early intervention programs, and families. We’re using quality improvement to address not only clinical concerns, but also public health priorities and systems – applying the interventions not to a single hospital but across entire states. It’s a very ambitious and thrilling undertaking.

These are some of the reasons NICHQ is buzzing and humming as never before. By using quality improvement methods to address long-standing gaps in coordination and care across groups frequently unconnected, we believe these projects will spark community and system-level change, improve efficiencies, and make a lasting difference in the lives of patients and families.

We welcome you to watch our progress on NICHQ’s website ( Thanks for your support!


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