Pediatrics © 2005 Kentucky Pediatric Society KENTUCKY fall 2012 I N The newsletter of the Kentucky Chapter of the American Academy of Pediatrics. This publication is sponsored by educational grants from Abbott Nutrition and MedImmune, Inc. T H I S I S S U E Spotlight: Senator Katie Kratz Stine (R).............................2 Pediatric Eye Disease..................6 Can Counting Steps Lead to Healthier Lives? Walking Works! Funded for another year............9 VOLUME XXVIV What is the American Academy of Pediatrics doing to promote quality in pediatric health care? By Francis E. Rushton M.D. F.A.A.P. Annual Meeting 2012...............12 Quality efforts of the American Academy of Pediatrics are designed to promote and sustain improvement in clinical behavior at the practice level and improve outcomes for children and are supervised by the AAP’s Quality Cabinet. The Steering Committee on Quality Improvement and Management (SCOQUIM) helps promote this vision by leveraging the AAP’s strong foundation in recommendations and policies based upon evidence and practical experiences. SQOQUIM offers an integrated voice for quality and enables AAP members to provide the highest quality clinical care for children in a Medical Home. Research has shown that despite the availability of best practices, there is a gap in incorporating this information into a physician’s daily practice. To close this quality gap, SCOQUIM and the broader AAP facilitate evidenced-based guidelines, quality measures, patient safetyandtranslation of policy into practice (PPI). The AAP has adopted a model linking testing, education and spread to ensure quality. The Quality Improvement Innovation Network (QUIIN) tests and develops new tools that enhance quality and improve health and developmental outcomes for children. The Education in Quality Improvement for Pediatric Practice (EQIPP) program educates pediatricians and helps them identify and close gaps in practice using practical tools. The Chapter Alliance for Quality Improvement (CAQI) program facilitates rapid spread of quality successes across the country. The AAP actively partners with facets of the CHIPRA program, national organizations and has members in leadership positions to ensure that the voice for children is heard in quality discussions at the national level. The Academy is actively working to ensure quality improvement efforts are incorporated into the meaningful use of EHRs. Finally, the AAP’s efforts are imbedded in the concept that quality is best facilitated within the organizing structure of the pediatric Medical Home. SUMMARY DESCRIPTIONS OF SPECIFIC AAP/ABP QI PROGRAMS AMERICAN BOARD OF PEDIATRICS: The ABP approves a wide range of established and web-based practice improvement initiatives. The ABP offers two options to meet Part 4 requirements: Established Quality Improvement Projects: Structured QI projects that involve physician teams collaborating across practice sites and/or institutions to implement strategies carefully designed to improve care. Experienced coaches guide these multipractice improvement projects in clinical improvement. Web-Based Improvement Activities: Self-paced, expert-developed quality improvement activities that physicians complete within their own practice setting. ABP(continued on page 4) F a l l 2 0 1 2 K E N T U C K Y P E D I AT R I C S L EGISLATU RE SPO TLI G HT Senator Katie Kratz Stine (R) President Pro Tem (2005 – present; lst woman) Senator Stine has served in the Senate from 1999 to present, representing Senate District 24, Campbell and Pendleton counties. Prior to this, from 1995 – 1998, she served in the House of Representatives, representing House District 68. Senator Stine has a JD from the Northern Kentucky University Chase College of Law and a BS in Biology from the University of Cincinnati. She is an attorney and homemaker. Senator Stine is a member of a number of organizations including the: Association of Builders and Contractors Campbell County Republican Party Daughters of the American Revolution Episcopal Church Women Former Vice Chair, Fort Thomas Board of Adjustments Fort Thomas Garden Club Board Member, Fort Thomas Weekday Religious Education Program Guardian of Small Business Homemakers Club Johnson Elementary School Parent Teacher Association Junior League of Cincinnati Kentucky Bar Association Kentucky Taxpayers United National Federation of Independent Businesses Northern Kentucky Right to Life Taxpayers Best Friend Senator Stine’s awards and recognitions include: A.D. Albright Outstanding Educational Governance Individual Award Taxpayer’s Friend Award by Taxpayers United Concerned Women For America Families First Award Northern Kentucky Right To Life JohnBauer Award Kentucky Right To Life 25th Anniversary Celebration of Life Award Department of Veterans AffairsAppreciation Award NFIB Guardian of Small Business Award Chase College of Law Alumni Association Professional Achievement Award Highlands High School Alumna of the Year Award Home Builder’s Public Official of the Year Award Justice For All Award for Support of Public Legal Defense City of Newport Thank You Award City of Southgate Thank You Award Bellevue Board of Education Thank You Award Kentucky Child Now Destiny Award American Advocates for Health “Health Achievement Award” American Heart American Stroke Assoc. You’re the Cure Legislator of the Year Award Childrens Law Center Thank You Award Kentucky Ambulance Providers Assocation Thank You Award Veterans/ Hardin-Browning Post 109 American Legion Thank You Award Kentucky Forward (small businesses) –highest rating the Senate for 2000 Kentucky Physical Therapists Assoc. (Friend of Physical Therapy Award) Burley Tobacco Cooperative (Friend of Tobacco Farmers Award) During the last legislative session, Senator Stine served on the following Interim Committees: Childhood Obesity Task Force [Co-Chair] Economic Development and Tourism Economic Development Task Force Energy Special Subcommittee Families & Children [Co-Chair] Health and Welfare Judiciary Labor and Industry Natural Resources & Environment Veterans, Military Affairs, and Public Protection. (continued on page 4) 2 K E N T U C K Y P E D I AT R I C S f a l l 2 0 1 2 Pediatrics MESSAGE FROM THE PRESIDENT KENTUCKY President Eric Bosley, MD, FAAP Vice President Kim Boland, MD, FAAP Secretary/Treasurer Rob Tagher, MD, FAAP Immediate Past President Stephen Church, MD, FAAP Chapter Executive Director Mary P. York Kentucky Pediatrics is a biannual publication of the Kentucky Chapter of the American Academy of Pediatrics/Kentucky Pediatric Society. The Chapter does not endorse opinions or statements contained in this publication as they are not necessarily reflective of the Chapter, its officers, or its staff. We welcome your opinions and ideas. Please send ideas for new articles or suggestions for making Kentucky Pediatrics more useful to: Kentucky Chapter of the AAP 420 Capitol Avenue Frankfort, KY 40601 502-875-2205 office 502-223-4200 fax [email protected] www.kyaap.org Newsletter Design Inside Creative Susan Mackowiak 502.386.7580 Newsletter Editor Daniel Finn, MD, FAAP As I look back at the first year of my term as president, it has certainly been an interesting twelve months. The chapter has seen great successes and progress with its clinical programs including Help Me Grow and Walking Works. The fine work of our Executive Director, Mary York, on Help Me Grow has helped put momentum behind the possibility of a statewide expansion of the 211 system for early childhood development evaluations and referrals. We continue our efforts to assist our members in training with our annual career day retreat and are working harder to keep our young members engaged once they leave training and enter practice by reviving our Young Physicians group. Thanks to the hard work of our staff and planning committee, the Chapter enjoyed another successful annual meeting and CME in August at our new venue of Lake Cumberland State Resort Park. Not only did we have our greatest attendance to date, but we enjoyed the continuation of our Friday Plenary series with an outstanding Sports Medicine Symposium. This is the third in a series which has also included sessions on mental health and obesity over the past two years. These sessions have complemented the Saturday CME and have allowed our members to gain additional free CME while addressing some of the most important clinical dilemmas we face each day in practice. The biggest challenges facing the Chapter over the past year have been the greatest challenges facing our members with both the state conversion of Medicaid to Managed Care Organizations as well as the implementation of HB 1 or the “KASPER” law. The Chapter continues to advocate on both of these issues for our members and will also continue our commitment to get as accurate information as possible out to our members as it becomes available. With HB 1, it is important to note that the Governor’s Office has announced that public hearings on the KBML regulations will be held on September 26th and 27th, 2012 in Frankfort. These meetings will provide an opportunity for comments on the KBML regulations. House Bill 1, on the other hand, has become law, is incorporated into Kentucky’s statutes, and is not subject to anything but legislative change. Once the comment period and meetings convene then the resultant regulations and law will be in full effect as of October 1st and full compliance will be expected from that point forward. It is issues like Medicaid, KASPER, and health care reform that make it important for us, as pediatricians, to have an active and unified voice and the Chapter is a great means by which to do that. But, we are only as strong as our members, so we encourage each of you to become active participants in these activities as you feel inclined so that we can continue to work towards our mission “to improve the health and welfare of all infants, children and adolescents of the Commonwealth. In addition, the KY Chapter of the AAP works on behalf of pediatricians and sub specialists, both those in practice and those in training, to ensure professional development and to facilitate the delivery of quality medical care to the children in the Commonwealth”. Eric Bosley, M.D., FAAP President The Editor reserves the right to edit submissions for spelling, punctuation and style to conform to the Associated Press style guidelines. All submissions are published at the discretion of the Editor. Next Issue Spring 2013 3 F a l l 2 0 1 2 K E N T U C K Y P E D I AT R I C S (continued from cover) (continued from page 2) approved web-based QI activities are ideal for pediatricians who do not have access to multi-practice improvement initiatives. Physicians who participate in ABP-developed Performance in Practice QI projects may receive continuing medical education (CME) credit from American Board of Pediatrics—Web based modules (Performance Improvement Modules (PIMS)). She also served on the following Session Committees: Current American Board of Pediatrics QI Modules: ADHD PIM Adolescent Depression Screening PIM Asthma PIM Breast Milk Use PIM Chlamydia Screening PIM Developmental Screening PIM Hand Hygiene PIM Influenza Immunization PIM Medication Safety and Safe Prescription Order Writing PIM Preschool Vision Screening PIM American Academy of Allergy, Asthma & Immunology (Asthma Specific Tool) Reach Out & Read AMERICAN ACADEMY OF PEDIATRICS: As part of Maintenance of Certification (MOC), quality improvement (QI) projects that meet standards set by the ABP can apply for approval by the ABP; physician participants are eligible for credit toward maintenance of their ABP certification. EQIPP courses help you identify and close gaps in your practice using practical tools. Earn CME credit and meet MOC Part 4: Performance in Practice requirements all at once. Each course requires some work online and offline. AAP EQIPP Modules Diagnosing and Managing Asthma in Pediatrics Give Your Immunization Rates A Shot in the Arm Differentiate and Manage GER and GERD Bright Futures Medical Home for Pediatric Primary Care Eliminate Tobacco Use and Exposures QuIIN: Members of the QuIIN Network will have the opportunity to meet ABP MOC Part 4 requirements when they participate in QuIIN quality improvement projects. Although not all QuIIN projects are eligible for ABP approval, the goal is for the majority of improvement projects, meet the rigors established by the ABP. How to be a part of QuIIN? To get involved in upcoming QuIIN projects, please join QuIIN by completing the Membership Application (this application will ask several quality related questions and may take up to 15 minutes to complete). Once you are a member of QuIIN, you will automatically be added to the QuIIN email list and have access to the QuIIN Members Only area of the Web site where you can learn more about how to apply for specific projects as they become available. Practice Management Online: Offers options to collect data and implement effective and innovation quality improvement programs in your practice; PMO provides pediatricians with theoretical and practical content as well as applicable tools that can be incorporated into the practice. 4 Committee on Committees (S) Economic Development, Tourism & Labor (S) Enrollment (S); Health & Welfare (S) Judiciary (S) [Vice Chair] Natural Resources and Energy (S) Rules (S) Veterans, Military Affairs, & Public Protection (S) and the following Statutory Committees: 2012–2014 Budget Preparation and Submission Legislative Research Commission Medicaid Oversight and Advisory Committee [Co-Chair] Program Review and Investigations Comm. Some of Senator Stine’s legislative accomplishments include: Secured vital water, sewer, road, and school construction funds Secured funding and construction for NKU and Gateway Sponsor of The Women’s Right To Know Law (1998 pro-life informed consent bill) Co-sponsor of 2009 SB1 – abolishing CATS and reforming Kentucky education Sponsor of energy efficient schools law that upgrades Kentucky school facilities Sponsor of law establishing Veteran’s Day recognition programs in Kentucky schools Senator Stine is married to Fred (Fritz) Stine and has 2 children. She resides Fort Thomas, Ky. The KY AAP gratefully acknowledges the work of Senator Stone in advocacy for the children of the commonwealth. Senator Stine’s Frankfort address is: 702 Capitol Ave, Annex Room 236, Frankfort KY 40601. Her phone number is: (502) 564-3120. Sources: http://www.lrc.ky.gov/legislator/s024.htm http://www.votesmart.org/bio.php?can_id=4136 http://www.katiestine.com/about/ K E N T U C K Y P E D I AT R I C S f a l l 2 0 1 2 MESSAGE FROM THE EXECUTIVE DIRECTOR C A L E N D A R As we are approaching election time and preparing for another legislative session in Frankfort, I wanted to share some words of wisdom from our District IV AAP Chair, Dr. Francis Rushton. Pediatricians have influential voices and can make significant contributions to the improvement of children’s health by a few simple action steps. Please take the time to participate in the process! Sept. 21 Peds & Mental Health in KY (Promoting Resilience Conference) Louisville Sept. 21 Staying Alive— Adolescent Health Conference Lexington Oct. 24–25 Career Day for Residents Berea “We are in the middle of a busy election season now, and this is a good time for discussions and letters to the editor on issues of access to health care for children. Whatever the outcome of health care reform, the Academy is sticking by its ABC platform: Access for all children; Benefits that are appropriate for age and Coverage (adequate funding) for pediatric care. These are concepts that we can all agree upon regardless of our political leanings. The Academy believes that the Affordable Care Act moves us substantially closer towards our goals with expansion of access, the incorporation of Bright Futures as the basic well child benefit package and parity on some codes between Medicaid and Medicare. Medicaid and other programs impacting the welfare of children are also caught in the election rhetoric. Although we hear more about funding Medicare, the impact of the Ryan budget on Medicaid is much more immediate. Close to 2/3 of all proposed cuts impact children and vulnerable populations, almost half of these cuts are to the Medicaid program. Medicaid under the Ryan proposal will be capped and block granted, and the entitlement aspect of the program will be discontinued. For children on Medicaid; and pediatric practices that care for them, these cuts could be catastrophic. It’s important for us as pediatricians to speak up for children and ourselves, and keep the debate honest and focused on the facts.” Mary York Executive Director 5 F a l l 2 0 1 2 K E N T U C K Y P E D I AT R I C S Pediatric Eye Disease By Dr. Craig Douglas and Dr. John Franklin Most of vision develops during childhood, which makes detection and treatment of pediatric eye diseases critical during this time frame. Several eye disorders occur in children, many of which can cause permanent visual disability or be irreparable if left untreated until adulthood. Pediatricians and pediatric ophthalmologists in Kentucky have an excellent track record for screening and treating theses problems, which has led to improved care for this age group. The earliest detected eye disease is retinopathy of prematurity, or ROP. This is a potentially devastating disease that can lead to life-long blindness. Those at greatest risk are infants born prior to thirty-four weeks gestational age, infants with very low birth weight, and infants who require high amounts of oxygen for long periods of time after birth. The screening examinations are often performed in the newborn nursery by an ophthalmologist. Some children are otherwise healthy enough to be discharged and will leave the hospital while still at risk for developing ROP. It is essential that these infants have timely outpatient follow up with a pediatric ophthalmologist to continue screening for this disease. Screening for other congenital eye diseases is routinely performed in the newborn nursery. The most basic of these screening procedures is to check for a normal red reflex in both eyes. If the reflex is dull, white, or abnormal in any way, a serious underlying problem can be present. The most dangerous of these is retinoblastoma, but other causes are congenital cataracts or glaucoma, corneal dystrophies, metabolic disorders, and various other retinal anomalies. Occasionally an abnormal red reflex does not represent any true pathology, but a formal evaluation by an ophthalmologist is highly recommended if any abnormality is discovered. One of the most common eye problems within the first year of life is nasolacrimal duct obstruction. Typically this presents within the first few weeks of life as unilateral or bilateral excessive tearing, and often with thick discharge along the lids and lashes. This may lead to crusting on the lid margins or the lids being 6 stuck together, especially after sleeping. Conservative measures are recommended for the first several months of life, as many children will have spontaneous resolution of the problem. If the obstruction persists until ten to twelve months of age, referral to a pediatric ophthalmologist is needed. If the child has recurrent infections, then earlier referral is recommended. Nasolacrimal duct probing is a brief outpatient procedure that often completely relieves the obstruction. Some children require temporary placement of a silicone stent, particularly if a previous probing has failed or when the child is much older than one year at the time of the procedure. Congenital glaucoma can be mistaken for nasolacrimal duct obstruction, because the most common sign is excessive tearing. Infants with tearing caused by glaucoma rarely have discharge on the lids and lashes. Other common signs of congenital glaucoma are photophobia, cloudy corneas, and buphthalmos (rapid enlargement of the eye). Glaucoma in this age group should be treated quickly, so any a child with tearing that does not seem to be from a nasolacrimal duct obstruction should be referred immediately. Conjunctivitis is common throughout most of childhood. The large majority of cases are caused by viruses, do not require any specific therapy, and will resolve within seven to ten days. The exception is herpes conjunctivitis. This virus (HSV1 and HSV2) can cause a chronic conjunctivitis that leads to corneal scarring and visual impairment. The child may also have a history of fever blisters. Any conjunctivitis that is not obviously improving after several days should be referred so that this infection is not missed. Bacterial conjunctivitis is usually far worse in appearance than that caused by viruses. Copious, thick, yellow or green discharge is the typical finding in bacterial conjunctivitis and should be treated with antibiotic drops or ointment. Rarely oral antibiotics are needed. A diagnosis of conjunctivitis may be made when the actual cause of a red eye is uveitis. This is inflammation within the eye that can lead to cataract formation, glaucoma, and vision K E N T U C K Y P E D I AT R I C S f a l l 2 0 1 2 loss. A child who has a red eye that does not improve when treated for conjunctivitis should be evaluated for this potential diagnosis. Uveitis may also be insidious, particularly in children, and is often associated with systemic disorders. Any child with rheumatologic disease like juvenile idiopathic arthritis should be evaluated for uveitis even if no symptoms are present. As a child ages, two of the most common barriers to normal visual development are amblyopia and strabismus. Amblyopia is vision loss caused by lack of use in one eye. Occasionally, amblyopia can be bilateral and it may also be present even when no strabismus exists. When a child is old enough (usually by age 4), visual acuity should be checked in each eye independently. If a family history of amblyopia or strabismus is present, earlier evaluation is encouraged. Fortunately, amblyopia can be effectively treated if discovered early. However, the window for effective treatment of amblyopia usually closes somewhere between the ages of eight and ten years. Therefore, this problem must be addressed early in life and treatment should begin as soon as possible. Treatment typically consists of glasses, patching, pharmacologic blurring of one eye (drops), or a combination of these. Strabismus is any misalignment of the eyes. Beyond the age of two to three months, any perceived misalignment should be considered abnormal. If strabismus is suspected, a child should be seen by a pediatric ophthalmologist. Strabismus can lead to amblyopia, loss of depth perception, and social barriers (which are too easily overlooked). Treatment for this condition can be as simple as prescribing the correct glasses or as complicated as surgery to realign the eyes. Some patients require a combination of therapies to achieve good alignment. Evaluation by a pediatric ophthalmologist is essential to determine which course is best. Pediatricians play a tremendous role in the care of children’s vision as well as their overall healthcare. Together with pediatric ophthalmologists, pediatricians can have an amazing positive effect on the visual development of their patients. When ocular anomalies are suspected, or when family history of such a problem exists, referral for ophthalmic evaluation is always a wise choice. 7 Good medicine deserves the best defense. WE KNOW GOOD MEDICINE WHEN WE SEE IT, AND WE’RE DETERMINED TO DEFEND IT. MagMutual’s Claims Committees consist of physicians just like you. They review cases with the same care they’d wish for their own. We hire the top local attorneys who are guided by our local expert claims specialists. And we won’t settle a claim without your consent. What else would you expect of a physician-owned, physician-led company? Endorsed by the Kentucky Chapter of the American Academy of Pediatrics. Insurance products and services are issued and underwritten by MAG Mutual Insurance Company and its affiliates. These agents are experts on the products and services MagMutual offers in Kentucky. Rusty Wells Chuck Durant Todd Sorrell MagMutual 1-888-642-3074 MagMutual.com Neace Lukens Hayes, Utley & Hedgspeth 270-393-6218 neacelukens.com 502-493-7974 huhinsurance.com K E N T U C K Y P E D I AT R I C S fall 2 0 1 2 Kentucky Pediatric Society F oundation Can Counting Steps Lead to Healthier Lives? Walking Works! Funded for another year. A continued member benefit to providers in the Metro Louisville and N. KY areas. Walking Works program has been awarded another year of funding from the WellPoint Foundation. The program represents a unique collaboration between the Kentucky Chapter of the AAP, (KPS) Foundation, pediatricians, YMCA’s, medical students with an interest in pediatrics, and overweight/at-risk children. The program is a collaborative partnership with local YMCA’s in the Louisville and Northern Kentucky areas and with pediatrician members of the Kentucky Chapter of the AAP. Pediatricians can refer their overweight 9-14 year old patients into the program. Once enrolled, a participant receives free nutrition counseling and fitness coaching over a six-month period, and is encouraged to keep a walking/activity log. Upon entry in the program, participants are assigned a health coach, who is a UC or UofL medical student with an interest in pediatrics. In addition, a pedometer is provided to each of them with a daily activity log. The local YMCA’s provide a nutrition education session and two fitness coaching sessions for the participants as well as FREE membership for the entire family the duration of the program! The nutrition session covers topics including food selection, portion sizes, and the 5210 concept (reference materials are also provided) and highlight specific categories of foods: unlimited (fruits/vegetables), those that should be eaten cautiously, and those that should be eaten less than two times per week (junk food).In addition to the individual coaching sessions, the YMCA allows participants and their families to work out for free at their facilities for six months. Each child and health coach work together to set goals for the 6-month program. Grant funds will cover a maximum of 250 enrollees in Louisville and Northern Kentucky areas through September of 2013. For additional program information, contact Walking Works Program Coordinator, Delle Blair [email protected] Program Stats to date 1,450 participants registered 62 medical student/resident health coaches assigned 190 pediatricians who have referred patients into the program 9 F a l l 2 0 1 2 K E N T U C K Y P E D I AT R I C S Annual Meeting 2012! Dr. Bill Hacker celebrating FOC award with Drs. Boland and Bosley Mary York with BBQ balloons The Grill family playing mini golf 2 Don Cantley award winners converse, Drs. Ron Lehocky and Julia Richerson Meeting attendees in session Drs. Rabalais and Hedrick sharing a laugh Enjoying a hot dog at the BBQ Drs. Bosley and Rushton after receiving Chapter AAP Award of Excellence 10 Baby enjoying the BBQ too! Drs. Labor, Honaker and Carothers at the exhibit space A healthy, happy tomorrow is every parent’s mission. It’s ours, too. ADVANCING SCIENCE FOR BETTER HEALTH www.medimmune.com KENTUCKY CHAPTER OF THE AAP (KPS) 420 Capital Avenue, Frankfort, KY 40601 Presort Standard US POSTAGE PAID KENTUCKY Pediatrics Permit #976 Louisville, KY IN THIS ISSUE Spotlight: Senator Katie Kratz Stine (R) Pediatric Eye Disease Can Counting Steps Lead to Healthier Lives? Walking Works! Funded for another year. Annual Meeting 2012 © 2005 Kentucky Pediatric Society
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