Using QI to Expedite the Annual Medical Review Process for California Children's Services Clients
BCPHD’s Nursing Division administers CCS, a state program for children with certain diseases or health problems. Through this program, children with specific health care needs are linked to medical specialist services. To qualify, a child must meet medical or family income criteria. Eligibility is determined by an AMR that includes determination of the medical and financial criteria by a combination of CCS nursing and administrative personnel. Long delays were being reported in the AMR process, causing delay of services for potentially eligible children in the service area. Several bottlenecks in the AMR process were identified, and solutions to streamline the process were tested in a Plan, Do, Study, Act (PDSA) cycle. These solutions included revising existing AMR forms to assist staff in sequestering only the necessary elements of a child’s records for review, thereby standardizing and expediting the review process. After implementing the streamlined process, the average time from open to close of an AMR was reduced by nearly 2 weeks. Qualitative feedback also demonstrated that staff felt that the streamlined process was an improvement over the prior methods for CCS eligibility review. The new process was adopted, and BCPHD’s Nursing Division is considering more PDSA cycles focused on other aspects of the CCS AMR process to achieve additional efficiencies. This submission includes quality improvement (QI) tools, documentation, and supplemental files.
Henley, S. Public Health Quality Improvement Exchange. Using QI to Expedite the Annual Medical Review Process for California Children's Services Clients. Fri, 10/20/2017 - 15:47. Available at http://phqix.org/content/using-qi-expedite-annual-medical-review-process-california-childrens-services-clients. Accessed April 20, 2021.