The Vermont Child Health Improvement Program (VCHIP)—an exciting model of statewide collaboration—supports clinicians in their efforts to improve care by providing a centralized resource for guidance on the techniques of quality improvement. With Fund support, VCHIP is helping five other regions develop improvement partnerships among state Medicaid programs, public health agencies, and local professional organizations. The improvement partnerships—in Kings County, Washington, Washington, D.C., and the states of Arizona, New York, and Rhode Island—will initially focus on strengthening developmental and preventive services for young children.

With Fund support, the American Academy of Pediatrics (AAP) is promoting cooperation among state government agencies, elected officials, child advocates, and state chapters of the AAP. Small grants have been awarded to eight AAP chapters (California, Iowa, Kansas, Maine, Maryland, Oregon, Puerto Rico, and Virginia) to launch a series of open forums focusing on early child development issues. The goal is to encourage ongoing, structured interactions among various stakeholders about ways to expand the availability and improve the quality of child health care.

The improvement partnerships and open forums seek to create environments in which primary care practice can become more effective and efficient. Two recent Fund projects provide guidance on how to redesign the structures and procedures of office practice. David Bergman, M.D., of Stanford University, undertook an extensive review of the literature and expert opinion to identify concepts that can contribute to the development of a high performing system of well-child care.

In the Fund report, A High Performing System for Well Child Care: A Vision for the Future, Bergman describes some of the most innovative strategies for leveraging new technology and systems in order to improve quality and efficiency.⁽³⁾ The report describes scenarios for improved practice in various settings, building on change concepts in the areas of information transfer, team-based care, family-centered care, cultural competency, financing, developmental screening, care coordination, and medical homes. Bergman is now creating a plan for implementing his framework for high performing pediatric care in an innovative health maintenance organization. If implementation is successful, an effort will be made to spread the model to other health plans.

In another Fund report, Amy Fine and Rochelle Mayer, Ed.D., of Georgetown University, describe the state-of-the-art in care coordination for children who have, or are at risk for, developmental problems.⁽⁴⁾ The researchers expanded the concept of care coordination to include the links between child health care practices and other family service providers and community resources. Based on their national search for best practices, Fine and Mayer conclude that successful strategies for connecting families to needed services depend on organizational changes within practices, partnerships among service providers, and system changes within communities.