Q: Our practice cannot access the Kindergarten Readiness Promotion Bundle data to share in the monthly report. Can we report on select components of the bundle?
A: Yes! We encourage practices to report as much as they are able. If there is a component that you cannot easily report on, please leave the survey item blank.
Q: How can our practice make sure we receive credit for the 1003F code, since it is not billable?
A: Your practice may need to modify the logic to make sure that $0 charges are allowed for this code when claims are sent.
Q: Our practice uses the ASQ screening tool, rather than the SWYC. Is that okay for participation in the Learning Collaborative?
A: There's no need to change screening tools if your practice has a combination that is working well. The ASQ is an accepted and validated tool for developmental screening, but does not include socio-emotional screening. The ASQ-SE is a separate questionnaire that screens for socio-emotional concerns and can be used in addition to the ASQ. Many other validated and accepted socio-emotional screening tools exists in addition to the ASQ-SE, such as the SWYC (which includes the BPSC or the PPSC), BITSEA, Strengths & Difficulties Questionnaire, and ECSA. Each practice should decide which screening tools effectively screen for both developmental and socio-emotional concerns, and determine which combination best fits the needs of their practice and patient population.
Participating in the Collaborative will also provide opportunities to learn about additional components that your practice may find valuable and provide a space both to share your work with practices and hear of successful processes and interventions that other practices have established. Our goal is for everyone to learn from each other so that we can collectively improve kindergarten readiness across the many patients we all see.
Q: Our practice has difficulty parsing out patients who are enrolled in and qualified for NC InCK. Could you help us identify those patients?
A: Thank you for highlighting this challenge. We have had discussions at NC InCK about the difficulties with identifying NC InCK patients at the practice level. For UNC practices, there is currently no definitive way to determine a patient's NC InCK status or eligibility via Epic. We at NC InCK will continue to work with leaders of UNC Health Alliance to develop and advocate for strategies to address this challenge.
Fortunately, particularly for these kindergarten readiness efforts, there's no need to know whether individual children are enrolled in NC InCK. Most practices have a mix of Medicaid, private payer, and NC InCK/non NC InCK children, and are taking the same approach to kindergarten readiness for all patients across the practice regardless of payer or NC InCK status. While incentive payments through NC InCK's Alternative Payment Model will only be based on NC InCK patients, for purposes of our Collaborative, we focus on strategies to improve kindergarten readiness for all children under 6.
Q: Currently we only do dental varnish for the Medicaid population. Should we be doing this for everyone, and, if so, what ages?
A: The current recommendation from the US Preventive Services Task Force, which is also included in the AAP Periodicity Schedule, is pasted below. The recommendation applies to all children "from tooth eruption to age 5." Fluoride varnish is currently recommended for all children regardless of insurance status and is covered by private insurers under the ACA; note that the code for private insurance is different (99188, in contrast to billing D1206 with D0145 for Medicaid). Medicaid pays for fluoride varnish through 41 months (so 3 ½ years), so a practical approach is to consider applying fluoride for all children in a practice through 3 ½ years.
"The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.(https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/preventionof-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1). Once teeth are present, apply fluoride varnish to all children every 3 to 6 months in the primary care or dental office based on caries risk. Indications for fluoride use are noted in “Fluoride Use in Caries Prevention in the Primary Care Setting” (https://doi.org/10.1542/peds.2020-034637).
Q: Where is the Healthy Steps program available?
A: Healthy Steps is currently available in a small number of practices in Durham, Guilford, and Cumberland Counties. More information on Healthy Steps in North Carolina is available here: https://buildthefoundation.org/pathways/initiatives/healthysteps/
Q: Where can our practice find resources for running PDSA cycles within our practice?
A: section, we have provided a template and example. Additionally, the Institute for Healthcare Improvement has nice materials available on their website: https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx
Q: How can my practice set up our electronic health record to easily add billing code and dot phrases to help implement kindergarten readiness activities?
A: Each health system's IT structure and usage varies, however, most EHRs allow for customized features such as billing code favorites for easy inclusion with encounters, dot phrases, and customized note templates. We recommend that you meet with your health system's IT team to discuss your preferences and to get personalized help with these custom features.
Q: How do we get QR code for childcare services added to our AVS? Is there a dot phrase available, or how could we create one?
A: In the resources section,
Q: Do you know of any partnerships for the Dolly Parton Imagination Library in Wake County?
A: The Dolly Parton Imagination Library in Wake County is managed by their local Smart Start. If they are unable to handle new signups, families can be added to the list and there are some additional preK resources that may be helpful. Please see their website here: https://www.wakesmartstart.org/program/imagination-library/
Please see an additional Wake County resource that may be helpful as well.
Q: For reporting purposes, should our practice only include data on counties served by NC InCK? Should our change idea/PDSA cycles focus only on patients within NC InCK counties?
A: For both the survey data and your PDSA cycles, please include all patients regardless of whether they are in an NC InCK county.
Q: What kind of infrastructure needs to be in place within a clinic to successfully implement the Reach Out and Read (ROR) model?
A: Detailed information about starting a Reach Out and Read program at your clinic is available here: https://www.rorcarolinas.org/research-and-training/. We recommend having ROR embedded throughout the whole clinic – from front desk to nursing staff to clinicians. One person orders books annually, and a few clinical staff members can unbox books and stock shelves. Each practice is also asked to submit a progress report twice a year that details the number of books distributed. This report takes approximately 1 hour to complete.
Understanding the “why” behind the model is the most important part. This can help engage clinicians and staff at all levels of the practice. For more information, and to hear about the Reach Out and Read program at Duke, please watch our September webinar, which focuses on literacy promotion.
Q: How can our practice fund Reach Out and Read within their clinic?
A: Detailed information about starting a Reach Out and Read program at your clinic can be found here: https://www.rorcarolinas.org/research-and-training/. There are various funding possibilities. For example, Reach Out and Read may be included within the clinic’s budget; and/or the county may provide funding for the program.
If your clinic is interested in beginning a Reach Out and Read program, but does not yet have a plan to fund this work, Reach Out and Read’s regional affiliate has grant writers and staff who can offer support. Please contact the Program Specialist for your area at the above website.
To estimate the cost of starting this program within your practice, consider that books are $2-3 each, and every child may receive 14 books over their first 5 years.
Q: How can our practice track the number of Reach Out and Read books distributed to patients?
A: Some practices develop a way to count books through the electronic health record, though that usually requires customization. Others may count the inventory of books monthly, and subtract those that remain at the end of the month.
