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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
maryyork@kyaap.org
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
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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 delleblair@kyaap.org
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
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PAID
KENTUCKY
Pediatrics
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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