Target Audience:
Primary Care Providers, Medical Providers, Nurse Practitioners, Families with children who have special health needs
Every other Wednesday:
January 11, 2023 – April 5, 2023Â Â Â Â Â Â Â Â Â Â 12:00 pm – 1:00 pm CT
Echo Resources
View Participant Guide
Case Presentation
What is Medical Home?
The Medical Home ECHO is a partnership between Minot State University and the Department of Health and Human Service Newborn Screening Program to provide information on the Medical Home Model.
Medical home is defined by the American Academy of Pediatrics (AAP) as an approach to providing comprehensive, high-quality primary care, which includes care that is:
- accessible
- family-centered
- continuous
- comprehensive
- coordinated
- compassionate
- culturally effective
Medical home is not a building or place. It builds partnerships with clinical specialists, families and community resources. Upon completion of these sessions, the learner will be able to incorporate a medical home approach in caring for their patients.
| Session Title | Date |
| Session 1: Family-Centered Care- The Medical Home in Action Clinics The family is recognized and acknowledged as the primary caregiver and support for the child, ensuring that all medical decisions are made in true partnership with the family Session Objectives: - Understand the Concept of the Medical Home - Understand Newborn Screening in North Dakota Speaker: Kathy Anderson, M.D. Dr. Kathy Anderson is a double board-certified general pediatrician and integrative medicine physician. She has been practicing in Bismarck, North Dakota for nearly 15 years having worked at Mid Dakota Clinic and St. Alexius Medical Center where she had been Chair of Pediatrics at both institutions. In April of 2020, Dr. Anderson launched her own pediatric practice, Nurturing Wellness: Pediatric Integrative Medicine where she can bring together her areas of expertise in pediatric medicine and wholistic wellness by partnering with families to optimize the health and well-being of children. Case Presenter: Kathy Anderson, M.D. Diagnosis Focus Area: Hemoglobin Disorder Dr. Anderson will provide an overview of a patient’s medical history and treatment plan for participants to learn about specific diagnoses, ask questions, and provide advice. | January 11, 2023 |
| Session 2: Partnerships Between Payer and Providers: Key to Improved Quality Outcomes for Patients and Families within a Patient-Centered Medical Home Care is easy for the child and family to obtain, including geographic access and insurance accommodation Session Objectives: - Describe how the standards of PCMH are foundational to improving quality, access to care, and care coordination. - Discuss how the partnerships between payers and providers can improve quality and reduce barriers to receiving necessary care for children. Speakers: Pat Spier, RN, and Stacy Chadwick, RN Pat Spier is a Registered Nurse with over 30 years of experience in a variety of areas of nursing which include hospital inpatient , home health, ambulatory care nursing in Internal Medicine as a clinical supervisor which focused on developing a care coordination model and ultimately a certified Patient-Centered Medical Home model for all of the primary care locations within that Health system. Pat’s current position is as Medical Home manager for Blue Cross Blue Shield of North Dakota. This role is to support primary care providers in North Dakota through a value-based program called BlueAlliance. This program is designed to promote prevention of illness and chronic disease management. Pat is one of the clinical contacts for participating providers in this program. Stacy Chadwick is a Registered Nurse with 28 years of experience in various aspects of the nursing field. She started her career in long-term care, then moved to acute care at West River Health Services, which is a Critical Access Hospital health system that also has 6 Rural Health Clinics in SW ND. Being in a rural setting allowed opportunities to provide patient care in many care settings including ED, Med/Surg, OB, Nursery, Surgery, etc. She transitioned to office nursing roles in 2007 in areas including Quality Improvement, Infection Control, Risk Management, Clinical Informatics, Population Health & Value-Based Care. She started with Blue Cross Blue Shield of North Dakota in August 2021 and is the Medical Home Quality Coordinator. Our team oversees & supports the quality components of the BlueAlliance & BlueAlliance Care+ value-based care programs. Case Presenter: Amanda Dahl, M.D. Diagnosis Focus Area: Congenital Hypothyroidism Dr. Dahl will provide an overview of a patient’s medical history and treatment plan for participants to learn about specific diagnoses, ask questions, and provide advice. Dr. Amanda Dahl is a Pediatric Endocrinology in Fargo ND. Dr. Dahl is originally from North Dakota and is happy to be back! She completed residency and fellowship training at Mayo Clinic in Rochester MN. She provides Pediatric Endocrinology outreach in East Grand Forks, Minot, and Bismarck. She performs detailed physical examinations such as pubertal assessments, growth velocity assessments, and specialized endocrine testing (including stimulation testing). She treats adrenal disorders, bone metabolism disorders, growth disorders (short stature), obesity, pituitary disorders, early/late puberty, thyroid dysfunction, type 1 and type 2 diabetes mellitus, and gender dysphoria. | January 25, 2023 |
| Session 3: Providing Continuous Care from Infancy to Adult Care The same primary care clinician cares for the child from infancy through young adulthood, providing assistance and support to transition to adult care Session Objectives: - Continuous care from birth to transition ages, including transitions to preschool and adulthood. - How providers can empower patients to take control of their own health Speaker: Danielle Hoff, RN, Program Administrator at Special Health Services Born and raised in North Dakota, Danielle currently resides in Bismarck, ND. She attended Dickinson State University where she graduated with a Bachelor of Science in Nursing and later obtained a Master of Science in Nursing with a concentration in Healthcare Informatics from the University of Mary. In addition, Danielle is currently earning her Doctorate in Nursing Practice with a focus in Nursing Organizational Leadership from the University of Mary with an expected graduation date of April 2023. Danielle has experience working as a nurse in a variety of settings including a Women’s Clinic, the operating room, and in public health. Danielle began her career in public health serving as the State Stroke and Cardiac Coordinator at the North Dakota Department of Health. She continued to expand her knowledge in public health as she transitioned to her current role as a Program Administrator and Assistant Unit Director for Special Health Services within the North Dakota Department of Health and Human Services. Case Presenter: Kari Casas, M.D. Diagnosis Focus Area: Metabolic Disease | February 8, 2023 |
| Session 4: Comprehensive Care for Children and Families Preventive, primary, and specialty care are provided to the child and family. Session Objectives: - Strategies for working across disciplinaries (specialists and PCP, information sharing) - What providers can do to ensure children are receiving necessary services - Using NDHIN to help coordinate care Speakers: Lisa Thorp, BSN, NDHIN Outreach Coordinator & Amy Burke, RN, Long-Term Follow-Up Coordinator, Newborn Screening Program Lisa has been a Registered Nurse for over 25 years with experience in a Critical Access Hospital cross-trained in all inpatient settings, as well as ER. She was a Clinic Nursing Supervisor for a Rural Health Clinic for several years and later managed an accredited Diabetes Education program and during that time received diabetes education certification. She joined Quality Health Associates of ND as a Quality Improvement Specialist in 2017 and she leads the quality care coalition work, as well as subcontracting with NDHIN as Outreach Coordinator. She has been leading the NDHIN training since 2020. Amy Burke is a Registered Nurse with 23 years of experience in Maternal/Child health, 14 of which were bedside nursing in Labor & Delivery. For the past 5 years, Amy has been working to develop a follow-up program for families of children who are identified with health conditions through the newborn screening process. No other program like this currently exists in the United States. Amy has a passion for helping families navigate the often confusing world of health care, insurance and community resources. Case Presenter: Jerrica Maxson, Audiologist & Nicole Swartwout Diagnosis Focus Area: Hearing Loss Jerrica Maxson, AuD is a Doctor of Audiology, working at Trinity Health since 2010. She provides hearing assessments and treatment options for those with hearing differences from birth to adult. Her clinical interests include pediatric audiology, cochlear implant programming, and fitting/management of hearing aids for children and adults. She is a Minot native who received her doctorate at the University of Iowa and worked as a pediatric cochlear implant audiologists at St. Louis Children’s Hospital before joining the team at Trinity Health. She has served as a board member of the North Dakota Hands & Voices chapter since institution in 2011. Nicole Swartwout is a Masters trained Teacher of the Deaf and Hard-of-Hearing as well as an Early Childhood Special Educator currently employed by the ND School for the Deaf where she has been part of NDSD’s Outreach Team, working as a Parent-Infant and School Age Outreach Specialist for the past 16 years. She has also been the Coordinator for NDSD for the past year and a half. Nicole is an adjunct professor in the Special Education Department at Minot State University where her office is located as well as Indiana State Universtiy. | February 22, 2023 |
| Session 5: Compassionate Care- Strategies for How to Have Difficult Conversations Genuine concern for the well-being of a child and family are emphasized and addressed. Session Objectives: - How to have difficult conversations with patients - Trauma-informed care delivery Speaker: Amy Gaviglio, Genetic Counselor/Consultant for the Association of Public Health Laboratories & CDC Amy Gaviglio is a certified genetic counselor and founder of Connetics Consulting, which provides public health genetics, genomics, and rare disease services across the country and has been working in the newborn screening and rare disease space for the past 15 years. Amy currently works with the Centers for Disease Control and Prevention’s Newborn Screening and Molecular Biology Branch, the Association of Public Health Laboratories (APHL), Expecting Health, and several other genetics and rare disease organizations. She is co-chair of APHL’s New Disorders in Newborn Screening workgroup and is a member of additional national groups including the Legal & Legislative Issues in Newborn Screening workgroups, the Rare Disease Diversity Coalition, and EveryLife Foundation’s Community Congress. She also serves as an Advisor for the Midwest Genetics Network and the Innovations in Newborn Screening Interoperability Center. Finally, Amy serves as Chair of the NBS Expert Panel for the Clinical and Laboratory Standards Institute and is currently the Chair of Minnesota’s Rare Disease Advisory Council. Case Presenter: Ana Tobias, M.D., Maternal Fetal Medicine Diagnosis Focus Area: Prenatal and Postnatal Diagnosis | March 8, 2023 |
| Session 6: Coordinator Care- Neurodevelopmental and Care Coordination Needs of Children with Congenital Heart Disease Genuine concern for the well-being of a child and family are emphasized and addressed. Session Objectives: - Recognize neurodevelopmental and psychosocial phenotype in CHD survivors. - Define Health-Related Quality of Life. - Describe the recommended neurodevelopmental guidelines. - Discuss associated neurodevelopmental/neurocognitive outcomes Speaker: Bradley S. Marino, MD, MPP, MSCE, MBA Cleveland Clinic Bradley S. Marino, MD, MPP, MSCE, MBA is the Chair of the Department of Pediatric Cardiology at Cleveland Clinic Children's and the Executive Co-Director of the Pediatric and Adult Congenital Heart Center at Cleveland Clinic. Dr. Marino is an internationally recognized pediatric cardiovascular outcomes researcher. His research interests have focused on the impact of surgical and intensive care unit factors on mortality and morbidity, as well as, the impact of neurodevelopmental, psychosocial, and physical morbidities on quality of life, functional status, and behavioral and emotional outcomes in the high-risk complex congenital heart disease population. He is also pursuing novel investigations on the impact of neurodevelopmental health on cardiovascular health in the young. Case Presenter:Carlos D Miranda, MD MS Sanford Health Diagnosis Focus Area: Congential Heart Disease | March 22, 2023 |
| Session 7: Health Equity and Providing Culturally Effective Car The family and child's culture, language, beliefs, and traditions are recognized, valued, and respected. Session Objectives: - Understand the foundations of Health Equity - Barriers NFI communities may face Speaker: Amy Gaviglio, Genetic Counselor/Consultant for the Association of Public Health Laboratories & CDC Amy Gaviglio is a certified genetic counselor and founder of Connetics Consulting, which provides public health genetics, genomics, and rare disease services across the country and has been working in the newborn screening and rare disease space for the past 15 years. Amy currently works with the Centers for Disease Control and Prevention’s Newborn Screening and Molecular Biology Branch, the Association of Public Health Laboratories (APHL), Expecting Health, and several other genetics and rare disease organizations. She is co-chair of APHL’s New Disorders in Newborn Screening workgroup and is a member of additional national groups including the Legal & Legislative Issues in Newborn Screening workgroups, the Rare Disease Diversity Coalition, and EveryLife Foundation’s Community Congress. She also serves as an Advisor for the Midwest Genetics Network and the Innovations in Newborn Screening Interoperability Center. Finally, Amy serves as Chair of the NBS Expert Panel for the Clinical and Laboratory Standards Institute and is currently the Chair of Minnesota’s Rare Disease Advisory Council. Case Presenter: TBD Diagnosis Focus Area: Cystic Fibrosis | April 5, 2023 |
