Community Spotlight: VCHIP

For Vermont Child Health Improvement Program (VCHIP), expertise, passion, and collaboration are the backbone of their work to support children, youth, and families in Vermont.

Vermonters are known for looking out for each other. In a small state with a big heart, collaboration and communication are essential to helping communities thrive. Those same traits are central to the mission and success of the Vermont Child Health Improvement Program (VCHIP).

Housed in the Larner College of Medicine at the University of Vermont, VCHIP is a population-based family and child health quality improvement and research program. Since 1999, the organization has focused on supporting child health professionals, building trust, and connecting clinical and policy partners. What began as a single project focused on preventive services for young children has grown into more than a dozen initiatives spanning ages, settings, and child health priorities across the state.

VCHIP’s mission is to improve the health outcomes for Vermont’s children and their families by using collaborative, measurement-based efforts to advance health care delivery and public health systems. One way the organization fulfills this vision is through its Childhood Chronic Care Initiative, which first identifies children who meet specific criteria, such as seeing three or more subspecialists or experiencing frequent hospital admissions or emergency department visits. From there, the team works backward to ensure those children have primary care, subspecialty services, and community-based support they need to stay healthy.

This population requires extensive services and coordination across health care, education, and social systems. VCHIP works to improve the system of support for the children’s families, who navigate medical, emotional, financial, and systemic challenges all at once.

Breaking down silos with shared plans of care

These children and supported families often sit at the center of complex systems that don’t naturally communicate with one another. VCHIP’s strength lies in understanding those systems and bringing them together.

“When those barriers persist, we see fragmentation in care and gaps in communication across teams,” said Alyssa Consigli, project director and quality improvement coach at VCHIP.

This is also true for UVM Children’s Hospital, whose goal is “to be the hospital without walls,” said Keith Robinson, MD, lead faculty for the CCCI project at VCHIP and Vice Chair of Quality Improvement and Population Health for UVM Children’s Hospital.

Dr. Robinson explained, “We are a children’s hospital that is not confined to just one building here in Burlington because we really try to improve access to specialists in the community. VCHIP helps us do that through their natural partnerships with primary care practices and through the improvement methodology that they use. VCHIP adds huge value by thinking about systems that surround both practitioners in the primary care setting and families. I think the children’s hospital heavily relies on VCHIP to make sure that we are truly the children’s hospital without walls.”

To address ongoing fragmentation across systems, VCHIP established an early partnership with VITL, Vermont’s nonprofit health data sharing network.

“We wanted to bring partners together to build a shared understanding and identify opportunities for improvement,” said Alyssa. VCHIP invited VITL to listen and observe as clinicians, patients, and families shared both challenges and successes.

“Through listening sessions, we learned clinicians were using multiple disconnected systems,” Alyssa said. “It became clear we needed to better leverage technology, and VITL was a natural fit.”

Through these conversations, an idea developed that technology could facilitate coordination around and access to shared plans of care. 

While full interoperability remains a long-term goal, VCHIP focused on what could be done with existing tools such as VITLAccess, which provides health care providers with secure, web-based access to health records for most Vermonters. “Over many years, we had ongoing conversations about what it would look like to co-create new functionality in VITLAccess to better support care teams,” Alyssa said. “As teams develop shared plans of care, this functionality allows them to upload and share those plans across care teams in different practices.”

Better connections through technology

Shared plans of care helped reduce silos, improve communication, and better support patients and families, while also generating insights to improve care quality, patient experience, and cost.  “Children and families often rely on multiple providers, and having shared plans of care that connect care teams across the community can have a significant impact,” said Michelle Rovnak, project coordinator, VCHIP. Moving away from faxing and paper-based processes created new efficiencies and fewer missed opportunities.

Without technology, communication often falls on families. “Families are often asked to repeat their stories across multiple settings,” said Alyssa. “That experience is understandably frustrating and highlights opportunities to improve coordination.” With VITLAccess, care teams are better connected, allowing families to experience more coordinated support across organizations.

The approach has also driven clinical improvements. “I think the important word in the shared plan of care is ‘shared,’” said Dr. Robinson. “That means sitting down with a patient, family, and primary care provider and to identify their major concerns and jointly develop goals for a care plan.”

The collaboration between VCHIP and VITL and the results experienced by UVM Children’s Hospital highlights what’s possible when committed partners come together around a shared purpose. “This project shows how much can come from planting a small seed, maintaining momentum, and testing small changes over time,” said Alyssa.

To learn more about the important work VCHIP is doing in Vermont, please visit https://www.uvm.edu/larnermed/vchip.