Post on 24-Feb-2016
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Improving Asthma Care Holger Link, M.D.
Carrie Phillipi, M.D., Ph.D. Art Jaffe, M.D.
Outline• Why You do Care • Building teams and partnerships to improve
patient outcomes• The Doernbecher Experience
Why You Do Care
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How can we partner with our patients and others to
achieve better outcomes?
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in improvement?
Act Plan
Study Do
AsthmaNurseEducators
AsthmaEducationPackets
DischargeEducationChecklist
What is Chapter Quality Improvement?
The involvement of AAP chapters in state and/or local activities aimed at improving the quality of care for children. These activities involve measurement and the collection of data over time to assess changes in practice performance.
Pediatric Member
Practices
State PartnersPublic Health,
Payors, Children’s hospitals
American Academy of PediatricsChapters
Improve Children's’ Health
Key Players• American Academy of Pediatrics
- Project Lead• Cincinnati Children’s Hospital Medical
Center- QI expertise and coaching• 4 Chapters- Alabama- Maine- Oregon- Ohio• 49 practices• 282 Clinicians
• Sandra Miller
• Theresa Rice
• Holger Link & Carrie Phillipi
• Arthur Jaffe (OPS)
The Oregon Chapter Team
Peace Health Medical Group RiverbendPeace Health Medical Group BargerPeace Health Medical Group SouthPeace Health Medical Group DowntownHillsboro PediatricsSouthern Oregon PediatricsOregon Medical Group Garden WayChildhood Health Associates of SalemLegacy Emanual Childrens ClinicDoernbecher PediatricsDoernbecher Pediatrics Westside
The Oregon Practices
CQN Asthma Pilot Project MAINE
OHIO
OREGON
ALABAMA
11 Practices
13 Practices
13 Practices
12 Practices
49 Practices282 Clinicians
Improvement Methods
How are we doing at the National Level?Practice System Changes
Registry Implementation Status
0%
10%
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90%
100%
Practices with a Registry Practices without aregistry
NationalOregon
How are we doing at the National Level?Practice System Changes
Options for Practices without a Registry
0%
10%
20%
30%
40%
50%
60%
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80%
90%
100%
Using an Excel database asalternative
Actively discussing/ exploringregistry
Not discussing/exploringregistry
National Oregon
Commitment to Quality as a result of CQN Participation
No change in my
commitment to QI, 9%
No Change in my commitment to QI work, 9%
More committed to QI work, 91%
Chapter Team Perspective: Value of Program Components
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sharedlearning
Serving as a QILeader
Improvementexpertise
Data Reports Assistancefrom National
ABP Part IV CME Credit
5 (very valuable) 4 3 2 1 (Not Valuable)
Improvement Work
Improvement WorkContinuous tests
of change
SustainabilityImbed in everyday work
Scale Up & SpreadTaking local improvement
And actively disseminating itacross a chapter and/or practice
Our First 6 months
Our DCH Experience
Art JaffeJulie JohnsonLisa JohnsonEveryone on the Gen Peds Clinic Team
GOALS
• Describe structure and process• Discuss our local focus• Show baseline data• Choosing PDSA’s and tracking results• Successes and challenges• The future: sustainability and generalizability
GLOBAL CQN AIMWe will build a sustainable quality improvement infrastructure within our practice to achieve measurable improvements in asthma outcomesSpecific Aim From fall 2009 to fall 2010, we will achieve measurable improvements in asthma outcomes by implementing the NHLBI guidelines and making CQN’s key practice changes
Measures/Goals
Outcome Measures: >90% of patients well controlled
Process Measures >90% of patients have “optimal” asthma care (all of the following) assessment of asthma control using a validated instrument stepwise approach to identify treatment options and adjust therapy written asthma action plan patients >6 mos. Of age with flu shot (or flu shot recommendation)
>90% of practice’s asthma patients have at least an annual assessment using a structured encounter form
Engaging Your QI Team and Your Practice*The QI team and practice is active and engaged in improving practice processes and patient outcomes
Using a Registry to Manage Your Asthma Population *Identify each asthma patient at every visit *Identify needed services for each patient *Recall patients for follow-up
Using a Planned Care Approach to Ensure Reliable Asthma Care in the Office * CQN Encounter Form * Care team is aware of patient needs and
work together to ensure all needed services are completed
Developing an Approach to Employing Protocols * Standardize Care Processes * Practice wide asthma guidelines
implemented
Providing Self management Support
* Realized patient and care team relationship
Key Drivers
Interventions
Form a 3-5 person interdisciplinary QI Team
Formally communicate to entire practice the importance and goal of this project
Meet regularly to work on improvement
All physicians and team members complete QI Basics on EQIPP
Collect and enter baseline data
Generate performance data monthly
Communicate with the state chapter and leaders within the organization
Turn in all necessary data and forms
Attend all necessary meetings and phone conferences
Select and install a registry tool
Determine staff workflow to support registry use
Populate registry with patient data
Routinely maintain registry data
Use registry to manage patient care & support population management
Select template tool from registry or create a flow sheet
Determine workflow to support use of encounter form at time of visit
Use encounter form with all asthma patients
Ensure registry updated each time encounter form used
Monitor use of encounter form
Select & customize evidence-based protocols for your office
Determine staff workflow to support protocol, including standing orders
Use protocols with all patients
Monitor use of protocols
Obtain patient education materials
Determine staff workflow to support SMS
Provide training to staff in SMS
Assess and set patient goals and degree of control collaboratively
Document & Monitor patient progress toward goals
Link with community resources
CQN Asthma Project Practice Key Driver Diagram Version 2.0
Base-line: % Well-controlled (visits vs patients?)
Base-line: % Well-controlled (visits vs patients?)
OOPS!
No data reported back from AAP!!
% Well-controlled Through July, 2010
DCH General Pediatrics Clinic Oregon
Base-line: % Optimal Care
DCH General Pediatrics Clinic Oregon
Drilling Down On Optimal Care
Validated Instrument Step-wise Approach to Care
Drilling Down On Optimal Care
Flu shot given or recommended Use of Asthma Action Plan
Targets of Opportunity
1. Validated Instrument- ACT and TRACK forms
2. Asthma Action Plan- PDSA iterations of plans- EPIC issues- The saga continues
Optimal Care: Good News in June!!!
DCH General Pediatrics Clinic Oregon
And then there was July
DCH General Pediatrics Clinic Oregon
The Future
• Sustainability- What happens when the project ends?
• Generalizability- Asthma management throughout Oregon- Chronic care management in DCH
• Registry- Management of populations, not patients- Clinical care vs. research data base- Options for all of us