aap chapter quality network maine aap asthma pilot project augusta, maine april 9, 2010
TRANSCRIPT
AAP Chapter Quality Network Maine AAP Asthma Pilot Project
Augusta, Maine
April 9, 2010
Introductions
National AAP– Judy Dolins, MPH, Laura Conley, MHSA, Peter
Margolis, MD, MPH
Maine AAP– Amy Belisle, MD, Aubrie Entwood, Barbara
Chilmonczyk, MD, Mike Ross, MD, Rhonda Vosmus, RRT-NPS, AE-C, Paula Gilbert, Kathryn Engel
Asthma EducatorsPractice Teams
Participating Practices
• Kennebec Pediatrics, Augusta• Franklin Health Pediatrics,
Farmington• Lake Region Pediatrics,
Windham• Maine Coast Pediatrics,
Ellsworth• Intermed Pediatrics, Portland
and Yarmouth• Bowdoin Pediatrics,
Brunswick• BBCH Pediatric Clinic,
Portland• CMMC Pediatrics, Lewiston
Medical Home Sites• Husson Pediatrics, Bangor• Winthrop Pediatrics• Westbrook Pediatrics
• Allergy and Asthma Associates of Maine
Objectives of Today’s Meeting
• Review Goals for National and State AAP• Highlight First 90 Days of Project• Review March Data for Maine• Discuss QI Sustainability at Chapter and
National Level• Introduce Groups to Motivational Interviewing• Continue work with Asthma Educators and
Self Management Support• Learn the Value of Spirometry• Create 90 Day Goals
Games
• Prize for “Best Theme Song” for Project• Prize for “Best Slogan” for Pilot• Prize for “Asthma Device” Worksheet• Prize for Physicians who read all 5
Spirometry cases properly• Prize for Groups with a New Registry since
the Pilot started- Maine Coast and CMMC
Chapter Quality Network (CQN)
Asthma Pilot ProjectOur First Six Months
Amy Belisle, MDPhysician Leader, Maine AAP
Judy Dolins, MPHDirector, Department of Community Chapter and State
Principle Investigator, Chapter Quality Network Asthma Pilot Project
Amy Belisle’s DisclosureI have no relevant financial relationships with the
manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME
activity.
Disclosure Statement
Judy Dolin’s DisclosureI have no relevant financial relationships with the
manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME
activity
National goals at the practice level
Changes in asthma care practices and child health outcome
Successful implementation of practice system change
Clinician investment and commitment to quality improvement work
Transparency and sharing of improvement data
Increased clinician demand for CQN programming
National goals at the chapter level Increased capacity for quality improvement
work
Governance group engagement
Sustain QI work at the chapter level
Key partnerships focused on improvement work
Funding for continued quality efforts
Increased chapter demand for CQN programming
Improvement Work
Improvement WorkImprovement WorkContinuous tests
of change
SustainabilitySustainabilityImbed in everyday work
Scale Up & SpreadScale Up & SpreadTaking local improvement
And actively disseminating itacross a chapter and/or practice
Our First 6 months
CQN Asthma Pilot Sites MAINE
OHIO
OREGON
ALABAMA
How are we doing at the National Level?
Practice System Changes
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MD NP
National Maine
Percent of eligible providers collecting data at point of care
How are we doing at the National Level?
Practice System ChangesRegistry Implementation Status
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Practices with a Registry Practices without aregistry
National
Maine
How are we doing at the National Level?
Practice System ChangesOptions for Practices without a Registry
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Using an Excel database asalternative
Actively discussing/ exploringregistry
Not discussing/ exploringregistry
National Maine
How are we doing at the National Level?
Practice System ChangesDegree of belief that workflows for collecting data for eligible patients/opportunities at point of care are highly reliable
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
High Moderate Low
National
Maine
How are we doing at the National Level?
Measures of Asthma Care Practices and Health Outcome
Key Measure Goal Alabama Maine Ohio OregonNational Average
% of patients with 1 or more asthma-related ED or Urgent Care Visits within the past 12 months 0% 21% 20% 35% 24% 25%
% of patients with 1 or more hospitalizations within the past 12 months 0% 5% 4% 7% 6% 6%
% of patients well controlled 90% 57% 68% 64% 51% 60%
% of patients with optimal asthma care 90% 75% 71% 71% 80% 74%
% of patients with key asthma indicators used when considering an asthma diagnosis 90% 91% 96% 80% 75% 86%
% of patients ages 5 and older in which spirometry is used to establish a asthma diagnosis 90% 63% 61% 61% 56% 60%
% of patients in which a validated instrument is used to determine the current level of asthma control 90% 99% 93% 99% 99% 98%
% of patients in which reasons for lack of asthma control is identified when asthma control is "not well controlled" or "very poorly controlled" 90% 96% 100% 94% 93% 96%
% of patients ages 5 and older where spirometry is scheduled to be tested or results have been obtained within the last 1-2 years 90% 59% 62% 67% 64% 63%
% of patients in which the stepwise approach is used to identify treatment therapy and adjust or maintain therapy based on asthma control 90% 99% 97% 99% 98% 98%
% of patients with asthma ages 6 months and older who have received a flu shot or flu shot recommendation within the past 12 months 90% 93% 98% 93% 94% 95%
% of patients who have a current written asthma action plan explained to them at this visit 90% 82% 78% 79% 85% 81%
% of patients in which self-management education materials (in addition to the asthma action plan) are provided and explained to the patient and family 90% 81% 84% 83% 74% 81%
% of patients for whom a follow-up appointment to monitor asthma control is recommended 90% 95% 89% 94% 95% 93%
Optimal Care
>70% 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)
Optimal Asthma Care
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Maine = 71%
Self-Management
Maine = 84%
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Use of a Validated Instrument
Maine = 93%
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Hospitalizations
Maine = 4%
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Patients Well-Controlled
Maine = 68%
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
CQN-MAINECQN-MAINE
Franklin Health Pediatrics-Farmington
Intermed Pediatrics-Portland
BBCH Pediatric Clinic- Portland
Allergy and Asthma Associates-Portland
Westbrook Pediatrics-Westbrook
Maine Coast Pediatrics-Ellsworth
Bowdoin Medical Group-Brunswick
Husson Pediatrics-Bangor
Lake Region Primary Care-Windham
Kennebec Pediatrics-Augusta
Winthrop Pediatrics-Winthrop
CMMC Pediatrics,Lewiston
Global Aim
Specific Aim
Maine’s Aim Statement
Global AimWe will build a sustainable quality improvement infrastructure within our chapter to achieve measurable improvements in the health outcomes of children within our member practices.
Specific AimFrom April 2009 to November 2010, we will lead a quality improvement collaborative and achieve measurable improvements in asthma outcomes with the participating 10 to 15 practices by improving use of the NHLBI/NAEPP guidelines and the documentation of quality care.
Maine’s Aim Statement
Goal: 90% of practices will achieve 70% optimal care on patients seen by September 2010.
Goal: 90% of practices use a structured electronic or paper asthma encounter tool 80% of the time by September 2010.
Outcome Goal: 90% of practices will have at least a yearly ACT score documented in 50% of their patients > 4 years old by September 2010.
Maine’s Aim Statement: Long Term Goals
Goal: All practices involved in this collaborative will continue to use a population based registry beyond the time of this grant.
Goal: The AH! Asthma Health evidence based asthma tools will be used by member practices.
Goal: Certified asthma educators will be available to all member practices.
Goal: A committee of AAP members experienced in quality improvement will be charged with infrastructure development in the organization; this will include identifying funding sources for activities. We will have semiannual reporting of QI activities at Maine AAP Fall and Spring conferences for all of its members.
Goal: The Maine AAP will partner with MaineHealth, MaineCare, the Maine CDC, Maine based Health Insurers and other organizations interested in child health improvement (such as the Maine Lung Association, the Maine Immunization Collaborative or the Maine Children's Association) to develop a sustainable approach to quality improvement in our organization.
27
Maine’s First 90 Days
Spread work of AH! Program in Maineto all 4 AAP groups
Sent Asthma Flip Charts (750) Tool kits (55) Medication Charts (214)
Learning Sessions at CMMC (Sept) Teleconference in January
Engaged statewide asthma educators in project- 4 Attended Learning session and 25 aware of project
Maine’s First 90 Days
Coached practices on data and PDSA cycles- 100% of groups submitted 1st PDSA on time
Communicated with Senior Leadership- 45 letters sent out to leadership of practices regarding project and need for registry; 5 monthly newsletters sent out
Identified ACT form for kids less than 4: TRACKhttp://www.asthmatracktest.com/
Worked with Patient Centered Medical Home Committee to Identify Asthma Quality Indicators
Started to form state AAP QI Committee
Updated asthma encounter forms- both paper and electronically
Updating EMR forms
• One of challenges is looking at different EMRs in state and figuring out how we can work together to incorporate NHLBI asthma guidelines and EQIPP measures into the templates
• By updating templates, would help us collect data from all physicians in group including those not doing EQIPP
• Logician, EPIC, Allscripts, EClinicalworks, etc.• Husson Pediatrics (Logician/Meridios), Mike Ross, MD:
– Used Cincinnati Children’s for a physical template– Added aspects from Ah!Asthma form, CAQI encounter form, and GE-
CCC-asthma.– Added specific obs terms to interface with our registry– 2-tabbed form:
Asthma follow-up & Asthma diagnosis
Stepwise Approach
Maine Chapter
0%10%20%30%40%50%60%70%80%90%
100%
256 281 304 255 293 304 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Maine = 97%
Flu Shot Recommendation
Maine Chapter
0%10%20%30%40%50%60%70%80%90%
100%
254 281 304 255 293 304 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Maine = 98%
Asthma Action Plan
Maine Chapter
0%10%20%30%40%50%60%70%80%90%
100%
197 281 304 255 293 304 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Maine = 78%
Spirometry
Maine Chapter
0%10%20%30%40%50%60%70%80%90%
100%
105 281 304 255 293 304 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Maine = 62%
Maine’s 90 Day GoalsFeb 2010-April 2010
• 1. Develop QI committee with Maine AAP• 2. Work on spirometry/peak flow implementation• 3. Organize Learning Session 3- April 9th in
Augusta• 4. Increase monthly EQIPP entries by 10% each
month for the next 3 months• 5. Have 75% of practices with a registry by May
2010
Asthma Care a Year From Now
• Healthier patients and empowered families• Engaged providers and staff employing asthma guidelines
including physicians not involved in EQIPP, encourage “spread” within practice
• Utilizing electronic records to improve quality• Efficient office systems that benefit from planned care• Reduced cost• Continue Partnerships with PCMH & Maine Asthma Council• Engage Senior Leaders and Healthcare Organizations• Reach out to Northern Maine and Family Practice groups to
spread Asthma QI• Close the Quality Gap and provide the best care for every
patient, every time