ICAP Project ICAP Project ICAP Project ICAP Project Orientation, Orientation, Orientation, Orientation, Metric Metric Metric Metric Evidence, & QIDA IntroductionEvidence, & QIDA IntroductionEvidence, & QIDA IntroductionEvidence, & QIDA IntroductionJULY 31, 2014JULY 31, 2014JULY 31, 2014JULY 31, 2014

SLIDE USED WITH PERMISSION FROM K PARIKH, E BIONDI, AND D WILLIAMS, “VIP NETWORK ICAP PROJECT ORIENTATION, METRIC EVIDENCE, AND QIDA

INTRODUCTION ” ORIGINALLY PRESENTED 7/31/14 TO THE VIP NETWORK ICAP QI PROJECT TEAMS

AgendaAgendaAgendaAgendaAgenda Item Speaker Time

Welcome and Introductions Faiza Khan 5 min

Project Overview/Teams Eric Biondi, MD

Kavita Parikh, MD

10 min

Inclusion/Exclusion Criteria Kavita Parikh, MD 5 min

Metric Evidence Derek Williams, MD 20 min

Overview of Chart Review Tool Kavita Parikh, MD 5 min

Brief Introduction to QIDA Lori Morawski 5 min

Questions and Answers All 10 min

ICAP WelcomeICAP WelcomeICAP WelcomeICAP Welcome

Improving care for pediatric patients with CAP across the county

Individual and community impact

4

53 Teams Accepted into ICAP in 26 53 Teams Accepted into ICAP in 26 53 Teams Accepted into ICAP in 26 53 Teams Accepted into ICAP in 26 States and PakistanStates and PakistanStates and PakistanStates and Pakistan

3 sites

1 site

1 site

1 site

1 site

5 sites

Indiana: 2 sites

2 sites

2 sites

2 sites

2 sites

1 site Massachusetts: 2 sites

Maryland: 2 sites

New Jersey: 1 site

4 sites

3 sites

West Virginia: 1 site

Virginia: 4 sites

Pennsylvania: 2 sites

South Carolina: 1 site

1 site

Tennessee: 1 site

Vermont: 1 site

Pakistan: 1 site

1 site

4 sites

How will we manage this large How will we manage this large How will we manage this large How will we manage this large collaborative?collaborative?collaborative?collaborative?

Listserv

Coaches

Email/Phone

Meet Deadlines

ICAP CoachesICAP CoachesICAP CoachesICAP CoachesJoanne Nazif – ICAP Project Lead Coach

JNAZIF@montefiore.org

Matthew D Garber, MD, FHM FAAPMatthew D Garber, MD, FHM FAAPMatthew D Garber, MD, FHM FAAPMatthew D Garber, MD, FHM FAAP

University of South Carolina

Michael P Koster, MD FAAPMichael P Koster, MD FAAPMichael P Koster, MD FAAPMichael P Koster, MD FAAP

Rhode Island Hospital

JoAnnaJoAnnaJoAnnaJoAnna K K K K LeyenaarLeyenaarLeyenaarLeyenaar, MD , MD , MD , MD

Tufts Medical Center

Michelle M Marks, DO FAAPMichelle M Marks, DO FAAPMichelle M Marks, DO FAAPMichelle M Marks, DO FAAP

Cleveland Clinic Foundation

Russell J Russell J Russell J Russell J McCullohMcCullohMcCullohMcCulloh, MD FAAP, MD FAAP, MD FAAP, MD FAAP

Children's Mercy Hospitals & Clinics

Vineeta Mittal, MDVineeta Mittal, MDVineeta Mittal, MDVineeta Mittal, MD

Children's Medical Center Dallas

Angela L Myers, MD, MPH FAAPAngela L Myers, MD, MPH FAAPAngela L Myers, MD, MPH FAAPAngela L Myers, MD, MPH FAAP

Children's Mercy Hospital/PedsID

Mary Ann Queen, MD FAAPMary Ann Queen, MD FAAPMary Ann Queen, MD FAAPMary Ann Queen, MD FAAP

University of Missouri at Kansas City School of Medicine

Shawn Shawn Shawn Shawn L Ralston, MD FAAPL Ralston, MD FAAPL Ralston, MD FAAPL Ralston, MD FAAP

Dartmouth-Hitchcock Medical Center

Emily A Emily A Emily A Emily A ThorellThorellThorellThorell, MD, MSCI FAAP, MD, MSCI FAAP, MD, MSCI FAAP, MD, MSCI FAAP

University of Utah Health Care

IlanaIlanaIlanaIlana WaynikWaynikWaynikWaynik, MD, FAAP , MD, FAAP , MD, FAAP , MD, FAAP

Connecticut Children’s Medical Ctr/Peds

Derek Derek Derek Derek J Williams, MD, MPH FAAPJ Williams, MD, MPH FAAPJ Williams, MD, MPH FAAPJ Williams, MD, MPH FAAP

Vanderbilt University School of Medicine

Jason G Newland, MD, MEd FAAPJason G Newland, MD, MEd FAAPJason G Newland, MD, MEd FAAPJason G Newland, MD, MEd FAAP

Children's Mercy Hospital

Natalia L Paciorkowski, MD, PhD FAAPNatalia L Paciorkowski, MD, PhD FAAPNatalia L Paciorkowski, MD, PhD FAAPNatalia L Paciorkowski, MD, PhD FAAP

Rochester General Hosp/Peds

Important Next Steps…Important Next Steps…Important Next Steps…Important Next Steps…Due dateDue dateDue dateDue date Next StepsNext StepsNext StepsNext Steps

ASAP Submit Pre-Project Survey via SurveyMonkey

Next 10 days Set up a time-table for meeting (integrated staff meet-ups, huddles, etc.) as

a core improvement team throughout this project

Next 10 days Review Orientation Packet PDF (sent out as a hyperlink this week)

Next 14 days Receive your Project Coach Assignment and touch base with your assigned

coach regarding your progress

August 28, 2014 Participate in Webinar 2: QI Orientation & Change Package Part 1, 10AM

PT/11AM MT/12Noon CT/1PM ET

August 29, 2014 Pending Final Approval: Submit ABP MOC Part 4 paperwork to Faiza Khan to

express interest in site participation in seeking ABP MOC Part 4 credit for

physicians at your site

August 31, 2014 Submit Baseline Data into QIDA (Cycle 1: Sept-Nov. 2013, Cycle 2: Dec 2013-

Feb 2014 & Cycle 3: March-May 2014)

How were Metrics Derived?How were Metrics Derived?How were Metrics Derived?How were Metrics Derived?

Expert Group Consensus:Expert Group Consensus:Expert Group Consensus:Expert Group Consensus:

• Kavita Parikh, MD

• Shawn Ralston, MD

• Eric Biondi, MD

• Joanne Nazif, MD

• Mary Ann Queen, MD

• Ricardo Quinonez, MD

• Derek Williams, MD

• Samir Shah, MD

Establishing MetricsEstablishing MetricsEstablishing MetricsEstablishing Metrics

1. Antibiotic Selection

2. Macrolide Utilization

3. CBC Utilization

4. Radiologic Imaging

5. Concurrent Asthma diagnosis with CAP

6. Blood Culture Utilization

Establishing MetricsEstablishing MetricsEstablishing MetricsEstablishing Metrics

Evidence-based best practices

Not exclusively based on IDSA guidelines

Targets established by group consensus

Inclusions and Inclusions and Inclusions and Inclusions and ExclusionsExclusionsExclusionsExclusions

Inclusions Exclusions

• Diagnosis (in any position) of

pneumonia (ICD9 codes: 481,

482.0, 482.2-.42, 482.89-.9, 485,

486)

• ICU care during admission

• Age 3 months to 18 years • Mechanical ventilation/Intubation

• Admitted to your hospital • Co-morbid conditions predisposing

to severe or recurrent respiratory

illness, including genetic,

congenital, chromosomal,

neuromuscular, or

neurodevelopmental abnormalities.

• Discharged from your hospital • Transfer to or from your hospital

• Received either a full inpatient

course of antibiotics or was

discharged to complete a full

course of antibiotics for CAP

• Any pleural drainage procedure

481 Pneumococcal pneumonia (s. pneumoniae) Pneumococcal Pneumonia

482.0 Pneumonia due to Klebsiella Pneumonia due to other bacteria

482.2 Pneumonia due to H.influnzae H. Flu Pneumonia

482.30 Pneumonia due to strep, unspecified Pneumonia due to Strep

482.31 Pneumonia due to strep, Group A Pneumonia due to Strep

482.32 Pneumonia due to strep, Group B Pneumonia due to Strep

482.39 Pneumonia due to other strep Pneumonia due to Strep

482.40 Pneumonia due to staph unspecified Pneumonia due to Staph

482.41 Methicillin susceptible pneumonia due to staph Pneumonia due to Staph

482.42 Methicillin resistant pnuemonia due to staph Pneumonia due to Staph

482.49 Other Staph pneumonia Pneumonia due to Staph

482.81 Pneumonia due to anaerobes Pneumonia due to other bacteria

482.82 Pneuomonia due to E.coli Pneumonia due to other bacteria

482.83 Pneumonia due to other gram negative bacteria Pneumonia due to other bacteria

482.89 Pneumonia due to other specified bacteria Pneumonia due to other bacteria

482.9 Bacterial pneumonia unspecified

Pneumonia due to unspecified

organism

485 Bronchopneumonia, organism unspecified

Pneumonia due to unspecified

organism

486 Pneumonia organism unspecified

Pneumonia due to unspecified

organism

Inclusion/Exclusion NotesInclusion/Exclusion NotesInclusion/Exclusion NotesInclusion/Exclusion Notes

Will use ICD9 codes to create chart poolWill use ICD9 codes to create chart poolWill use ICD9 codes to create chart poolWill use ICD9 codes to create chart pool

Will need chart review to verify inclusion and exclusions, Will need chart review to verify inclusion and exclusions, Will need chart review to verify inclusion and exclusions, Will need chart review to verify inclusion and exclusions, and include up to and include up to and include up to and include up to 20202020 charts per quarter in our samplecharts per quarter in our samplecharts per quarter in our samplecharts per quarter in our sample

Will not include viral and atypical PNA ICD9 codesWill not include viral and atypical PNA ICD9 codesWill not include viral and atypical PNA ICD9 codesWill not include viral and atypical PNA ICD9 codes

Will not include complicated PNA. Will not include Will not include complicated PNA. Will not include Will not include complicated PNA. Will not include Will not include complicated PNA. Will not include aspiration PNA.aspiration PNA.aspiration PNA.aspiration PNA.

Metric EvidenceMetric EvidenceMetric EvidenceMetric EvidenceDEREK WILLIAMS, MD, MPH

Metric #1: Narrow Spectrum AntibioticsMetric #1: Narrow Spectrum AntibioticsMetric #1: Narrow Spectrum AntibioticsMetric #1: Narrow Spectrum Antibiotics

Increase overall usage of narrow-spectrum antibiotics (e.g. ampicillin/penicillin G) for

inpatients with uncomplicatedCAP to 80% for eligible population

RationaleRationaleRationaleRationale

2011 PIDS/IDSA: Ampicillin or PCN G first-line for most children hospitalized with CAP (strong rec./mod. evidence)

S. pneumoniae remains most common bacterial cause of CAP(1)

Decrease in invasive pneumococcal infections and decrease in PCN-non-susceptible strains with PCV7/PCV13 (2,3)

Penicillin resistance not associated with treatment failure for non-CNS S. pneumoniae infections (4, 5)

Broader-spectrum antibiotics (e.g. ceftriaxone) used almost exclusively (>85% 2005-10) (6)

◦ Few head to head comparisons

171. Michelow I Peds 2004; 2. Pilishvili T JID 2010; 3. Kyaw MH NEJM 2006; 4: Dagan PIDJ 2001;

5. Weinstein MP CID 2009 6. Brogan PIDJ 2012

None of the outcomes studied favored OCG over ACG

Unmatched cohort: No differences in outcomes

Metric #2: Macrolide UseMetric #2: Macrolide UseMetric #2: Macrolide UseMetric #2: Macrolide Use

Decrease overall usage of macrolides for Decrease overall usage of macrolides for Decrease overall usage of macrolides for Decrease overall usage of macrolides for

inpatients with inpatients with inpatients with inpatients with uncomplicateduncomplicateduncomplicateduncomplicated CAP to:CAP to:CAP to:CAP to:

---- <5<5<5<5% for children under age % for children under age % for children under age % for children under age 5 years5 years5 years5 years

---- <25<25<25<25% for children age % for children age % for children age % for children age 5555----18 years18 years18 years18 years

RationaleRationaleRationaleRationale

2011 PIDS/IDSA: Combination therapy with macrolide for children in whom atypical pathogens are a “significant consideration” (weak rec./low evidence)

Distinguishing viral from atypical bacterial pathogen impossible based on clinical exam alone

◦ M. pneumoniae most common in school age children

◦ Endemic vs. epidemic

Macrolide use increasing among children (1,2)

◦ Increased use associated with antimicrobial resistance (3)

Questionable efficacy of macrolide therapy for atypical CAP

◦ Few prospective studies; many children recover without tx

211. Grijalva CG JAMA 2009; 2. Hersh A Peds 2011; 3. Hicks LA CID 2011

“We identified insufficient evidence to support or refute treatment of M. “We identified insufficient evidence to support or refute treatment of M. “We identified insufficient evidence to support or refute treatment of M. “We identified insufficient evidence to support or refute treatment of M.

pneumoniaepneumoniaepneumoniaepneumoniae in CAin CAin CAin CA----LRTI. These data highlight the need for wellLRTI. These data highlight the need for wellLRTI. These data highlight the need for wellLRTI. These data highlight the need for well----designed, designed, designed, designed,

prospective RCTs assessing the effect of treating M. prospective RCTs assessing the effect of treating M. prospective RCTs assessing the effect of treating M. prospective RCTs assessing the effect of treating M. pneumoniaepneumoniaepneumoniaepneumoniae in CAin CAin CAin CA----LRTI.”LRTI.”LRTI.”LRTI.”

MetaMetaMetaMeta----analysis of randomized trialsanalysis of randomized trialsanalysis of randomized trialsanalysis of randomized trials

Metric #3: CBC UseMetric #3: CBC UseMetric #3: CBC UseMetric #3: CBC Use

Decrease overall usage of complete Decrease overall usage of complete Decrease overall usage of complete Decrease overall usage of complete

blood counts for inpatients with blood counts for inpatients with blood counts for inpatients with blood counts for inpatients with

uncomplicated uncomplicated uncomplicated uncomplicated CAP CAP CAP CAP to less than 10%to less than 10%to less than 10%to less than 10%

RationaleRationaleRationaleRationale

2011 PIDS/IDSA: Complete blood counts should be obtained for those with severe pneumonia (weak rec./low evidence)

Complete blood counts obtained frequently among children hospitalized with acute infectious illness, >65%. (1) ◦ Rarely changes clinical management

◦ Potential source of waste/overuse

Association between high peripheral WBC count and bacterial pneumonia◦ Cut-offs are problematic

251. Brogan TV PIDJ 2012

“White “White “White “White blood blood blood blood cell indicators cell indicators cell indicators cell indicators are less valuable than inflammatory are less valuable than inflammatory are less valuable than inflammatory are less valuable than inflammatory markers for markers for markers for markers for ruling in ruling in ruling in ruling in

serious infection (positive likelihood serious infection (positive likelihood serious infection (positive likelihood serious infection (positive likelihood ratio 0.87ratio 0.87ratio 0.87ratio 0.87----2.432.432.432.43), and have no value for ruling out ), and have no value for ruling out ), and have no value for ruling out ), and have no value for ruling out

serious infection serious infection serious infection serious infection (negative likelihood ratio 0.61(negative likelihood ratio 0.61(negative likelihood ratio 0.61(negative likelihood ratio 0.61----1.141.141.141.14).”).”).”).”

On average, white cell counts higher in bacterial vs. viral infection; however, On average, white cell counts higher in bacterial vs. viral infection; however, On average, white cell counts higher in bacterial vs. viral infection; however, On average, white cell counts higher in bacterial vs. viral infection; however,

significant overlap exists which limits predictive powersignificant overlap exists which limits predictive powersignificant overlap exists which limits predictive powersignificant overlap exists which limits predictive power

Metric #Metric #Metric #Metric #4444: Radiologic Imaging: Radiologic Imaging: Radiologic Imaging: Radiologic Imaging

Uncomplicated CAP: Uncomplicated CAP: Uncomplicated CAP: Uncomplicated CAP:

----Decrease usage Decrease usage Decrease usage Decrease usage of of of of >1 CXR to <10%>1 CXR to <10%>1 CXR to <10%>1 CXR to <10%

Complicated CAP:Complicated CAP:Complicated CAP:Complicated CAP:

----Increase Increase Increase Increase usage of ultrasound to 10usage of ultrasound to 10usage of ultrasound to 10usage of ultrasound to 10%%%%

----Decrease Decrease Decrease Decrease usage of CT to 5%usage of CT to 5%usage of CT to 5%usage of CT to 5%

RationaleRationaleRationaleRationale

2011 PIDS/IDSA: CXR should be obtained in all hospitalized children with CAP…repeat CXRs are not routinely recommended among those improving clinically (strong rec./mod. evidence)

Chest radiographs offer valuable information ◦ Disease severity, complications, etc.(1)

Radiographic resolution often lags clinical improvement◦ Repeat radiographs rarely change management

◦ Significant clinical deterioration is the exception

Complicated CAP: Advanced imaging often useful◦ US similar/superior to CT; no ionizing radiation

291. McClain L JHM 2014

“CT detects “CT detects “CT detects “CT detects more more more more parenchymal abnormalities…the additional parenchymal abnormalities…the additional parenchymal abnormalities…the additional parenchymal abnormalities…the additional information does not alter information does not alter information does not alter information does not alter

management and management and management and management and is unable is unable is unable is unable to predict clinical to predict clinical to predict clinical to predict clinical outcome…omission outcome…omission outcome…omission outcome…omission of routine CT scanning in of routine CT scanning in of routine CT scanning in of routine CT scanning in

empyema will empyema will empyema will empyema will reduce the exposure of children to reduce the exposure of children to reduce the exposure of children to reduce the exposure of children to unnecessary radiation unnecessary radiation unnecessary radiation unnecessary radiation and reduce costsand reduce costsand reduce costsand reduce costs.”.”.”.”

31 children (8 mo-17 yr) with empyema who had CXR, CT, and US

10/25 with simple 10/25 with simple 10/25 with simple 10/25 with simple

consolidation on CXR had consolidation on CXR had consolidation on CXR had consolidation on CXR had

necrosis or cavitation on CT; necrosis or cavitation on CT; necrosis or cavitation on CT; necrosis or cavitation on CT;

findings findings findings findings ddddid not change id not change id not change id not change

management or predict management or predict management or predict management or predict

outcomeoutcomeoutcomeoutcome

19 children (8 mo-17 yr) with complicated pneumonia and parapneumonic effusion

ResultsResultsResultsResults

18/19 with effusion on CT and US18/19 with effusion on CT and US18/19 with effusion on CT and US18/19 with effusion on CT and US

LoculationLoculationLoculationLoculation: : : :

15/18 CT+, 13/18 US+15/18 CT+, 13/18 US+15/18 CT+, 13/18 US+15/18 CT+, 13/18 US+

Fibrin strands: Fibrin strands: Fibrin strands: Fibrin strands:

0/18 CT+, 17/18 US+0/18 CT+, 17/18 US+0/18 CT+, 17/18 US+0/18 CT+, 17/18 US+

“chest ultrasound and chest CT were similar in their ability to detect

loculated effusion and lung necrosis or abscess…CT did not provide any

additional clinically useful information…”

Metric #5: Concurrent Asthma TherapyMetric #5: Concurrent Asthma TherapyMetric #5: Concurrent Asthma TherapyMetric #5: Concurrent Asthma Therapy

Decrease concurrent treatment Decrease concurrent treatment Decrease concurrent treatment Decrease concurrent treatment for for for for asthma asthma asthma asthma

and pneumonia to and pneumonia to and pneumonia to and pneumonia to less than 10%less than 10%less than 10%less than 10%

RationaleRationaleRationaleRationaleOveruse of Overuse of Overuse of Overuse of chest radiographs among chest radiographs among chest radiographs among chest radiographs among children with asthma leads children with asthma leads children with asthma leads children with asthma leads to unnecessary antibiotic to unnecessary antibiotic to unnecessary antibiotic to unnecessary antibiotic use (atelectasis vs. infiltrate)use (atelectasis vs. infiltrate)use (atelectasis vs. infiltrate)use (atelectasis vs. infiltrate)

CXRs frequently obtained among children with acute asthma in ED (25-44%)(1, 2)◦ Narayanan: 180 children hospitalized with acute asthma: 18 (10%) had

‘abnormal’ CXR: atelectasis vs. infiltrate (n=9), consolidation/infiltrate (n=6), air leak (n=3); All with equivocal CXR findings received antibiotics (2)

Wheezing uncommon among children with typical bacterial pneumonia ◦ Michelow et al: wheezing documented in 13%, 41%, and 41% of children

with typical bacteria, atypical bacteria, and viruses, respectively(3)

◦ Corticosteroids may worsen pneumonia outcomes for those without acute wheezing

331Stanley RM Acad Em Med 2007; 2Narayanan S J Asthma 2014; 3Michelow I Peds 2004

Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with

longer hospital LOS. longer hospital LOS. longer hospital LOS. longer hospital LOS.

Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with

increased risk of readmission. increased risk of readmission. increased risk of readmission. increased risk of readmission.

Overview of Overview of Overview of Overview of Chart Review ToolChart Review ToolChart Review ToolChart Review Tool

ICAP Chart Review Tool

MONTH/YEAR______________________

CHART NUMBER _________ (number sequentially 1-5…)

PATIENT DATA: This section should be completed for each chart

INCLUSION CRITERIA EXCLUSION CRITERIA

• Diagnosis (in any position) of pneumonia (ICD9

codes: 481, 482.0, 482.2-.42, 482.89-.9, 485, 486)

• ICU care during admission

• Age 3 months to 18 years • Mechanical ventilation/Intubation

• Admitted to your hospital • Co-morbid conditions predisposing to severe or

recurrent respiratory illness, including genetic,

congenital, chromosomal, neuromuscular, or

neurodevelopmental abnormalities.

• Discharged from your hospital • Transfer to or from your hospital

• Received either a full inpatient course of

antibiotics or was discharged to complete a full

course of antibiotics for CAP

• Any pleural drainage procedure

1. I certify that I have reviewed the inclusion/exclusion criteria and this patient does meet the criteria.

� I certify that this patient does meet the criteria

2. Patient age ____

(In days if < 30 days, in months if < 24 months, in years if > 2 years)

3. Age is recorded in days months years

4. Select the appropriate age group for this patient:

Less than 5 years of age / 5 years of age and older

5. Gender MALE FEMALE

6. Length of stay in calendar days (LOS) _____ days

(Any part of 1 calendar day that is spent in the hospital is to be recorded as one full day e.g., a patient admitted at

8:30AM on Jan 1st who stays until 8:00AM on Jan 2nd will be recorded as “2”)

Metrics #1 and #2: Narrow Spectrum Antibiotic Use and Macrolide Use

- common macrolides include erythromycin, clarithromycin and azithromycin

1. What antibiotic, or combination of antibiotics, did the patient receive in your ED? (this excludes antibiotics given for

non-CAP reasons, i.e. otitis media)

a. Amoxicillin/ampicillin/penicillin only

b. Macrolide only

c. Amoxicillin/ampicillin/penicillin AND macrolide

d. Third generation cephalosporin only

e. Third generation cephalosporin AND macrolide

f. None

g. Not applicable (patient not admitted via my ED)

h. Other

2. What antibiotic, or combination of antibiotics, did the patient receive in the inpatient setting for management of CAP?

(This excludes ED management and antibiotics given for non-CAP reasons in the inpatient setting, i.e. otitis media)

a. Amoxicillin/ampicillin/penicillin only

b. Macrolide only

c. Amoxicillin/ampicillin/penicillin AND macrolide

d. Third generation cephalosporin only

e. Third generation cephalosporin AND macrolide

f. None

g. Other

3. What antibiotic, or combination of antibiotics, did the patient receive for CAP at discharge? (This excludes antibiotics

given for non-CAP reasons, i.e. otitis media)

a. Amoxicillin/ampicillin/penicillin only

b. Macrolide only

c. Amoxicillin/penicillin AND macrolide

d. Oral cephalosporin only

e. Oral cephalosporin AND macrolide

f. None

g. Other

Chart Review Tool (Chart Review Tool (Chart Review Tool (Chart Review Tool (contcontcontcont)…)…)…)…

Metric #3: Radiologic Imaging for CAP

Chest X-ray

1. Was a chest x-ray performed for this patient as an inpatient? YES NO

2. Was more than more than ONE chest X-ray performed for this patient as an inpatient? YES NO

Pulmonary Ultrasound

3. Was a pulmonary ultrasound performed in your ED or the inpatient setting? YES NO

Chest CT scan:

4. Was a chest CT scan performed in your ED or in the inpatient setting? YES NO

Metric #4: Complete Blood Count (CBC) utilization for CAP

5. Was a CBC performed for this patient as an inpatient? YES NO

6. Was more than one CBC performed for this patient as an inpatient? YES NO

Metric #5: Concurrent Asthma Diagnosis and Treatment

7. Did the patient receive MORE THAN ONE dose of a beta-agonist (e.g. Albuterol) as an inpatient?

YES NO

8. Did the patient receive MORE THAN ONE dose of systemic (oral/IV) corticosteroids as an inpatient? YES NO

Chart Review Tool (Chart Review Tool (Chart Review Tool (Chart Review Tool (contcontcontcont)…)…)…)…

Brief Introduction Brief Introduction Brief Introduction Brief Introduction to the to the to the to the Quality Improvement Data Quality Improvement Data Quality Improvement Data Quality Improvement Data

Aggregator (QIDA) Aggregator (QIDA) Aggregator (QIDA) Aggregator (QIDA)

ABOUT QIDAABOUT QIDAABOUT QIDAABOUT QIDA

� Web-based data aggregation system

� Secure login for all project participants

� Clinician enter chart data securely by patient or in aggregate

� Analyzes data via real time run charts

� Collaboration between project team members

� View project specific resources (workspace) and QIDA system

documents

ACCESSING QIDAACCESSING QIDAACCESSING QIDAACCESSING QIDA

• To access QIDA, go to the following link:

http://qidata.aap.org/quiincap

• For AAP members, you will use your AAP log-in

and password to access the site

• For non-AAP members, an AAP log-in has been

created for you and that information will be

e-mailed to you from qidata@aap.org by August 6

QIDA SCREEN SHOTS FOR ICAP QIDA SCREEN SHOTS FOR ICAP QIDA SCREEN SHOTS FOR ICAP QIDA SCREEN SHOTS FOR ICAP ICAP Home Page

with Log-In

1 2 3

Once you log-in there are three

main areas: Project Home,

Workspace, and My Group

GROUP ADMINISTRATOR’S QIDA WEBINARGROUP ADMINISTRATOR’S QIDA WEBINARGROUP ADMINISTRATOR’S QIDA WEBINARGROUP ADMINISTRATOR’S QIDA WEBINAR

• QIDA Orientation WebinarQIDA Orientation WebinarQIDA Orientation WebinarQIDA Orientation Webinar (Open to all team

members, required for Group required for Group required for Group required for Group AdministratorsAdministratorsAdministratorsAdministrators)

• 20 minute pre20 minute pre20 minute pre20 minute pre----recorded webinar recorded webinar recorded webinar recorded webinar

• Available now at http://youtu.be/ZfgKONu5jRQhttp://youtu.be/ZfgKONu5jRQhttp://youtu.be/ZfgKONu5jRQhttp://youtu.be/ZfgKONu5jRQ\\\\

Important Next Steps…Important Next Steps…Important Next Steps…Important Next Steps…Due date Next Steps

ASAP Submit Pre-Project Survey via SurveyMonkey

Next 10 days Set up a time-table for meeting (integrated staff meet-ups, huddles, etc.) as

a core improvement team throughout this project

Next 10 days Review Orientation Packet PDF (sent out as a hyperlink this week)

Next 14 days Receive your Project Coach Assignment and touch base with your assigned

coach regarding your progress

August 28, 2014 Participate in Webinar 2: QI Orientation & Change Package Part 1, 10AM

PT/11AM MT/12Noon CT/1PM ET

August 29, 2014 Pending Final Approval: Submit ABP MOC Part 4 paperwork to Faiza Khan to

express interest in site participation in seeking ABP MOC Part 4 credit for

physicians at your site

August 31, 2014 Submit Baseline Data into QIDA (Cycle 1: Sept-Nov. 2013, Cycle 2: Dec 2013-

Feb 2014 & Cycle 3: March-May 2014)