AAP Chapter Quality Network Maine AAP Asthma Pilot ProjectAugusta, MaineApril 9, 2010
Introductions
National AAP
–Judy Dolins, MPH, Laura Conley, MHSA, PeterMargolis, MD, MPH
Maine AAP
–Amy Belisle, MD, Aubrie Entwood, BarbaraChilmonczyk, MD, Mike Ross, MD, Rhonda Vosmus,RRT-NPS, AE-C, Paula Gilbert, Kathryn Engel
Asthma Educators
Practice Teams
Participating Practices
•Kennebec Pediatrics, Augusta
•Franklin Health Pediatrics,Farmington
•Lake Region Pediatrics,Windham
•Maine Coast Pediatrics,Ellsworth
•Intermed Pediatrics, Portlandand Yarmouth
•Bowdoin Pediatrics, Brunswick
•BBCH Pediatric Clinic, Portland
•CMMC Pediatrics, Lewiston
Medical Home Sites
•Husson Pediatrics, Bangor
•Winthrop Pediatrics
•Westbrook Pediatrics
•Allergy and Asthma Associatesof 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 NationalLevel
•Introduce Groups to Motivational Interviewing
•Continue work with Asthma Educators and SelfManagement 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 Spirometrycases properly
•Prize for Groups with a New Registry since thePilot started- Maine Coast and CMMC
Chapter Quality Network (CQN)
Asthma Pilot Project
Our First Six Months
Amy Belisle, MD
Physician Leader, Maine AAPJudy Dolins, MPH
Director, Department of Community Chapter and State
Principle Investigator, Chapter Quality Network Asthma Pilot Project
Amy Belisle’s Disclosure
I have no relevant financial relationships with themanufacturers(s) of any commercial products(s) and/orprovider of commercial services discussed in this CMEactivity.
Disclosure Statement
Judy Dolin’s Disclosure
I have no relevant financial relationships with themanufacturers(s) of any commercial products(s) and/orprovider of commercial services discussed in this CMEactivity
National goals at the practice level
Changes in asthma care practices and childhealth outcome
Successful implementation of practice systemchange
Clinician investment and commitment to qualityimprovement work
Transparency and sharing of improvement data
Increased clinician demand for CQNprogramming
National goals at the chapter level
Increased capacity for quality improvementwork
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 CQNprogramming
Improvement Work
Improvement WorkImprovement Work
Continuous tests
of change
SustainabilitySustainability
Imbed in everyday work
Scale Up & SpreadScale Up & Spread
Taking local improvement
And actively disseminating it
across 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
Percent of eligible providers collecting data at point of care
How are we doing at the National Level?Practice System Changes
Registry Implementation Status
How are we doing at the National Level?Practice System Changes
Options for Practices without a Registry
How are we doing at the National Level?Practice System Changes
Degree of belief that workflows for collecting data for eligiblepatients/opportunities at point of care are highly reliable
How are we doing at the National Level?
Measures of Asthma Care Practices and Health Outcome
Key Measure
Goal
Alabama
Maine
Ohio
Oregon
NationalAverage
% of patients with 1 or more asthma-related ED or Urgent Care Visits withinthe 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 asthmadiagnosis
90%
91%
96%
80%
75%
86%
% of patients ages 5 and older in which spirometry is used to establish aasthma diagnosis
90%
63%
61%
61%
56%
60%
% of patients in which a validated instrument is used to determine the currentlevel of asthma control
90%
99%
93%
99%
99%
98%
% of patients in which reasons for lack of asthma control is identified whenasthma 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 orresults 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 treatmenttherapy 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 flushot 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 themat this visit
90%
82%
78%
79%
85%
81%
% of patients in which self-management education materials (in addition to theasthma 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 isrecommended
90%
95%
89%
94%
95%
93%
Optimal Care
>70% of patients have “optimal”asthma care (all of the following)
•assessment of asthma controlusing a validated instrument
•stepwise approach to identifytreatment options and adjusttherapy
•written asthma action plan
•patients >6 mos. of age with flushot (or flu shot recommendation)
Optimal Asthma Care
Maine = 71%
Self-Management
Maine = 84%
Use of a Validated Instrument
Maine = 93%
Hospitalizations
Maine = 4%
Patients Well-Controlled
Maine = 68%
CQN-MAINECQN-MAINE
Franklin HealthPediatrics-Farmington
IntermedPediatrics-Portland
BBCH PediatricClinic- Portland
Allergy and AsthmaAssociates-Portland
WestbrookPediatrics-Westbrook
Maine CoastPediatrics-Ellsworth
Bowdoin MedicalGroup-Brunswick
Husson Pediatrics-Bangor
Lake RegionPrimary Care-Windham
KennebecPediatrics-Augusta
WinthropPediatrics-Winthrop
CMMC Pediatrics,
Lewiston
Global Aim
Specific Aim
Maine’s Aim Statement
Global Aim
We will build a sustainable quality improvementinfrastructure within our chapter to achieve measurableimprovements in the health outcomes of children within ourmember practices.
Specific Aim
From April 2009 to November 2010, we will lead a qualityimprovement collaborative and achieve measurableimprovements in asthma outcomes with the participating 10to 15 practices by improving use of the NHLBI/NAEPPguidelines and the documentation of quality care.
Maine’s Aim Statement
Goal: 90% of practices will achieve 70%optimal care on patients seen by September2010.
Goal: 90% of practices use a structuredelectronic or paper asthma encounter tool 80%of the time by September 2010.
Outcome Goal: 90% of practices will have atleast a yearly ACT score documented in 50% oftheir 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 populationbased registry beyond the time of this grant.
Goal: The AH! Asthma Health evidence based asthma tools will be used bymember practices.
Goal: Certified asthma educators will be available to all member practices.
Goal: A committee of AAP members experienced in quality improvement will becharged with infrastructure development in the organization; this will includeidentifying funding sources for activities. We will have semiannual reporting of QIactivities at Maine AAP Fall and Spring conferences for all of its members.
Goal: The Maine AAP will partner with MaineHealth, MaineCare, theMaine CDC, Maine based Health Insurers and other organizations interested inchild health improvement (such as the Maine Lung Association, the MaineImmunization Collaborative or the Maine Children's Association) to develop asustainable approach to quality improvement in our organization.
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Maine’s First 90 Days
Spread work of AH! Program in Maine
to 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- 4Attended 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 letterssent out to leadership of practices regarding projectand need for registry; 5 monthly newsletters sentout
Identified ACT form for kids less than 4: TRACK
Worked with Patient Centered Medical HomeCommittee 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 stateand figuring out how we can work together toincorporate NHLBI asthma guidelines and EQIPPmeasures into the templates
•By updating templates, would help us collect data fromall 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 = 97%
Flu Shot Recommendation
Maine = 98%
Asthma Action Plan
Maine = 78%
Spirometry
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 monthfor 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 includingphysicians not involved in EQIPP, encourage “spread” withinpractice
•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 spreadAsthma QI
•Close the Quality Gap and provide the best care for every patient,every time