update on the alberta childhood asthma pathway … · pathway components • ed algorithm •...

UPDATE ON THE ALBERTA CHILDHOOD

ASTHMA PATHWAY

March 30, 2015

Overview • Broad Goals and Historical Background

• Why a pathway? • IN THE BEGINNING: Calgary Health Region • BECOMING ONE: Alberta Health Services

• ED and Inpatient Management Algorithms • Key pathway components • NEARING THE END: Pathway implementation • Pathway success

• Primary Care Algorithm • LONG TIME COMING: EMR based • Rigorous evaluation • Alberta-wide rollout?

BROAD GOALS AND HISTORICAL BACKGROUND

Why use a pathway? • Gap between best evidence and practice

• Variability in care delivered • Good evidence for both chronic and acute management

• Good care improves QOL, burden on family and health

care costs

IN THE BEGINNING: Calgary Health Region • Confluence of interest in developing acute care pathway

• Development of pathway 2004-6

• Implement ACH 2006 & remainder of Region by 2007/8

• Formal evaluation funded by CIHR

• Improved use of best therapies

• No decrease in health care utilization

BECOMING ONE: Alberta Health Services • Four Regions had acute asthma pathways • Prioritized by AHS Child Health Administration • Part of AHS Integration Teams

• Incorporation of primary care as well as acute care pathways

• Funded by CIHR Partners for Health Service Improvements

• Transferred to Respiratory Clinical Networks

ED AND INPATIENT MANAGEMENT ALGORITHMS

Development of AHS Acute Care Pathway • ED & Inpatient pathways developed 2010-2012

• Broad Alberta Representation

• Nurses, RTs, Pharmacists, Physicians • Rural, Urban, Both Children’s Hospitals

• Wide vetting across province

Pathway Components • ED Algorithm

• Validated clinical score • Use by nurses & RTs

• MDI with spacers in place of nebulizers • Advocating asthma education

• Various Tools • Standardized ED physician order set • Standardized ED documentation form • Patient Education Checklist • Pediatric Asthma Discharge Prescription, Short-Term Plan, &

Education Pamphlet • Coordinate Care between Acute Care Facilities and Community

Physicians

FOR HEALTH CARE STAFF

Web-based learning module {www.AHSchildhoodpathways.com}

Continuing Education Credit

Patient/family education • Evidence: Cochrane SR, 2009. • 38 RCTs, 7,843 children, educational interventions directed at

children and/or parents who present to ED • Subsequent ED visit, RR 0.73, 95% CI 0.65 to 0.81 • Hosp admission, RR 0.79, 95% CI 0.69 to 0.92 • Unscheduled MD visit, RR 0.68, 95% CI 0.57 to 0.81

• At discharge from ED or hospital: “Refer to the highest level of education available”

NEARING THE END: Pathway implementation

Sites • Covenant as well! • Inpatient Units (8 totlal)

• ACH & Stollery • PLC in-patient unit • Regional centres

• Emergency Departments (105 total)

• Urgent Care Centres (8 total in Calgary and Edmonton)

Timeline/Success • Pilot Fall 2012

• Last site May 2015

• First SCN project rolled

out provincially

Pathway Evaluation Medicine Hat/Brooks • ↑ MDI/spacers

• ↑ optimal therapies

• No ∆ asthma education

• No ∆ admit rate or LOS

Other Zones/sites?

PRIMARY CARE ALGORITHM

LONG TIME COMING • Lead by Andrew Cave, FP Edmonton

• No existing pathways

• Is it simple enough?

• The ‘right format’? EMR-based

• Substantial consolation

EMR Screen Shot • Med Access

• Standard scenarios

• Diagnosis • Phenotypes

• Follow-up

• Exacerbation

Rigorous evaluation – AIHS PRIHS • “Partnerships for Research and Innovation in the Health

System “

• Compare standard care vs EMR-based pathway/asthma education

• Cluster controlled trial: 22 primary care practices

• “Canadian Primary Care Sentinel Surveillance Program”

• “Health Quality Council of Alberta”

Rigorous evaluation – AIHS PRIHS Outcomes (admin data and standardized surveys))

• Increase anti-inflammatory medications? Prescriptions Dispensing

• Decrease health care utilization? • Increase family and child QOL and disease control? • Decrease in health care costs?

Alberta-wide rollout? • ~ 1200 total primary care practices

• 41 PCNs

SUMMARY

QUESTIONS?