Broadway QI 2012-2013:Improving Asthma Risk

StratificationAttendings: Heidi Beutler, Annika Hofstetter, Mariellen Lane, John

Rausch, Laura-Robbins-Milne, Nan Salamon, Omalara Uwemedimo, Rene Eis

Residents: Lacy-Ann Harari, Daniel Stephens, Kristal Woldu, Michael Goldman, Emily Whitesel, Arash Salavitabar, Anna Hays, Erin Paul,

Joe Grillo, Uchechi Azubuine, Dominique Bailey, Tom Wallach, Pamela Good, Rebecca Tamez, Jessica George, Michelle Jamison,

Kristen SchratzRNs: Sally Ortiz, Haydee Bayon, Becky Ofori, Megan Cummings

Registration Coordinator: Ingrid MirandaMAs: Celia Mendez, Blanca Cordero, Reina Quiroz, Felipe JoaquinPFAs: Conchita Laurencio, Evelyn Reyes, Shirley Laurencio, Iraida

Torres, Tenee Jones

Team Broadway

AIM STATEMENTThe goal for our PSDA is to improve patients overall control

of asthma in accordance with the National Asthma Education and Prevention Program (EPR-3 Report). – Increase the % of asthmatics to receive a priority level from

27% to a goal of 50%– Focus efforts on providers pre-rounding on all asthmatic

patients and working collectively with MA’s and PFA’s to ensure that parents are provided with an ACT form

– Increase the number of patients referred to WIN for Asthma by 25%

– Increase the number of patient enrolled in WIN for Asthma by 10%

Didactic/Background

• Asthma has a large effect on Childhood health• National Asthma Education and Prevention

Program formed to improve outcomes• 11% Childhood asthma prevalence in NYC– 18-22% in Washington Heights

• Asthma patients in all Peds ACN clinics: 3,355– Total asthma patients at Broadway: 789

Didactic/Standard of Care

• After 12 months in WIN for Asthma:– Caregiver confidence in controlling their child’s

asthma increased by 40%,– ED and hospitalization rates decreased by more

than 50%,– Child school absenteeism decreased by 30%.

• Priority and Severity scores help identify patients to multidisciplinary teams and direct intervention/prevention efforts

Baseline Measures

Pre-QI Data

Pre Broadway Audubon Rangel 181st

No Priority 78% 66% 57% 25%

Any Priority 22% 32.5% 40% 72%

I 15% 24% 30% 54%

II 7% 8% 8% 16%

III 0% 0.5% 2% 2%

22%

ACT Form

Assigning Asthma Priority

• Education of residents and faculty about the role of pre-rounding, asthma priority levels, ACT score and WIN for asthma.

• Discussion with MA’s and PFA’s about ACT score distribution.

• Posted reminder signs.• Implementation of task column in Eclipsys (Feb).• Personalized report cards (February and April)

with comparison to peer group.

PDSA Cycles

27%

18%

41%

54%

6% 5%7%

4% 5% 5% 4%0%

10%

20%

30%

40%

50%

60%

2/2011 - 8/2012 9/16/12 - 11/29/12 11/20/12 - 2/14/13 1/7/13 - 3/6/13

Perc

ent o

f Bro

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ay A

sthm

atic P

atien

ts

Broadway's QI Project

Priority level given to ptReferred to WINEnrolled in WIN

At start of QI Project

-After staff education about pre-rounding , giving out ACT forms and

- Priority Level now copies forward-WIN coordinator no longer available at Broadway

-After implementation of Task Column-After distribution of individual report cards

INTERVENTION

QI Priority Level Goal

Final MeasuresPre Broadway Audubon Rangel 181st

No Priority 78% 66% 57% 25%

Any Priority 22% 32.5% 40% 72%

I 15% 24% 30% 54%

II 7% 8% 8% 16%

III 0% 0.5% 2% 2%

Post

No Priority 50% 50% 40% 21%

Any Priority 50% 51% 58% 76%

I 35% 36% 38% 53%

II 13% 12% 16% 21%

III 2% 3% 4% 2%

% Change 28% 18.5% 18% 4%

Provider Report CardAttending A’s report card for 11/30-2/14 and 2/25-4/11

Total Asthmatics % Severity Completed % Priority Assigned

11/30-2/14 61 74 64

2/25-4/11 20 85 80

Overall Average (%):

11/30-2/14 44 35

2/25-4/11 62 51

Comparison to Broadway

Comparison to Attending averages670 Asthmatics Assigned Attending Weighted Average (%):

11/30-2/14 41 34

2/25-4/11 50 40

139 Asthmatics Assigned Resident Weighted Average (%):

11/30-2/14 67 55

2/25-4/11 79 71

Comparison to Resident averages

Feedback from Providers

Progress reports help to sustain improvements

Strongly Disagree

Disagree Neutral Agree Strongly Agree

0%0

0%0

31.68%6

42.11%8

28.32%5

Spread

• Task column• Role of accurate coding of asthmatics –

CHRONIC Dx• Report cards• Benefits to patient and provider

Thank You!!!!