Chapter Quality Network (CQN)

Asthma Pilot Project Team Progress Presentation

State Name: AlabamaPractice Name: Dothan Pediatric ClinicTeam Members: Dr. Lee Scott, Amy Marshall, Kelli Watson, Carlotta McCallister and Haley Smith

GLOBAL CQN AIMWe will build a sustainable quality improvement infrastructure within our practice to achieve measurable improvements in asthma outcomesSpecific Aim From fall 2009 to fall 2010, we will achieve measurable improvements in asthma outcomes by implementing the NHLBI guidelines and making CQN’s key practice changes

Measures/Goals

Outcome Measures: >90% of patients well controlled

Process Measures >90% 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)

>90% of practice’s asthma patients have at least an annual assessment using a structured encounter form

Engaging Your QI Team and Your Practice*The QI team and practice is active and engaged in improving practice processes and patient outcomes

Using a Registry to Manage Your Asthma Population *Identify each asthma patient at every visit *Identify needed services for each patient *Recall patients for follow-up

Using a Planned Care Approach to Ensure Reliable Asthma Care in the Office * CQN Encounter Form * Care team is aware of patient needs and

work together to ensure all needed services are completed

Developing an Approach to Employing Protocols * Standardize Care Processes * Practice wide asthma guidelines

implemented

Providing Self management Support

* Realized patient and care team relationship

Key Drivers

Interventions

Form a 3-5 person interdisciplinary QI Team

Formally communicate to entire practice the importance and goal of this project

Meet regularly to work on improvement

All physicians and team members complete QI Basics on EQIPP

Collect and enter baseline data

Generate performance data monthly

Communicate with the state chapter and leaders within the organization

Turn in all necessary data and forms

Attend all necessary meetings and phone conferences

Select and install a registry tool

Determine staff workflow to support registry use

Populate registry with patient data

Routinely maintain registry data

Use registry to manage patient care & support population management

Select template tool from registry or create a flow sheet

Determine workflow to support use of encounter form at time of visit

Use encounter form with all asthma patients

Ensure registry updated each time encounter form used

Monitor use of encounter form

Select & customize evidence-based protocols for your office

Determine staff workflow to support protocol, including standing orders

Use protocols with all patients

Monitor use of protocols

Obtain patient education materials

Determine staff workflow to support SMS

Provide training to staff in SMS

Assess and set patient goals and degree of control collaboratively

Document & Monitor patient progress toward goals

Link with community resources

CQN Asthma Project Practice Key Driver Diagram Version 2.0

Asthma Progress

•Before we started the asthma project the percentage of asthma action plans given was 5%. Since the beginning of the asthma project the number of asthma action plans given has jumped to 90%. We have 11 doctors and 3 nurse practitioners and they are all doing encounter forms and are utilizing asthma action plans in patient care. By the end of the pilot project, our goal is to have completed an encounter form and utilized an asthma action plan on 90% of our asthma patients.

•Since the beginning of the pilot we have doubled the number of spirometry tests performed.

•As a part of the asthma project we are awaiting incorporation of Reach My Doctor into our EMR through the BCBS Medical Home project. This registry includes data tracking and reporting options that will offer providers easier and more efficient ways to monitor individual patient progress and assess how the clinic’s overall asthma patient population is improving.

Obtain spirometry measurements every 1-2 years

Spirometry

Spirometry Flow Graph

Spirometry Data

Provide/review current Asthma Action Plan at every visit

Optimal Asthma Care

Recommend annual flu shot

TEST 1What:: Computerize encounter formWho (executes): BJWhere: Dothan Pediatric ClinicWhen: September 2009

P D

S A

TEST 2What:: Test encounter formWho (population): Dr. Scott’s asthma patientsWho (executes): Dr. ScottWhere: Dothan Pediatric ClinicWhen: September 2009

P D

S A

TEST 3What:: Implement encounter formWho (population): all asthma patientsWho (executes): All doctorsWhere: Dothan Pediatric Clinic When: October 2009

P D

S A

TEST 1What:: Develop Asthma action planWho (executes): Dr. Scott and BJWhere: Dothan Pediatric ClinicWhen: September 2009

P D

S A

TEST 2What:: Finalize asthma action planWho (executes): All Dothan Pediatric Clinic doctors Where: Dothan Pediatric ClinicWhen: September 2009

P D

S A

TEST 3What:: Implement asthma action planWho (population): All asthma patientsWho (executes): All Dothan Pediatric Clinic doctorsWhere: Dothan Pediatric ClinicWhen: October 2009

P D

S A

TEST 1What:: Research RegistryWho (executes): BJWhere: Dothan Pediatric ClinicWhen: November 2009

P D

S A

TEST 2What:: Training about Reach My Doctor Who (executes): Dr. Scott, Dr. Ramsey, BJ, HaleyWhere: Dothan Pediatric ClinicWhen: December 2009

P D

S A

TEST 3What:: Implement Reach My DoctorWho (executes): BJ and HaleyWhere: Dothan Pediatric ClinicWhen: April 2009

P D

S A

CQN Encounter Form Asthma Action Plan Registry

PDSA Ramps

Parent Encounter Form

Physician Encounter Form

Key Learnings

With good motivation and education the group was quite accepting of change.

The process of completing the encounter form was not as time consuming as anticipated.

Quantitative results have been motivational for the group.

Barriers and Successes

Barriers• Finding a registry to interface with our

EMR was not as easy as anticipated.

Successes• Spirometry use rapidly increased.• Use of asthma action plans dramatically

increased.

Future Plans

Dothan Pediatric Clinic is in the process of implementing Reach My Doctor’s Patient Registry to further improve patient care. This registry includes data tracking and

reporting options that will offer providers easier and

more efficient ways to monitor individual patient progress and assess how the clinic’s overall

asthma patient population is improving.