Chapter Quality Network (CQN)

Asthma Pilot Project

Our Now and Our Future

James C. Wiley, MD, FAAPCQN Chapter Physician Leader

Alabama Chapter-AAP PresidentApril 15, 2010

James C. Wiley, MD, FAAP Disclosure

I have no relevant financial relationships with the manufacturers(s) of any commercial

products(s) and/or provider of commercial services discussed in this CME activity

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ALABAMAALABAMAMarshall County Pediatric Clinic-Guntersville

Infants and Children's Clinic-Florence

Bessemer Health Center/Jefferson Co.-Birmingham

University Medical Center Pediatrics-Tuscaloosa

Partners in Pediatrics-Montgomery

The Charles Henderson Child Health Center-Troy

USA Dept. of Pediatric & Adolescent Medicine-Mobile

Dothan Pediatric Clinic

Pediatric Associates of Auburn

Huntsville Pediatric Associates

Pediatric Clinic, LLC-Opelika

Pediatric Associates of Alexander City

Global AimWe will build a sustainable quality improvement infrastructure within the Alabama Chapter-AAP to achieve measurable improvements in the health outcomes of children within our member practices.

Specific AimFrom April 2009 to November 2010, we will lead a quality improvement collaborative and achieve measurable improvements in asthma outcomes with the participating 10 to 15 practices by implementing the National Heart, Lung and Blood Institute (NHLBI) asthma guidelines.

Alabama Chapter-AAP Individualized Aim Statement

SECTION 1 (AIMS)

Goal: 90% of the CQN Asthma Pilot Practices will achieve 80% Optimal care by September 2010.

Goal: 90% of the CQN Asthma Pilot Practices will use a structured encounter form 90% of the time by September 2010.

Outcome Goal: 90% of the CQN Asthma Pilot Practices will reach 80% of patients “well controlled” by September 2010.

What is Optimal Asthma Care?Optimal Asthma Care - % of patients with all of the following:•patients with assessment of asthma control using a validated instrument•patients which stepwise approach is used to identify treatment options or adjust therapy•patients with asthma action plan •patients 6 months and older with a flu shot or flu shot recommendation

Alabama Chapter-AAP Individualized Aim StatementSECTION 2 (GOALS)

Long Term Goals

Goal: All CQN Asthma Pilot Practices will use a population based registry

Goal: 90% of the CQN Asthma Pilot Practices using a population based registry will achieve 90% perfect care by August 2012

Other Action Items: •The CQN Asthma Pilot Practices will submit annual follow-up data in August 2011 and August 2012, with the Chapter Team providing quarterly check-in/follow-up calls/emails.•The CQN Asthma Pilot Practices will host an Asthma QI Project sharing session/summit at the Chapter’s 2011 Spring Meeting in April 2011.•The Chapter will push out results of the CQN project and lessons learned on QI infrastructure to Chapter members through a variety of communication efforts: newsletter tips, case studies, etc.•The Chapter will collaborate with Alabama Medicaid Agency and Blue Cross Blue Shield of Alabama to design and fund a second phase of pilot practices based on results of this quality improvement project.

Alabama Chapter-AAP Individualized Aim Statement

SECTION 3 (LONG TERM GOALS)

Defining success at the chapter level – how are we doing?

• Increase capacity for QI work• Engage the governance group• Sustain QI work at the chapter level • Key partnerships focused on improvement

work• Funding and the will for continued quality

improvements (BCBS’s assistance with this LS3 meeting)

Defining Success at the Practice/Individual Clinician

level

HOW ARE WE DOING AT THE PRACTICE LEVEL?

Optimal Care

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)

Goal: 90% of the CQN Asthma Pilot Practices will achieve 80% Optimal care by September 2010

Alabama Chapter

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Goal: 90% of the CQN Asthma Pilot Practices will use a structured encounter form 90% of the time by September 2010.

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Outcome Goal: 90% of the CQN Asthma Pilot Practices will reach 80% of patients “well controlled” by September 2010.

One of our Challenges – 57%Alabama Chapter

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Where are our successes?

•Alabama practices met 6 of the 13 goals in just five months of data collection:

•91% of patients with key asthma indicators used when considering an asthma diagnosis -- 10 practices at goal

•99% of patients in which a validated instrument is used to determine current level of asthma control – 12 practices at goal

•96% of patients in which reasons for lack of asthma control is identified when asthma control is ‘not well controlled’ or ‘poorly controlled’ – 11 practices at goal

Where are our successes? (continuted)

•Alabama practices met 6 of the 13 goals in just five months of data collection:

•99% of patients in which the stepwise approach is used to identify treatment and treat or maintain therapy based on asthma control – all of our practices are at goal

•93% of patients with asthma 6 months or older who have received a flu shot or a flu shot recommendation within the past 12 months -- all of our practices are at goal

•95% of patients for whom a follow up appointment to monitor asthma control is recommended – 11 of our practices are at goal

Goals within achievable range

• Our practice hospitalization rate is at 5% (goal is 0)

• 82% of patients who have a written asthma action plan explained to them at the visit -- 6 of our practices are at goal

• 81% of patient in which self-management education materials are provided and explained to the patient and family -- 8 of our practices are at goal

What are our challenges?

• 63% of patients ages 5 and older where spirometry is used to establish an asthma diagnosis – 2 practicex at goal

• 59% of patients ages 5 and older where spirometry is scheduled to be tested or results have been obtained within the last 1 – 2 years -- 3 practices at goal

• 57% of well controlled patients -- no practices at goal

Our Now and Our Future: Perspectives from the National Level

Judy Dolins, MPHDirector, Department of Community Chapter and State

Principle Investigator, Chapter Quality Network Asthma Pilot Project

Disclosure Statement

I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME

activity

National goals at the practice level

Changes in asthma care practices and child health outcome

Successful implementation of practice system change

Clinician investment and commitment to quality improvement work

Transparency and sharing of improvement data

Increased clinician demand for CQN programming

National goals at the chapter level Increased capacity for quality improvement

work

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 CQN programming

Improvement Work

Improvement WorkImprovement WorkContinuous tests

of change

SustainabilitySustainabilityImbed in everyday work

Scale Up & SpreadScale Up & SpreadTaking local improvement

And actively disseminating itacross 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

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National Alabama

Percent of eligible providers collecting data at point of care

How are we doing at the National Level?

Practice System ChangesRegistry Implementation Status

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Practices with a Registry Practices without aregistry

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How are we doing at the National Level?

Practice System ChangesOptions for Practices without a Registry

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Using an Excel database asalternative

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National Alabama

How are we doing at the National Level?

Practice System ChangesDegree of belief that workflows for collecting data for eligible patients/opportunities at point of care are highly reliable

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How are we doing at the National Level?

Measures of Asthma Care Practices and Health Outcome

Key Measure Goal Alabama Maine Ohio Oregon

National Average

% of patients with 1 or more asthma-related ED or Urgent Care Visits within the past 12 months 0% 21% 20% 35% 24% 25%

% of patients with 1 or more hospitalizations within the past 12 months0% 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 asthma diagnosis 90% 91% 96% 80% 75% 86%

% of patients ages 5 and older in which spirometry is used to establish a asthma diagnosis 90% 63% 61% 61% 56% 60%

% of patients in which a validated instrument is used to determine the current level of asthma control 90% 99% 93% 99% 99% 98%

% of patients in which reasons for lack of asthma control is identified when asthma 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 or results 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 treatment therapy 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 flu shot 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 them at this visit

90% 82% 78% 79% 85% 81%

% of patients in which self-management education materials (in addition to the asthma 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 is recommended 90% 95% 89% 94% 95% 93%

Self-Management

Alabama = 81%

National Project (All Chapters)

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Hospitalizations

Alabama = 5%

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Spirometry

Alabama = 63%

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Flu Shot

Alabama = 93%

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Improvement Work

Improvement WorkImprovement WorkContinuous tests

of change

SustainabilitySustainabilityImbed in everyday work

Scale Up & SpreadScale Up & SpreadTaking local improvement

And actively disseminating itacross a chapter and/or practice

Next 6 months

National Efforts to Sustain WorkContinued CQN Project Support

• Short-term – EQIPP access through December - MOC eligibility through December• Long-term - Working on business plan

Grant Opportunities• AAP Venture Capital Proposal• IPIP – “Transforming Primary Care” Grant

Application to the Office of the National Coordinator of HIT

• Working with AAP Development Office on opportunities