Chapter Quality Network (CQN)

Asthma Pilot Project

Primary Care: a Registry for ME!

Stephen DiGiovanni, MDBayview Pediatrics

MMC Physician Hospital Organization

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.

Clinical Improvement Registry

• CIR Data highlights

• CIR What’s New!

• Flu Shot: Santa Redux

• Clinical Uses: Beyond the numbers

Pediatric Asthma Process CarePercent of Patients Receiving All Process Care

10%

47% 47%

44%

38%

25%27%

2,651

3,855 3,887

4,626

2,923

3,427

4,020

0%

10%

20%

30%

40%

50%

2004 2005 2006 2007 2008 Jul08-Jun09

Jan09-Dec09

-

1,000

2,000

3,000

4,000

5,000CIR Process %

Population

193 additional patients received complete process care in 2009

Office Visit, Severity Class, Controller, Asthma Plan, Tobacco Assessment

Pediatric Asthma Process CarePercent of Patients Receiving All Process Care

Practice Results (20 + Patients)

25244575

306

219

835561254

203

154

341

493

30235

221

66416

26415

145

242

232

0%

20%

40%

60%

80%

100%

2008

2009

EPIC96%

Office Visit, Severity Class, Controller, Asthma Plan, Tobacco Assessment

Clinical Improvement Registry: What’s New!

• Agnostic Approach: Continue to expand generic interface to work with multiple EMRs.

• Data Interfaces: NORDX, IMMPACT2

• Prompting Data Reports

• Self-Care Reports

• Shared Patient Registry

• Reports: NCQA, ARRA meaningful use

Moving beyond “compliance”…

• Think differently!• Focus on collaborative goal setting

with patients• Effectively support behavior

change with patients:1. Do you want to make a

change?2. How are you going to make the

change?3. What can I do to help you?

“Non-compliant patient”

Bayview Pediatrics: Flu Shot

• Objective: >80% of asthmatic patients receiving a flu shot each year

• Create the team: not physician dominated

• “Santa Theory”: The LIST– Who has been naughty, who has been nice– TRACK’ em– BUG’ em– Repeat

Bayview Pediatrics: Flu Shot Integrate the registry into your office

design • Year round CIR is utilized to schedule

Asthma reviews on a 4 to 12 month basis– Opportunity to sell the FLU shot

• Each September: CIR generated mailing list

• CIR data highlights before all visits if the patient is due for a FLU shot.– Standing Order to give FLU shot

Bayview Pediatrics: Flu Shot Integrate the registry into your office

design

• November: Santa Theory Redux– 3 calls per patient

• The Physician Steps in....

• Review success and difficulties with staff– CELEBRATE– Compare against local and national data

Bayview Pediatrics: Flu Shot results

• Year Bayview MMCPHO National• 2007 30%• 200889%• 200992%

• Shared Patient Registry: Collaborative methodology

Clinical Approach

• Our numbers in the CIR looked great but…still felt there were patients slipping through the cracks. (>90% with core process care

• Wake-up call… 2 asthmatics admitted to the BBCH with under-controlled asthma this fall.– Challenge: how to use the registry and our

asthma teams to measure and improve clinical outcomes

Clinical Approach

• Education– New guidelines, accurate classification, emphasis

on control

• Track the data: expanded asthma vital sign for nurses

• New Team Design and Schedule

• Utilize community resources: Asthma Education, home visiting nurses, MMCPHO Care Managers, Specialists.

• Started work with MMCPHO to generate more clinical based reports