aap chapter quality network maine aap asthma pilot project augusta, maine april 9, 2010

AAP Chapter Quality Network Maine AAP Asthma Pilot Project

Augusta, Maine

April 9, 2010

Introductions

National AAP– Judy Dolins, MPH, Laura Conley, MHSA, Peter

Margolis, MD, MPH

Maine AAP– Amy Belisle, MD, Aubrie Entwood, Barbara

Chilmonczyk, MD, Mike Ross, MD, Rhonda Vosmus, RRT-NPS, AE-C, Paula Gilbert, Kathryn Engel

Asthma EducatorsPractice Teams

Participating Practices

• Kennebec Pediatrics, Augusta• Franklin Health Pediatrics,

Farmington• Lake Region Pediatrics,

Windham• Maine Coast Pediatrics,

Ellsworth• Intermed Pediatrics, Portland

and Yarmouth• Bowdoin Pediatrics,

Brunswick• BBCH Pediatric Clinic,

Portland• CMMC Pediatrics, Lewiston

Medical Home Sites• Husson Pediatrics, Bangor• Winthrop Pediatrics• Westbrook Pediatrics

• Allergy and Asthma Associates of Maine

Objectives of Today’s Meeting

• Review Goals for National and State AAP• Highlight First 90 Days of Project• Review March Data for Maine• Discuss QI Sustainability at Chapter and

National Level• Introduce Groups to Motivational Interviewing• Continue work with Asthma Educators and

Self Management Support• Learn the Value of Spirometry• Create 90 Day Goals

Games

• Prize for “Best Theme Song” for Project• Prize for “Best Slogan” for Pilot• Prize for “Asthma Device” Worksheet• Prize for Physicians who read all 5

Spirometry cases properly• Prize for Groups with a New Registry since

the Pilot started- Maine Coast and CMMC

Chapter Quality Network (CQN)

Asthma Pilot ProjectOur First Six Months

Amy Belisle, MDPhysician Leader, Maine AAP

Judy Dolins, MPHDirector, Department of Community Chapter and State

Principle Investigator, Chapter Quality Network Asthma Pilot Project

Amy Belisle’s DisclosureI 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.

Disclosure Statement

Judy Dolin’s DisclosureI 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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MD NP

National Maine

Percent of eligible providers collecting data at point of care


Practice System ChangesRegistry Implementation Status

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Practices with a Registry Practices without aregistry

National

Maine


Practice System ChangesOptions for Practices without a Registry

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Using an Excel database asalternative

Actively discussing/ exploringregistry

Not discussing/ exploringregistry

National Maine


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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

High Moderate Low

National

Maine


Measures of Asthma Care Practices and Health Outcome

Key Measure Goal Alabama Maine Ohio OregonNational 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 months 0% 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%

Optimal Care

>70% 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)

Optimal Asthma Care

National Project (All Chapters)

0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Maine = 71%

Self-Management

Maine = 84%


0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0


Use of a Validated Instrument

Maine = 93%


0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0


Hospitalizations

Maine = 4%


0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0


Patients Well-Controlled

Maine = 68%


0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0


CQN-MAINECQN-MAINE

Franklin Health Pediatrics-Farmington

Intermed Pediatrics-Portland

BBCH Pediatric Clinic- Portland

Allergy and Asthma Associates-Portland

Westbrook Pediatrics-Westbrook

Maine Coast Pediatrics-Ellsworth

Bowdoin Medical Group-Brunswick

Husson Pediatrics-Bangor

Lake Region Primary Care-Windham

Kennebec Pediatrics-Augusta

Winthrop Pediatrics-Winthrop

CMMC Pediatrics,Lewiston

Global Aim

Specific Aim

Maine’s Aim Statement

Global AimWe will build a sustainable quality improvement infrastructure within our chapter 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 improving use of the NHLBI/NAEPP guidelines and the documentation of quality care.

Maine’s Aim Statement

Goal: 90% of practices will achieve 70% optimal care on patients seen by September 2010.

Goal: 90% of practices use a structured electronic or paper asthma encounter tool 80% of the time by September 2010.

Outcome Goal: 90% of practices will have at least a yearly ACT score documented in 50% of their patients > 4 years old by September 2010.

Maine’s Aim Statement: Long Term Goals

Goal: All practices involved in this collaborative will continue to use a population based registry beyond the time of this grant.

Goal: The AH! Asthma Health evidence based asthma tools will be used by member practices.

Goal: Certified asthma educators will be available to all member practices.

Goal: A committee of AAP members experienced in quality improvement will be charged with infrastructure development in the organization; this will include identifying funding sources for activities. We will have semiannual reporting of QI activities at Maine AAP Fall and Spring conferences for all of its members.

Goal: The Maine AAP will partner with MaineHealth, MaineCare, the Maine CDC, Maine based Health Insurers and other organizations interested in child health improvement (such as the Maine Lung Association, the Maine Immunization Collaborative or the Maine Children's Association) to develop a sustainable approach to quality improvement in our organization.

27

Maine’s First 90 Days

Spread work of AH! Program in Maineto all 4 AAP groups

Sent Asthma Flip Charts (750) Tool kits (55) Medication Charts (214)

Learning Sessions at CMMC (Sept) Teleconference in January

Engaged statewide asthma educators in project- 4 Attended Learning session and 25 aware of project

Maine’s First 90 Days

Coached practices on data and PDSA cycles- 100% of groups submitted 1st PDSA on time

Communicated with Senior Leadership- 45 letters sent out to leadership of practices regarding project and need for registry; 5 monthly newsletters sent out

Identified ACT form for kids less than 4: TRACKhttp://www.asthmatracktest.com/

Worked with Patient Centered Medical Home Committee to Identify Asthma Quality Indicators

Started to form state AAP QI Committee

http://www.asthmatracktest.com/

Updated asthma encounter forms- both paper and electronically

Updating EMR forms

• One of challenges is looking at different EMRs in state and figuring out how we can work together to incorporate NHLBI asthma guidelines and EQIPP measures into the templates

• By updating templates, would help us collect data from all physicians in group including those not doing EQIPP

• Logician, EPIC, Allscripts, EClinicalworks, etc.• Husson Pediatrics (Logician/Meridios), Mike Ross, MD:

– Used Cincinnati Children’s for a physical template– Added aspects from Ah!Asthma form, CAQI encounter form, and GE-

CCC-asthma.– Added specific obs terms to interface with our registry– 2-tabbed form:

Asthma follow-up & Asthma diagnosis

Stepwise Approach

Maine Chapter

0%10%20%30%40%50%60%70%80%90%

100%

256 281 304 255 293 304 0 0 0 0 0 0 0


Maine = 97%

Flu Shot Recommendation

Maine Chapter

0%10%20%30%40%50%60%70%80%90%

100%

254 281 304 255 293 304 0 0 0 0 0 0 0


Maine = 98%

Asthma Action Plan

Maine Chapter

0%10%20%30%40%50%60%70%80%90%

100%

197 281 304 255 293 304 0 0 0 0 0 0 0


Maine = 78%

Spirometry

Maine Chapter

0%10%20%30%40%50%60%70%80%90%

100%

105 281 304 255 293 304 0 0 0 0 0 0 0


Maine = 62%

Maine’s 90 Day GoalsFeb 2010-April 2010

• 1. Develop QI committee with Maine AAP• 2. Work on spirometry/peak flow implementation• 3. Organize Learning Session 3- April 9th in

Augusta• 4. Increase monthly EQIPP entries by 10% each

month for the next 3 months• 5. Have 75% of practices with a registry by May

2010

Asthma Care a Year From Now

• Healthier patients and empowered families• Engaged providers and staff employing asthma guidelines

including physicians not involved in EQIPP, encourage “spread” within practice

• Utilizing electronic records to improve quality• Efficient office systems that benefit from planned care• Reduced cost• Continue Partnerships with PCMH & Maine Asthma Council• Engage Senior Leaders and Healthcare Organizations• Reach out to Northern Maine and Family Practice groups to

spread Asthma QI• Close the Quality Gap and provide the best care for every

patient, every time

aap chapter quality network maine aap asthma pilot project augusta, maine april 9, 2010

Documents

portlandcmmc pediatrics

ellsworthintermed pediatrics

yarmouthbowdoin pediatrics

asthma care practices

practice system changesoptions

chapter level key partnerships

windhammaine coast pediatrics

practice levelchanges