kirsten d. bennett, phd, rd, ld envision new … d. bennett, phd, rd, ld envision new mexico...
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Kirsten D. Bennett, PhD, RD, LDEnvision New MexicoUniversity of New Mexico Health Sciences Center Department of Pediatrics
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9%, 47,000 New Mexico children deal with asthma every day
Distance to care and difficulties with self-management present challenges to asthma control
Physician adherence to evidence-based guidelines for clinical asthma management remains poor
Delivery system design in primary care often does not allow for optimal best practice care of any chronic conditions
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QI approach to change The Model for Improvement
• Improvements are data driven
• Data reported in the fast feedback format using the proficiency model
• Run charts provide a an overview for selected measures
• Physicians awarded MOC• Other medical providers
awarded CME
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Focuses attention on the core functions of the clinic and staff before moving on to more complex elements of providing care
Data elements are partitioned into Basic (level 1) nearing proficiency (level 2) proficiency (level 3)
Feedback is provided quickly in graphic form to quickly identify areas in need of improvement
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Intervention consists of: Site visits Training on Model for Improvement and basic QI
methodology Training on best practice asthma care guidelines (in
person and via telehealth) Monthly PDSA developed and completed by site
participants 6 rounds of medical record reviews (MRR) submitted
electronically using REDCap over 6-12 months Structured fast feedback form (FFF) using the results of
the MRR Monthly coaching calls to review data and discuss PDSAs
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4334 MRRs from 2013-2017 for 16 NM practices 1312 MRRs for 3 Navajo Nation Practices
Percent change from baseline adherence to best practice asthma care
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Measure All Practices* Navajo Nation Practices*
Documentation of asthma severity
23.6% 13.56%
Completion of ACT 33.8% 59.64%
Having current AAP 45.4% 47.79%
Having scheduled follow-up visit
23.4% 8.51%
*% change
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72.24%
86.76% 88.07% 85.69%
93.03%95.82%84.11% 85.85%
88.65% 87.93%92.31%
97.67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2 3 4 5 Round 6
Severity Documented
All Practices Navajo Nation Practices
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53.46%
74.32%79.95% 78.06%
82.57%87.26%
27.57%
73.17%78.17%
71.55%75.77%
87.21%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2 3 4 5 Round 6
ACT Completed
All Practices Navajo Nation Practices
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29.72%
45.95%53.47% 54.17%
66.39%
75.10%
24.30%
48.78% 48.47% 48.71%
57.31%
72.09%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2 3 4 5 Round 6
Asthma Action Plan (AAP) Current
All Practices Navajo Nation Practices
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58.18%
73.38%75.75%
79.86%85.36%
81.56%70.56%
84.88%82.53%
86.21%90.77%
79.07%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2 3 4 5 Round 6
Follow-Up Visit Scheduled
All Practices Navajo Nation Practices
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85.14%88.11%
78.24%80.97%
90.79% 89.92%
100.00% 98.05% 99.13% 99.57% 99.62% 100.00%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2 3 4 5 Round 6
Quick Meds Prescribed
All Practices Navajo Nation Practices
Quality Improvement coaching leads to meaningful improvements in the rates of physician
adherence to best practice, evidence-based guidelines for asthma care
Care can be improved systematically A team-based approach can lead to system change and
adoption of best practices Small changes can lead to large and sustained improvements
in care Training in QI methodology increases participants’ ability to
make and manage change on their own
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US Department of Human Services, National Institutesof Health, National Heart, Lung, and Blood Institute(2007). Langley GL, Nolan KM, (2009).
The Improvement Guide: A Practical Approach toEnhancing Organizational Performance (2nd edition). SanFrancisco: Jossey-Bass.
Global Initiative for Asthma. (2017). GINA reports. http://ginasthma.org/gina-reports/
UNM HSC IRB Study #-09-177
NNHRRB Study # NNR-07-198
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Envision New Mexico QI Staff DirectoryTelephone 505-925-7600 www.EnvisionNM.unm.eduKirsten Bennett, PhD, RD, LDAssistant Professor Pediatrics
Director kdbennett@salud.unm.edu
Kristine Lucero, MAProgram Operations Managerkrisgonzales@salud.unm.edu
Andrea Andersen, MPHHealth Education Consultantaanderse@salud.unm.edu
Brandon Bell, MA.EdHealth Education Consultant
BRBell@salud.unm.edu
Terri Chauvet, CAPMProgram Coordinator
tchauvet@salud.unm.edu
Carole Conley, LMSWEducation and Outreach Manager: Primary
Care and SBHCcconley@salud.unm.edu
Zachary Johnson, MPAHealth Education Consultantzjohnson@salud.unm.edu
Adrienne McConnell, MSHealth Education Consultantaemcconnell@salud.unm.edu
Courtney McKinney, BAProgram Manager
cacklin@salud.unm.eduMary Ramos, MDAssistant Professor
Principal Investigator-Hilton GrantMRamos@salud.unm.edu
Daisy RoseroProgram Manager-Hilton Grant
DRosero@salud.unm.edu
Eleana Shair, MEdSr. Statistician
elshair@salud.unm.edu
Jeanene SiskAdministrative Assistant II
jsisk@salud.unm.edu
Maya Trujillo, BCH, MPAHealth Education Consultantmaetrujillo@salud.unm.edu
Kevin Werling, BASystems Analyst llI
kwerling@salud.unm.edu
Michelle WidenerProgram Specialist
miwidener@salud.unm.edu
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