Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation State Name: Ohio Practice Name : Locust Pediatric Care Group Team Members: Kay Rose, Jo Murray, Lee Orin, Cooper White, David Baum, Holly Ross, Beth Tenda

Progress Summary Since Learning Session 1

Optimal Care

Spirometry to establish diagnosis

Spirometry scheduled or obtained

Self-management

PDSA Cycles PDSA Title: Encounter form implementation  Plan: Provide encounter form and have completed by the time provider sees the patient  Do:  Tracking with office flow education  Education of front desk and MA staff  Stickers  Educating parents  Study: Back desk tracking for compliance ~90%  Act: Reformat and educate

PDSA Cycles PDSA Title: Action Plan  Plan: Improve understanding/utility of form  Do: Redesign plan (maybe more of a task)  Study: Survey patients (old vs new)  Act: Patients preferred original form – reworked original form to increase information while keeping format the same

Failure Mode Effects Analysis

TEST 1 What: improve action plan Who (population): Patients Who (executes): Providers Where: Exam rooms When: Patient visits PD SA TEST 2 What: Reexamine AAP Who (population): Patients Who (executes): Providers Where: Exam rooms When: Patient visits PD SA TEST 3 What: Who (population): Who (executes): Where: When: PD SA TEST 4 What: Who (population): Who (executes): Where: When: PD SA TEST 1 What: Form Utility Who (population): Sample asthmatics Who (executes): Providers Where: Exam room / work desk When: Selected asthma visits PD SA TEST 2 What: Availability Who (population): all asthma pts Who (executes): MA Where:Triage room When: Triage PD SA TEST 3 What: Availability Who (population): all asthma pts Who (executes): MA, check in secretaries, providers Where: Front desk, Triage, exam rooms When: pre & during visit PD SA TEST 4 What: Universal availability Who (population): all asthma pts Who (executes): MA, check in secretaries Where: Front desk & exam rooms When:Pre/during visit PD SA TEST 1 What: Who (population): Who (executes): Where: When: PD SA TEST 2 What: Who (population): Who (executes): Where: When: PD SA TEST 3 What: Who (population): Who (executes): Where: When: PD SA TEST 4 What: Who (population): Who (executes): Where: When: PD SA PDSA Title: Action PlanPDSA Title: Encounter formPDSA Title PDSA Ramps

Patient’s charts identified with sticker. Sticker identified at check-in and asthma form given to family to complete while waiting to be roomed. Parent/patient completes form while waiting for provider Patient identified by provider Forms in triage room. Provider discusses asthma form information and helps family complete if necessary. Provides education and assess need for medications and spirometry. Back desk Check-out: Scripts and Asthma Action Plan given Spirometry scheduled Follow-up scheduled Info form copied – one form to chart & one to folder for data entry Non-marked charts identified and marked Forms checked for completeness Incomplete forms returned to providers for completion. RN provides asthma education as needed Office Visit - Prework During Office Visit Post Visit Activities Data entered into EQIPP by available staff weekly. Entered forms stored for entry into registry when it is available.. Office Flow Process Map Unidentified patient given form By MA during triage. Forms in triage room. Provider completes asthma info form and asthma action plan.

CQN Encounter Form

Other Please add in any other information that you think it important to communicate.

Key Learnings  We are improving our care  We are just short of 90% optimal care  Spirometry rates are improving  We have yet to see a meaningful impact on patient outcomes, but expect to see this by December

Barriers and Successes Staff buy-in – has improved, but still with some resistance Time In spite of the barriers, our care continues to improve.

Future Plans Registry after EPIC is implemented We will be leaning heavily on our EPIC-literate colleagues in the next several months