Chapter Quality Network (CQN) Asthma Pilot Project Our Now and Our Future James C. Wiley, MD, FAAP CQN Chapter Physician Leader Alabama Chapter-AAP President April 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

4 ALABAMA Marshall 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 Aim We 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 Aim From 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 Goal: 90% of the CQN Asthma Pilot Practices will use a structured encounter form 90% of the time by September Outcome Goal: 90% of the CQN Asthma Pilot Practices will reach 80% of patients “well controlled” by September 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 Statement SECTION 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/ s. The CQN Asthma Pilot Practices will host an Asthma QI Project sharing session/summit at the Chapter’s 2011 Spring Meeting in April 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

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 One of our Challenges – 57%

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

Our Now and Our Future: Perspectives from the National Level Judy Dolins, MPH Director, 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 Continuous tests of changeSustainability Imbed in everyday work Scale Up & Spread Taking local improvement And actively disseminating it across 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 Percent of eligible providers collecting data at point of care

How are we doing at the National Level? Practice System Changes Registry Implementation Status

How are we doing at the National Level? Practice System Changes Options for Practices without a Registry

How are we doing at the National Level? Practice System Changes Degree of belief that workflows for collecting data for eligible patients/opportunities at point of care are highly reliable

How are we doing at the National Level? Measures of Asthma Care Practices and Health Outcome

Self-Management Alabama = 81%

Hospitalizations Alabama = 5%

Spirometry Alabama = 63%

Flu Shot Alabama = 93%

Improvement Work Continuous tests of changeSustainability Imbed in everyday work Scale Up & Spread Taking local improvement And actively disseminating it across a chapter and/or practice Next 6 months

National Efforts to Sustain Work  Continued 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