1. Optimal Asthma Care Project

2. Identify Asthma Patients at check – in Parents to complete the Asthma Data Collection Form given by the front desk staff Office Manager goes into the EMR and pulls up the completed Data collection forms and enters the data into EQIPP Completed data form is to Be given to the RN In exam room By patient. Yes Physician completes their section Of questions on the Asthma Data Collection Form directly Into the EMR No Nurse to go over questions on the form and enter patients answers into the EMR in exam room Either the RN or the physician enters the patients data from form into the EMR Follow up appointment immediately Scheduled within the next 2 weeks to Get a formal asthma evaluation with spriometry. Southern Oregon Pediatrics Acute Visit Flow Chart 1. Problem Points: 1. 2. Making sure patients follow thru with recheck appt. 2. Making sure we have enough time to enter the answers from the CAQI form before Dr. enters exam room.

3. Spriometry performed by MA/RN and data is put on fee ticket for physician to review. Patient is ready to be seen by Physician During the visit the physician fills out the form while having Informed clinical Discussion Questions 1-27 If patient is well controlled a follow up visit will be made in 6 months. If patient is not in good control the follow up will be determined by physician Parent/patient education handouts given And Action plan given and reviewed YES During Office Visit Post Visit Activities Brenda pulls up Report with All completed forms. Forms will not appear Until visit is Signed by Doctor. If necessary, go to physician to obtain missing information or to have them sign the patient’s record if complete NO All necessary information on the form is entered into EQIPP by Brenda Brenda verifies in schedule that parent has Scheduled the follow up Appointment recommended by The physician Southern Oregon Pediatrics Clinical Assessment Process Map MA/RN rooms pt. And makes sure CAQI form is completed for physician review CAQI form attached by the records staff when preparing tickets for next days appts on asthma patients identified in the EMR Pre Visit

4. TEST 1 What: ensuring all asthma pts complete a CAQI form Who: Front Desk Where: Waiting room or Exam Room When: prior to Dr. in room P D SA TEST 2 What:: revised process for forms to be Placed on pts with specific dx. Who: records clerk Where: to be paper clipped behind Fee ticket so front desk can Have completed at check in When: day before appt its attached PD SA TEST 1 What: need spirometry machine Who: Barb ordered and calibrated Where: back office When: decided in Dec 2009 PD SA TEST 2 What: training of staff on spirometer Who : all MA’s and RN’s Who : Barb set up training mtg Where: office When: 2/16/10 PD SA TEST 3 What: implementing routine testing On all asthma visits Who: MA’s and RN’s have all been Trained and have practiced on New machine Where: office When: ongoing PD SA TEST 4 What: ongoing familiarity with getting The data printed out. Who: MA’s and RN’s Who :Barb is our main contact Person for problems with the Machine. Where: She helps resolve any Equipment issues When: ongoing PD SA TEST 1 What: physician directs pt to Schedule rck appt to obtain A complete asthma evaluation Who : patient families Who (executes): physician Where: during unrelated acute appt Where need was identified When: at unrelated appt PD SA TEST 2 What: revised plan to have parents Be escorted to a scheduler to Make a follow up asthma appt Who : patient family Who : physician or nurse Where: at schedulers desk When: after unrelated acute appt PD SA TEST 3 What: Action in case a pt cancels or no shows follow up rck asthma appt Who: patient Who : front desk/RN sends msg To physician that pt has not kept appt. Call placed to pt to reschedule Where: msg sent in EMR When: at time of cancellation or after the no showed appt PD SA Encounter Forms Spriometry Follow up Appointments Southern Oregon Pediatrics

19.  We show an improvement in our follow up appointments from 60% to over 90% but feel we still need to monitor changes we have made to continue success.  90-100% of our asthma patients over 6 months of age are recommended or receiving a flu vaccine.  Lastly, our percentage of patients receiving optimal asthma care has reached over 90% this last month.