1. Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation State Name: Ohio Practice Name: Cleveland Clinic Beachwood Family Health Center Team Members: Joe Lock, MD; Conrad Foley, MD; Jacalyn Hazen, MD; Steve Wexberg, MD; Judy Zivoder, RN; Kathy Nelson, RN

2. Progress Summary Since Learning Session 1 Revised Asthma CQN Questionnaires - more user friendly Developed EMR tool to allow rapid documentation of Asthma CQN Questionnaires into progress note Modified asthma education material for EMR use Modified Asthma Action Plans for EMR use Developed Smart Set to provide efficiency Group to achieved the following practice changes: Utilize Asthma CQN Questionnaires Follow 2007 Diagnosis and Management Guidelines Provide Asthma Action Plans Order Spirometry Provide asthma education Schedule follow up visits

3. Obtain Spirometry

4. Provide Asthma Education

5. Provide Asthma Action Plan

6. Optimal Asthma Care

7. PDSA Cycles PDSA Title: Administer Asthma CQN Questionnaire to all asthma patients at any office visit  Plan: Administer Asthma CQN Questionnaire if medication history reveals asthma medication. Start small and generalize as able.  Do: Try on 3 patients/5-day period.  Study: Learned that questionnaire can provide useful information without seriously interrupting office flow.  Act: Modified questionnaire, developed EMR documentation tool, generalized use, involved office MA’s

8. TEST 1 What:: administer questionnaire Who (population): 3 patients Who (executes): Joe Lock Where: all docs When: Oct 09 PD SA TEST 2 What:: revised questionnaire Who (population): 3 patients Who (executes): Joe Lock Where: office When: Oct 09 PD SA TEST 3 What:: revised questionnaire #2 Who (population): 3 patients Who (executes): all docs Where: office When: Oct 09 PD SA TEST 4 What:: EMR documentation tool For CQN Questionnaire Who (population): 3 patients Who (executes): all docs Where: office When: Oct 09 PD SA TEST 1 What:: administer only at wellness visits Who (population): 5 days Who (executes): all docs Where: office When: Nov 09 PD SA TEST 2 What:: administer at any visit Who (population): 5 days Who (executes): Joe Lock Where: office When: Nov 09 PD SA TEST 3 What:: administer at any visit Who (population): 5 days Who (executes): all docs Where: office When: Nov 09 PD SA TEST 1 What:: MA’s administer Who (population): 5 days Who (executes): all docs Where: office When: Dec 09 PD SA TEST 2 What:: MA’s with questionnaires In all rooms Who (population): 5 days Who (executes): all docs Where: office When: Dec 09 PD SA TEST 3 What:: MA’s after in-service Who (population): 5 days Who (executes): all docs When: Jan 10 PD SA TEST 4 What:: MA’s with physician review Who (population): ongoing Who (executes): all docs Where: office When: Jan 10 PD SA Try CQN QuestionnaireExpand questionnaire useImprove questionnaire administration PDSA Ramps

9. Physician orders spirometry and asthma recheck visit Time for Discussion? Paper questionnaires entered into EQUIPP by RN/team member Office Flow Diagram – Cleveland Clinic Beachwood FHC MA rooms patient. MA gives Asthma CQN Questionnaire If asthma med noted on medication history. Physician reviews chart to identify asthma Patients not identified by MA. During the visit the physician reviews questionnaire Physician discusses asthma control, orders spirometry, reviews Action Plan, and provides asthma education no yes Physician documents data and visit in EMR

10. EMR Smart Set Smart Set EMR tool to allow user to construct a complete patient encounter for a specific topic Makes it easy (simple and quick) to do the right thing One stop shopping for all your asthma needs A work in progress: Pieces are added, deleted, or modified as needed and as a result of user suggestions.

11. Smart Set

20. Key Learnings  Process is driven by Asthma CQN Questionnaire  Spirometry provides useful/essential information  Improved asthma treatment can be accomplished without disturbing office flow  Docs like it: professional satisfaction from solving problems  Parents like it:healthier child, stay in school, stay at work

21. Barriers and Successes Biggest barrier is fitting this process into an already busy office routine. Success/solution for us: Administer questionnaire whenever asthma medication use identified Review questionnaire to determine who needs an asthma visit Schedule an asthma visit and spirometry for a future date

22. Future Plans Create an abbreviated questionnaire Administer questionnaire whenever asthma medication use identified Review questionnaire to determine who needs an asthma visit Schedule an asthma visit and spirometry for a future date