2. Broadway QI 2012-2013: Improving Asthma Risk Stratification Attendings: Heidi Beutler, Annika Hofstetter, Mariellen Lane, John Rausch, Laura-Robbins-Milne, Nan Salamon, Omalara Uwemedimo, Rene Eis Residents: Lacy-Ann Harari, Daniel Stephens, Kristal Woldu, Michael Goldman, Emily Whitesel, Arash Salavitabar, Anna Hays, Erin Paul, Joe Grillo, Uchechi Azubuine, Dominique Bailey, Tom Wallach, Pamela Good, Rebecca Tamez, Jessica George, Michelle Jamison, Kristen Schratz RNs: Sally Ortiz, Haydee Bayon, Becky Ofori, Megan Cummings Registration Coordinator: Ingrid Miranda MAs: Celia Mendez, Blanca Cordero, Reina Quiroz, Felipe Joaquin PFAs: Conchita Laurencio, Evelyn Reyes, Shirley Laurencio, Iraida Torres, Tenee Jones

3. Team Broadway

4. AIM STATEMENT The goal for our PSDA is to improve patients overall control of asthma in accordance with the National Asthma Education and Prevention Program (EPR-3 Report). – Increase the % of asthmatics to receive a priority level from 27% to a goal of 50% – Focus efforts on providers pre-rounding on all asthmatic patients and working collectively with MA’s and PFA’s to ensure that parents are provided with an ACT form – Increase the number of patients referred to WIN for Asthma by 25% – Increase the number of patient enrolled in WIN for Asthma by 10%

5. Didactic/Background Asthma has a large effect on Childhood health National Asthma Education and Prevention Program formed to improve outcomes 11% Childhood asthma prevalence in NYC – 18-22% in Washington Heights Asthma patients in all Peds ACN clinics: 3,355 – Total asthma patients at Broadway: 789

6. Didactic/Standard of Care After 12 months in WIN for Asthma: – Caregiver confidence in controlling their child’s asthma increased by 40%, – ED and hospitalization rates decreased by more than 50%, – Child school absenteeism decreased by 30%. Priority and Severity scores help identify patients to multidisciplinary teams and direct intervention/prevention efforts

7. Baseline Measures Pre-QI Data PreBroadwayAudubonRangel181st No Priority78%66%57%25% Any Priority22%32.5%40%72% I15%24%30%54% II7%8% 16% III0%0.5%2% 22%

8. ACT Form

9. Assigning Asthma Priority

10. Education of residents and faculty about the role of pre-rounding, asthma priority levels, ACT score and WIN for asthma. Discussion with MA’s and PFA’s about ACT score distribution. Posted reminder signs. Implementation of task column in Eclipsys (Feb). Personalized report cards (February and April) with comparison to peer group. PDSA Cycles

11. QI Priority Level Goal

12. Final Measures PreBroadwayAudubonRangel181st No Priority78%66%57%25% Any Priority22%32.5%40%72% I15%24%30%54% II7%8% 16% III0%0.5%2% Post No Priority50% 40%21% Any Priority50%51%58%76% I35%36%38%53% II13%12%16%21% III2%3%4%2% % Change28%18.5%18%4%

13. Provider Report Card Attending A’s report card for 11/30-2/14 and 2/25-4/11 Total Asthmatics% Severity Completed% Priority Assigned 11/30-2/14617464 2/25-4/11208580 Overall Average (%): 11/30-2/144435 2/25-4/116251 Comparison to Broadway Comparison to Attending averages 670 Asthmatics AssignedAttending Weighted Average (%): 11/30-2/144134 2/25-4/115040 139 Asthmatics AssignedResident Weighted Average (%): 11/30-2/146755 2/25-4/117971 Comparison to Resident averages

14. Feedback from Providers Progress reports help to sustain improvements Strongly Disagree DisagreeNeutralAgreeStrongly Agree 0% 0 0% 0 31.68% 6 42.11% 8 28.32% 5

15. Spread Task column Role of accurate coding of asthmatics – CHRONIC Dx Report cards Benefits to patient and provider

16. Thank You!!!!