1. Chapter Quality Network (CQN) Asthma Pilot Project Chapter and National Sustainability Amy Belisle, MD Physician Leader, Maine AAP Judy Dolins, MPH Director, Department of Community Chapter and State Principle Investigator, Chapter Quality Network Asthma Pilot Project

2. Amy Belisle’s 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. Disclosure Slide Judy Dolin’s 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

3. Sustainability? The Life Cycle of QI Projects

4. Defining success at the National 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  Increased capacity for quality improvement work  Governance group engagement  Insight into successes and challenges to sustaining work at the chapter level  Key partnerships focused on improvement work  Funding for continued quality efforts  Increased chapter demand for CQN programming Practice/Individual Clinician Chapter

5. 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

6. 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

7. Building a QI Infrastructure at the AAP and Maine Maine AAP QI Committee Build network among pediatric offices Build infrastructure within health care organizations State of Maine- PCMH, Quality Counts, CHIPRA grant Need to tie in P4P, reimbursement with Quality Measures- Maine AAP hopes to develop a Pediatric Council in next 2 years

8. Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA grant) $11 million dollar grant over next 5 years The grants are totally federally funded and are designed help establish a national quality system for children’s health care through Medicaid and CHIP Maine is partnered with Vermont High risk group is children in foster care- how to track quality measures & coordinate mental health and medical care

9. CHIPRA First 9 months- Planning Phase Develop QI committee at State level Implement Bright Futures in all pediatric offices in state Look at 27 new QI measures with Medicaid Implement EMR and registries to track QI measures Look at secondary prevention measures- pediatric detailing to look at asthma, ADHD, etc.

10. CHIPRA Focus Areas Immunizations Screening- BMI, Development, Breastfeeding, Chlamydia Well Child Visits Dental Management of Acute Conditions- Pharyngitis, Otitis Media with Effusion Emergency Dept Use Pediatric Catheter Infection Rates

11. More CHIPRA Focus Areas ADHD Mental Health Diabetes Family Experience of Care Availability- Children and Adolescent Access to PCP Asthma- see chart on next slide

12. CHIPRAMeaningful UseEQIPPCIRPTE?PCMH ED visits in last 12 mo xxx-6moxx Hosp admits in past 12 mo xx-6 moxx Asthma Key Indicators x Lung function measured by spirometry to establish dx x ACT done to determine level of control xxxx Symptom free day survey x Current level of control (Primary care)xxxx Spirometry test in last 1-2 years xxx NHLBI stepwise table used x x classf’n x controller x Flu shot recommendation in past 12 mo/given xxxx Written Action Plan xxxx Asthma Self- management education x Follow up appointment x Tobacco Use/Exposure xxx Peak flow- annualx Annual asthma visitxxx

14. Persistence Change is Hard

15. How can we spread QI? How do you envision the spread of quality measures in your local area? How have you engaged your senior leadership and how receptive have they been? What can we do better as we reach out to the practices? What is the best way to communicate- in person learning sessions, conference calls, listerv? What resources do you need at the practice level for QI? What other QI projects have you been working on or thinking about initiating in your area?

16. Next 90 Day Goals What do you want to do next? What do you need to do next? How can the AAP at the state and national level help you achieve your goals? 16

17. Next 180 Days What do you want us to work on at the state level to move the project forward? What is your vision for the project once we finish collecting data in September? How will we measure success?