1. Chapter Quality Network (CQN) Ohio Asthma Pilot Project Cooper White MD Chapter Physician Leader Kim Spoonhower MD Asthma Expert Heather Hall Ohio Chapter AAP Project Coordinator 7/24/2010

2. CQN Asthma Pilot Sites MAINE OHIO OREGON ALABAMA

3. Akron Children's Hospital Pediatrics - Broadway (Akron) Nationwide Children's Hospital - Primary Care Centers-Red Team (Columbus) Pediatric Associates (Columbus) Locust Pediatric Care Group / Children's Hospital Medical Center of Akron (Akron) Cleveland Clinic Children's Hospital - Main Campus (Cleveland) PrimeCare Pediatrics (Zanesville) Cleveland Clinic Children's Hospital at Marymount (Garfield Heights) Cleveland Clinic Willoughby Hills FHC (Willoughby Hills) Toledo Children's Primary Care (Toledo) Cleveland Clinic Beachwood FHC (Beachwood) PediatriCenter of Greater Cleveland (Broadview Heights) Pediatric Associates of Mt. Carmel (Cincinnati) Oxford Pediatrics & Adolescents (Oxford) CQN - OHIO

4. CQN Theoretical Models: A three-legged stool Chronic Disease Model The Improvement Model, i.e.Rapid Cycle Improvement (PDSA) Breakthrough Series Collaborative Method

6. Cambridge Health Alliance Childhood Asthma: % Patients with Asthma Admissions Goal <= 0.5%

7. Practice Key Driver Diagram

8. Ohio CQN Timeline 3/09 Ohio Selected for CQN 10/10 CQN1 ends 10/09 LS11/10 LS2 Webinar 4/10 LS3 8/10 LS4 H1N1 EpidemicRecruitment Throughout: Monthly conference calls, rating calls, leadership group calls, and regular practice QI and group meetings.

9. Accomplishments Practice Engagement: All practices with an active Asthma QI committee, meeting regularly Planned Care: All practices with practice flow analysis aimed at providing the right care, 100% of the time. Widespread use of standard encounter form designed for use with Eqipp. Extensive availability of and adherence to 2007 NHLBI Guidelines. Increased use of spirometry. Patient and family education protocols established in all practices.

10. Optimal Care Use of a validated instrument to assess control Guideline adherence, i.e. “stepwise management” Written Asthma Action Plan Flu vaccine or recommendation (depending on the season)

11. Optimal Care

12. Ohio CQN Successes Use of a Validated Instrument Assessment of reasons for lack of control Stepwise management Influenza Vaccination Follow-up Appointment Average practice rating rising, 3.7 in 7/10

13. Successes

14. Significant and Sustained Improvement Optimal Care Use of Spirometry at diagnosis Spirometry scheduled or accomplished Updated asthma plan Self management support

15. Sustained Improvement

16. Challenges ER visits Hospitalizations % Well controlled Registry Use Expanding SMS beyond asthma education

17. Challenges

18. One Practice’s Experience

22. Chapter QI Vision Support EMR transformation in Ohio Pediatric practices Sustainable QI initiatives: Improving care, and meeting MOC needs of members and practices Building partnerships

23. CQN: The Future for Ohio Wave 2 recruitment planned to begin in the fall/winter of 2010. Kickoff early 2011. New financial model Financing for Ohio appears most likely to be payer supported Existing practices hopefully will continue data collection. Incentives need exploration System based activities possible in Cleveland and Columbus.

24. “I think we are a perfect example of what the data can do to change physician behaviors on a practice-wide level. We all THOUGHT we were doing a good job with asthma care (even the pulmonologists at Nationwide Children's had told us so) but it was obvious after our first months with the project that we could do better, and that there was a HUGE variation amongst practitioners within the practice. This project has made us look at some other aspects of care where we thought we were doing well, when indeed we have a LOT of room for improvement.” Bill Long MD, Pediatric Associates, Columbus Ohio