1 / 55

Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation

State Name: Oregon Practice Name:PHMG-Barger Pediatrics Team Members: Lorna Wong, MD, Paul Benda, MD, Tammy Barstow, MD, Heather Rutherford, CMA, Tonja Wells, RN, Michelle Dimitri, CMA, Jamie Brownlee, Cheryl Ivey, and Sandy Campbell, RN. Chapter Quality Network (CQN)

hesper
Download Presentation

Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. State Name: Oregon Practice Name:PHMG-Barger Pediatrics Team Members: Lorna Wong, MD, Paul Benda, MD, Tammy Barstow, MD, Heather Rutherford, CMA, Tonja Wells, RN, Michelle Dimitri, CMA, Jamie Brownlee, Cheryl Ivey, and Sandy Campbell, RN Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation

  2. State Name: Oregon Practice Name:PHMG-Downtown EugenePediatrics Team Members: Jeff Joehnk, MD, Chris Hammond, MD, Mary Miller, MD, Richard Hansen, RN, Debra Ard, RN, Dayle Martinez, CMA, Linda Himber, Blanca Quintero, and Sandy Campbell, RN Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation

  3. State Name: Oregon Practice Name:PHMG-Riverbend Pavilion Pediatrics Team Members: Christine McKee, MD, Lauren Herbert, MD, Leslie Pelinka, MD, Fay Sunada, MD, Diane Citti, RN, Veronica Hernandez, LPN, Katie Salinas, CMA, Linda Brigleb, Gilma Vergara, and Sandy Campbell, RN Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation

  4. State Name: Oregon Practice Name:PHMG-South Eugene Pediatrics Team Members:Jimmy Unger, MD, Debbie Fuerth, MD, Eileen Hanna, RN, Irina Gidenko, CMA, Sara Stout, RN, Virginia Nelson, Sherri Schor, and Sandy Campbell, RN Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation

  5. PeaceHealth Medical Group Pediatrics We will establish and use sustainable quality improvement tools within our practices to achieve measurable improvements in asthma outcomes. From fall 2009 to fall 2010 we will achieve measurable improvements in asthma outcomes by implementing appropriate NHLBI guidelines, making CQN Asthma Pilot Project’s key practice changes, and with the goal of potential incorporation into the EMR.

  6. PHMG QI Measurement points at 1 year, 2 years, and 3 years • Asthma Action Plan in the EMR: 75% year one, 85% year two, and 90% year three. • Flu vaccine given or recommended each year: 75% year one, 85% year two, 90% year three. • Annual asthma checkup with evaluation using accepted asthma encounter form: 75% year one, 85% year two, 90% year three • Asthma diagnosis marked appropriately on the problem list in the EMR: 75% year one, 85% year two, 90% year three

  7. Asthma Action Plan in the EMR Goal 75% year one, 85% year two, 90% year three Baseline to now changes • Barger: 35% to 63% • Downtown Eugene: 100% to 90% • RiverBend Pavilion: 20% to 94% • South: 75% to 100%

  8. % of patients who have a current written asthma action plan explained to them at this visit – PHMG Barger Pediatrics

  9. % of patients who have a current written asthma action plan explained to them at this visit - PHMG Downtown Eugene Pediatrics

  10. % of patients who have a current written asthma action plan explained to them at this visit PHMG RiverBend Pavilion Pediatrics

  11. % of patients who have a current written asthma action plan explained to them at this visit - PHMG South Eugene Pediatrics

  12. Flu vaccine given or recommended each year: 75% year one, 85% year two, 90% year three. Baseline to Now Changes • Barger: 78% to 60% • Downtown Eugene: 100% to 100% • RiverBend Pavilion: 100% to 94% • South: 83% to 100%

  13. % of patients with asthma ages 6 months & older who have received a flu shot or flu shot recommendation within the past 12 months – Barger Pediatrics

  14. % of patients with asthma ages 6 months & older who have received a flu shot or flu shot recommendation within the past 12 months – Downtown Eugene Pediatrics

  15. % of patients with asthma ages 6 months & older who have received a flu shot or flu shot recommendation within the past 12 months – RiverBend Pavilion Pediatrics

  16. % of patients with asthma ages 6 months & older who have received a flu shot or flu shot recommendation within the past 12 months – South Eugene Pediatrics

  17. Annual asthma checkup with evaluation using accepted asthma encounter form75% year one, 85% year two, 90% year three Using our excel registry we will be able to monitor this in the coming years based on the patients we are seeing for asthma encounters this year.

  18. Asthma diagnosis marked appropriately on the problem list in the EMR 75% year one, 85% year two, 90% year three • We began measuring this in January of this year Our baseline and current measurements are: • Barger: 76% and 100% • Downtown: 73% and 100% • RiverBend: 67% and 100% • South: 52% and 100%

  19. Factors considered for optimal asthma care • Was the parent/patient questionnaire used to determine the current level of asthma control? • Was the age-appropriate NHLBI EPR-3 stepwise table used to identify treatment options or to adjust therapy based on asthma control? • Has the patient received, or had recommended, a flu shot during this flu season? • Does the patient have a written asthma action plan?

  20. % of patients receiving optimal asthma carePHMG Barger Pediatrics

  21. % of patients receiving optimal asthma carePHMG Downtown Eugene Pediatrics

  22. % of patients receiving optimal asthma carePHMG RiverBend Pediatrics

  23. % of patients receiving optimal asthma carePHMG South Eugene Pediatrics

  24. Spirometry PHMG Percentiles

  25. % of patients ages 5 and older in which spirometry is used to establish an asthma diagnosis – Barger Pediatrics

  26. % of patients ages 5 and older in which spirometry is used to establish an asthma diagnosis – Downtown Eugene Pediatrics

  27. % of patients ages 5 and older in which spirometry is used to establish an asthma diagnosis – RiverBend Pavilion Pediatrics

  28. % of patients ages 5 and older in which spirometry is used to establish an asthma diagnosis – South Eugene Pediatrics

  29. Obstacles to implementing spirometry recommendations • Physician’s perception that it rarely alters treatment recommendations • Accessibility: for many families it means a separate appointment and another ½ day off work/school • Result reliability: highly dependent on technique and age of patient • small offices don’t have the test volume and personnel to guarantee reliability • Reliable results are more difficult to obtain on children less than 8-10 years old • Cost of obtaining high quality equipment to perform test

  30. Our Spirometry Dilemma Centralized testing: • Potentially more reliable results • Less expensive, but less accessible for patients Decentralized testing: • More accessible for patients • More expensive • Potentially less reliable results • Disruption of patient flow in busy practice setting

  31. Benefits of Spirometry • Objective data • Using routinely will promote better use of spirometry tool, more familiarity, and better results • Can be an effective tool in distinguishing intermittent asthma from persistent asthma

  32. What we learned from EQIPP data Tipping point with the AAP. Support of the team / meetings, important for practice change Improved formalized use of a step-wise approach to asthma care Shock value of formal data collection. Importance of processes. (refills, capturing patients)

  33. PDSA Cycles

  34. Plan: Encounter form will be completed prior to the provider entering the exam room Do: engage & educate staff, identify patients, create poster for waiting rooms, get encounter form in Spanish Study: Small sample to broader group Act: slightly different at each site PDSA Title: Encounter Form Completion

  35. P P P P P P P P P P P P D D D D D D D D D D D D S S S S S S S S S S S S A A A A A A A A A A A A Encounter Form Completion prior To MD entering Exam room TEST 4 What: Who (population): Who (executes): Where: When: TEST 4 What: Who (population): Who (executes): Where: When: TEST 4 What: Who (population): Who (executes): Where: When: TEST 3 What: Who (population): Who (executes): Where: When: TEST 3 What: Who (population): Who (executes): Where: When: TEST 3 What: Who (population): Who (executes): Where: When: TEST 2 What:form completion Who (population)patient: Who (executes)PAS or roomer: Where:in waiting room or exam room When:at arrival or if missed, during rooming process TEST 2 What:form completion Who (population):patiient Who (executes):PAS or roomier Where:in waiting or iexam room When:at arrival or during rooming TEST 2 What:form completion Who (population):patient Who (executes):rooming nurse Where:in exam room When:during rooming process TEST 1 What: form completion Who (population)patient: Who (executes):PAS Staff Where: Waiting room When:at arrival TEST 1 What: form completion Who (population):patient Who (executes):PAS staff Where:in waiting room When:at arrival TEST 1 What:form completion Who (population)patient: Who (executes):PAS staff Where:in waiting room When:at arrival Barger Downtown & RiverBend South

  36. PDSA Title: Collection of forms and data entry – test two • PLAN: Collect encounter forms and enter data into excel registry, EQIPP, and EMR • DO: engage & educate staff, designate a data entry person at each site, designated person collects forms and enters data • STUDY: studied and successful • ACT: adopted at all sites

  37. PDSA Title: Collection of forms and data entry • PLAN: Collect encounter forms and enter data into excel registry, EQIPP, and EMR • DO: engage & educate staff, send forms by interdepartmental mail to primary administrator • STUDY: forms inadvertently sent to medical records, forms left on provider desks, forms lost to the black hole of interdepartmental mail • ACT: adapted

  38. PDSA Title: completion of electronic asthma action plan • PLAN: asthma action plan will be completed in the EMR on 75%, 85%, and 90% of patients seen with asthma over the course of the next 3 years • DO: Physician will complete the AAP during the visit and give copy to patient • STUDY: not enough time to complete this during visits other than asthma recheck appointments - not happening consistently • ACT: adapted

  39. PDSA Title: completion of electronic asthma action plan – test two • PLAN: asthma action plan will be completed in the EMR on 75%, 85%, and 90% of patients seen with asthma over the course of the next 3 years • DO: Physician will either complete AAP electronically at time of visit or dictate AAP into note, give patient a handwritten version, and data entry staff will create electronic version during data entry process • STUDY: studied and successful • ACT: adopted

  40. PDSA Title: Increased rate of flu vaccine administration • PLAN: Flu vaccine will be given or recommended to 75%, 85%, and 90% of patients with an asthma diagnosis in years 1, 2, and 3 • DO: flu vaccine clinics, flu vaccine capture with all visit types, call patients from registry or other high risk patient lists and schedule for vaccine • STUDY: studied • ACT: adopted

  41. PDSA Title: Increase number of patients receiving annual asthma check with use of accepted asthma encounter form • PLAN: Increase the number of asthma patients receiving an annual asthma check • DO: increase number of patients on registry, appointments triggered by asthma med refill requests, use form during well child checks in patients with known asthma, include patients being seen for an illness visit with wheezing identified by either provider or rooming nurse • STUDY: ongoing study being done • ACT: adapted encounter form to increase usage by non-participating providers within all groups

  42. PDSA Title: Asthma appropriately documented on the EMR problem list • PLAN: 75%, 85%, and 90% of identified asthma patients will have an asthma diagnosis on the EMR Problem list in years 1, 2, and 3 respectively • DO: updated by provider, updated by rooming nurse, updated by data entry staff • STUDY: ongoing study • ACT: currently a combination of the above is happening at each site. Study continues.

  43. Process Maps

  44. The CQN Encounter Form • Too lengthy • Revamped form many times to shorten it • Not user friendly • Suggestions of colleagues, participating and non-participating • Providers wanted a form they could score • incorporated the ACT into the form

  45. Use of a formalized encounter form improved quality of asthma care (surprise – we thought we did a good job before) Improved asthma quality of care due to standardization of care Asthma handouts AAP in EMR (useful for providers and staff) Identifying and prevention of asthma triggers Aerochamber use and education Increased use of inhaled steroids Change requires process change and engagement Continued motivation of the entire team promotes teamwork and improves outcomes Key Learnings page 1

More Related