AAP Chapter Quality Network Maine AAP Asthma Pilot Project Augusta, Maine April 9, 2010

1. AAP Chapter Quality Network Maine AAP Asthma Pilot ProjectAugusta, MaineApril 9, 2010

2. Introductions National AAP • Judy Dolins, MPH, Laura Conley, MHSA, Peter Margolis, MD, MPH Maine AAP • Amy Belisle, MD, Aubrie Entwood, Barbara Chilmonczyk, MD, Mike Ross, MD, Rhonda Vosmus, RRT-NPS, AE-C, Paula Gilbert, Kathryn Engel Asthma Educators Practice Teams

3. Participating Practices • Kennebec Pediatrics, Augusta • Franklin Health Pediatrics, Farmington • Lake Region Pediatrics, Windham • Maine Coast Pediatrics, Ellsworth • Intermed Pediatrics, Portland and Yarmouth • Bowdoin Pediatrics, Brunswick • BBCH Pediatric Clinic, Portland • CMMC Pediatrics, Lewiston • Medical Home Sites • Husson Pediatrics, Bangor • Winthrop Pediatrics • Westbrook Pediatrics • Allergy and Asthma Associates of Maine

4. Objectives of Today’s Meeting • Review Goals for National and State AAP • Highlight First 90 Days of Project • Review March Data for Maine • Discuss QI Sustainability at Chapter and National Level • Introduce Groups to Motivational Interviewing • Continue work with Asthma Educators and Self Management Support • Learn the Value of Spirometry • Create 90 Day Goals

5. Games • Prize for “Best Theme Song” for Project • Prize for “Best Slogan” for Pilot • Prize for “Asthma Device” Worksheet • Prize for Physicians who read all 5 Spirometry cases properly • Prize for Groups with a New Registry since the Pilot started- Maine Coast and CMMC

6. Chapter Quality Network (CQN) Asthma Pilot Project Our First Six Months Amy Belisle, MD Physician Leader, Maine AAPJudy Dolins, MPH Director, Department of Community Chapter and State Principle Investigator, Chapter Quality Network Asthma Pilot Project

7. Disclosure Statement 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. 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

8. National goals at the practice 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

9. National goals at the chapter level • Increased capacity for quality improvement work • Governance group engagement • Sustain QI work at the chapter level • Key partnerships focused on improvement work • Funding for continued quality efforts • Increased chapter demand for CQN programming

10. Improvement Work Continuous tests of change Sustainability Imbed in everyday work Our First 6 months Improvement Work Scale Up & Spread Taking local improvement And actively disseminating it across a chapter and/or practice

11. MAINE OREGON OHIO ALABAMA CQN Asthma Pilot Sites

12. How are we doing at the National Level?Practice System Changes Percent of eligible providers collecting data at point of care

13. How are we doing at the National Level?Practice System Changes Registry Implementation Status

14. How are we doing at the National Level?Practice System Changes Options for Practices without a Registry

15. How are we doing at the National Level?Practice System Changes Degree of belief that workflows for collecting data for eligible patients/opportunities at point of care are highly reliable

16. How are we doing at the National Level? Measures of Asthma Care Practices and Health Outcome

17. Optimal Care >70% of patients have “optimal” asthma care (all of the following) • assessment of asthma control using a validated instrument • stepwise approach to identify treatment options and adjust therapy • written asthma action plan • patients >6 mos. of age with flu shot (or flu shot recommendation)

18. Optimal Asthma Care Maine = 71%

19. Self-Management Maine = 84%

20. Use of a Validated Instrument Maine = 93%

21. Hospitalizations Maine = 4%

22. Patients Well-Controlled Maine = 68%

23. CQN-MAINE Winthrop Pediatrics-Winthrop Kennebec Pediatrics-Augusta CMMC Pediatrics, Lewiston Franklin Health Pediatrics-Farmington Husson Pediatrics-Bangor Westbrook Pediatrics-Westbrook Allergy and Asthma Associates-Portland Maine Coast Pediatrics-Ellsworth BBCH Pediatric Clinic- Portland Bowdoin Medical Group-Brunswick Intermed Pediatrics-Portland Lake Region Primary Care-Windham

24. Maine’s Aim Statement Global Aim Specific Aim Global Aim We will build a sustainable quality improvement infrastructure within our chapter to achieve measurable improvements in the health outcomes of children within our member practices. Specific Aim From April 2009 to November 2010, we will lead a quality improvement collaborative and achieve measurable improvements in asthma outcomes with the participating 10 to 15 practices by improving use of the NHLBI/NAEPP guidelines and the documentation of quality care.

25. Maine’s Aim Statement Goal: 90% of practices will achieve 70% optimal care on patients seen by September 2010. Goal: 90% of practices use a structured electronic or paper asthma encounter tool 80% of the time by September 2010. Outcome Goal: 90% of practices will have at least a yearly ACT score documented in 50% of their patients > 4 years old by September 2010.

26. Maine’s Aim Statement: Long Term Goals Goal: All practices involved in this collaborative will continue to use a population based registry beyond the time of this grant. Goal: TheAH! Asthma Health evidence based asthma tools will be used by member practices. Goal: Certified asthma educators will be available to all member practices. Goal: A committee of AAP members experienced in quality improvement will be charged with infrastructure development in the organization; this will include identifying funding sources for activities. We will have semiannual reporting of QI activities at Maine AAP Fall and Spring conferences for all of its members. Goal: The Maine AAP will partner with MaineHealth, MaineCare, the Maine CDC, Maine based Health Insurers and other organizations interested in child health improvement (such as the Maine Lung Association, the Maine Immunization Collaborative or the Maine Children's Association) to develop a sustainable approach to quality improvement in our organization.

27. Maine’s First 90 Days • Spread work of AH! Program in Maine to all 4 AAP groups • Sent Asthma Flip Charts (750) Tool kits (55) Medication Charts (214) • Learning Sessions at CMMC (Sept) Teleconference in January • Engaged statewide asthma educators in project- 4 Attended Learning session and 25 aware of project 27

28. Maine’s First 90 Days • Coached practices on data and PDSA cycles- 100% of groups submitted 1st PDSA on time • Communicated with Senior Leadership- 45 letters sent out to leadership of practices regarding project and need for registry; 5 monthly newsletters sent out • Identified ACT form for kids less than 4: TRACK http://www.asthmatracktest.com/ • Worked with Patient Centered Medical Home Committee to Identify Asthma Quality Indicators • Started to form state AAP QI Committee

29. Updated asthma encounter forms- both paper and electronically

30. Updating EMR forms • One of challenges is looking at different EMRs in state and figuring out how we can work together to incorporate NHLBI asthma guidelines and EQIPP measures into the templates • By updating templates, would help us collect data from all physicians in group including those not doing EQIPP • Logician, EPIC, Allscripts, EClinicalworks, etc. • Husson Pediatrics (Logician/Meridios), Mike Ross, MD: • Used Cincinnati Children’s for a physical template • Added aspects from Ah!Asthma form, CAQI encounter form, and GE-CCC-asthma. • Added specific obs terms to interface with our registry • 2-tabbed form: Asthma follow-up & Asthma diagnosis

31. Stepwise Approach Maine = 97%

32. Flu Shot Recommendation Maine = 98%

33. Asthma Action Plan Maine = 78%

34. Spirometry Maine = 62%

35. Maine’s 90 Day GoalsFeb 2010-April 2010 • 1. Develop QI committee with Maine AAP • 2. Work on spirometry/peak flow implementation • 3. Organize Learning Session 3- April 9th in Augusta • 4. Increase monthly EQIPP entries by 10% each month for the next 3 months • 5. Have 75% of practices with a registry by May 2010

36. Asthma Care a Year From Now • Healthier patients and empowered families • Engaged providers and staff employing asthma guidelines including physicians not involved in EQIPP, encourage “spread” within practice • Utilizing electronic records to improve quality • Efficient office systems that benefit from planned care • Reduced cost • Continue Partnerships with PCMH & Maine Asthma Council • Engage Senior Leaders and Healthcare Organizations • Reach out to Northern Maine and Family Practice groups to spread Asthma QI • Close the Quality Gap and provide the best care for every patient, every time