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

Alabama Collaborative Infants’ and Children’s Clinic Grant Allen, MD, Kelli McAfee, RN, and Angela Alexander. Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation. Progress Summary Since Learning Session 1.

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

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  1. Alabama Collaborative Infants’ and Children’s Clinic Grant Allen, MD, Kelli McAfee, RN, and Angela Alexander Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation

  2. Progress Summary Since Learning Session 1 • Increased use of PFTs 75% with no change in number of asthma coded visits. • Standardized approach to asthma care among providers • Standardized coding and tracking of patients • Reaching more patients with daily controllers • Standardizing nurse protocols for appointments and phone calls • Increased inhaler teaching by 110%

  3. ED visits

  4. Hospitalizations

  5. Optimal Care

  6. PFTs over 5yrs of age

  7. PFTs within last 1-2 years

  8. Current asthma action plan

  9. Follow up appointment

  10. Well controlled

  11. 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 PDSA Ramps TEST 4 What: edited AAP Who: all patients Who: MDs and NPs Where: Main office When: November TEST 4 What: refined form Who: asthma patients Who: MDs and NPs Where: Main office When: November TEST 4 What: form in EMR Once developed, will have to rethink office flow as well as motivation to get form completed TEST 3 What: modified AAP Who: all patients Who: MDs Where: Main office When: Oct 1 TEST 3 What: Edited form Who: asthma patients Who: MDs Where: Main office When: Oct 1 TEST 3 What: forms Who : MDs/NPs Who : MD/NP Where: both offices When: Nov TEST 2 What: chosen plan for 3 MDs Who: 3 patients each Who: 3 MDs Where: Main office When: Sept 27 TEST 2 What: CQN form Who: 5 patients Who : MDs Where: Main office When: Sept 27 TEST 2 What: modified form/AAP at workstations Who : MDs Who : MDs Where: Main office When: Oct/Nov TEST 1 What: CQN form with physician AAP at workstations Who MDs Who : MDs given forms at desk Where: Main office When: start of program TEST 1 What: test 3 AAP Who: 3 patients 1st week Who: Dr Allen Where: Main office When: Sept 20 TEST 1 What: CQN form Who: 5 patients Who: Dr Allen Where: Main office When: Sept 20 Asthma Action Plans Encounter forms Form location

  12. Asthma patients identified at time of service by provider Forms and Asthma Action Plans located at computer stations in hall, nurse or provider asks/gives questions to parent before PFTs/ during visit Office Flow Document Office Visit - Prework Clinical Assessment Process Map – Paper Chart System Has patient had flu shot and PFTs this year? inhaler teaching, asthma action plan discussed, Rx given During the visit the physician fills out the remainder of form while having Informed clinical discussion Completed form to provider workstation Once parent input is completed the form is returned to provider Season and stock available, flu shot given During Office Visit YES Physician completes the form immediately after the visit NO Physician reviews parent’s answers as part of HPI, ROS If patient not in distress, do PFTs need to be done? If PFTs not done, recheck in 1-2 weeks, if PFTs done, recheck in 1-3 months Tracking of patients for future use of EMR registry function through coding and chronic illness alerts. Immunization alerts All necessary information on the form is entered into EQIPP before end of month Post Visit Activities

  13. Where are we now? • EMR upgrade likely to have registry functionality • Also Asthma Action Plans, adding Encounter Form • Optimal care will increase as more kids become part of the “system” • ED visits among kids with Asthma Action Plans is down, therefore admits are down • Payments for PFTs 9/09 – 2/10 are 4x original investment • Cost of meetings, travel, staff duties more than offset by payments – and we’re providing better care

  14. Small cycles really do work better Small cycles really do work faster Teamwork results in better work This really can make a difference in individual patient’s lives, even though it isn’t designed that way! The office staff are unlikely allies Providers can be unlikely obstacles Key Learnings

  15. Barriers and Successes • Time constraints have hindered adoption by all providers at all encounters • We have learned to reinforce positive behaviors with asthma action plans and PFTs • Form fatigue has set in and we have had some difficulty during some reporting periods getting enough encounters in by a few providers • The work we have done so far will be an excellent base for working toward NCQA certification and Meaningful Use of EMR

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