Asthma Registries

1. Asthma Registries Jim Stout, MD, MPH Professor of Pediatrics University of Washington (With thanks to Jim Krieger MD, MPH)

2. Disclaimer • 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. • I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

3. What is an asthma registry? • A list of patients with asthma • A source of data for asthma management • A tool to incorporate guidelines into practice • How is a registry different than an electronic medical record?

4. Types of registries • Paper-based • Computer-based • Excel • Access • And beyond…

5. Odessa Brown Children’s Clinic • Originally a safety net clinic for Seattle’s African American community • Still a safety net clinic, though much more diverse • 4 pediatricians, 2 nurse practitioners • A satellite of Children’s Hospital (and a clinical teaching site for UW and other programs) • Four “chronic illness” programs: • Sickle Cell Clinic • Asthma Clinic • AD/HD clinic • Childhood overweight clinic

6. Getting started • Asthma hospitalizations in last year • Use first discharge diagnosis • (Find the right person or department) • Asthma ED visits • Use first discharge diagnosis • Pharmacy data (if available) • Especially frequency of albuterol fills • Support this effort at the practice level • Billing department

7. How is our registry used? • Recalling patients for follow-up • Identifying patient sub-sets for additional support • Performance feedback to providers

11. Using Registries to Measure Improvement • IS: • Designed to help your team and other teams learn • For proactive, population-based management • Like a growth curve: it’s not where you are, but where you are going • IS NOT: • Designed for criticism or punishment • Supposed to end (it should be sustainable) • The medical record Source: NICHQ

12. Reports for QI - Run Chart • Definition: A visual representation of data plotting a measurement over time • Best Use: To monitor a process over time, allowing focus on vital changes over time observed • To Construct: • Label y axis with measurement scale • Label x axis with time scale • Plot data in order and connect points • Label changes -- annotate graph Source: NICHQ

13. QI Tools - Run Chart Process Change Source: NICHQ

17. Suggested Core Measures • Children with persistent asthma will experience an average of 12 or more symptom-free days in a two week period • Providers will classify asthma severity or control at 95% or more of asthma visits • 95% or more of patients with persistent asthma will be treated with maintenance anti-inflammatory medications • 95% or more of asthma visits for patients with persistent asthma will include an “up-to-date” written asthma management plan • Among children 5 years and older, 95% will receive pulmonary function testing at planned asthma visits • 95% or more of patients will have an environmental assessment • Hospitalizations and ED visits for asthma

22. Integrate Data Collection into Daily Work • Let your structured encounter from be your data collection form (this is the fastest and easiest way to improve measures!) • Clearly define roles and responsibilities for ongoing data collection • Share reports with those who collect it, and those who generate it (patients, providers, support staff)  Source: NICHQ

23. Integrate Data Collection into Daily Work • Let your structured encounter from be your data collection form (this is the fastest and easiest way to improve measures!) • Clearly define roles and responsibilities for ongoing data collection • Share reports with those who collect it, and those who generate it (patients, providers, support staff)  Source: NICHQ