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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. Chapter Quality Network (CQN) Ohio Asthma Pilot Project. CQN Asthma Pilot Sites. MAINE. OREGON. OHIO. ALABAMA.

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Chapter Quality Network (CQN) Ohio Asthma Pilot Project

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

  2. CQN Asthma Pilot Sites MAINE OREGON OHIO ALABAMA

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

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

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

  6. Practice Key Driver Diagram

  7. Ohio CQN Timeline 4/10 LS3 8/10 LS4 3/09 Ohio Selected for CQN 10/09 LS1 1/10 LS2 Webinar 10/10 CQN1 ends Recruitment H1N1 Epidemic Throughout: Monthly conference calls, rating calls, leadership group calls, and regular practice QI and group meetings.

  8. 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 .

  9. 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)

  10. Optimal Care

  11. 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

  12. Successes

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

  14. Sustained Improvement

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

  16. Challenges

  17. One Practice’s Experience

  18. One Practice’s Experience

  19. One Practice’s Experience

  20. 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

  21. 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.

  22. “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

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