AAP Medical Home Chapter Champions Program on Asthma

1. AAP Medical Home Chapter Champions Program on Asthma [insert name] [insert title] AAP [insert state] Chapter Champion

2. AAP Comprehensive Asthma Program • Funded by the Merck Childhood Asthma Network (MCAN) through March 2012 • Components: • Chapter Quality Network (CQN) Asthma Project — a quality improvement project implemented through AAP chapters and supported by the national AAP office • Medical Home Chapter Champions Program on Asthma (MHCCPA)

3. AAP Accelerating Improved Care for Children with Asthma Program • Funded by The JPB Foundation • Components: • Chapter Quality Network (CQN) Asthma Project — a quality improvement project implemented through AAP chapters and supported by the national AAP office • Medical Home Chapter Champions Program on Asthma (MHCCPA)

4. Program Overview: Overarching Goal To facilitate dissemination of best practices and advocacy related to asthma care within a medical home

5. Program Overview: Program Goals • Increase access to a medical home for all children and youth, with a specific focus on reducing health disparities • Facilitate pediatric practices’ adoption and implementation of NHLBI asthma guidelines within the context of a medical home • Increase advocacy efforts for implementation of asthma care within medical homes at chapter/state level(s)

6. Imagine • Staff recognizing a parent when appointment is made • Adequate time scheduled for that child • Prior asthma care plan in chart • Specialist’s record in your hands prior to the visit with lab, allergy testing, spirometry, X-ray results • Parent concerns identified before the visit; multiple tasks completed at the visit • Lab slips ready and EMLA cream on child prior to visit • Help by your staff for families with referrals, resources, equipment, forms • Follow-up to assure completion of tasks

7. What is a Medical Home? “The Medical Home is the model for 21st century primary care, with the goal of addressing and integrating high quality health promotion, acute care and chronic condition management in a planned, coordinated and family-centered manner.” -American Academy of Pediatrics

8. Joint Principles of Medical Home AAP, AAFP, ACP, AOA, 2007 • Personal physician • Physician-directed practice • Whole-person orientation • Coordinated care • Quality and safety • Enhanced access • Appropriate payment

9. Essential Components of a Medical Home: The 6 R’s • Ready Access • Relationships/Respect • Registry and Records • Resources • Reimbursement • Recruitment

10. NIH Asthma GuidelinesNHLBI NAEPP, 2007 Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

11. Principle 1: Personal Physician • Provide continuity of care in a partnership • Schedule routine follow-up care • Monitor use of beta2-agonist medications

12. Relationships/Respect

13. Principle 2: Physician-Directed Medical Practice Coordinate services for children with asthma that are: • Family-centered • High quality • Accessible • Affordable

14. Principle 3: Holistic Orientation • Control of environmental triggers • Allergens • Irritants, especially tobacco smoke • Treat and prevent co-morbid conditions • Promote physical fitness and nutrition for children with asthma • Help address socioeconomic barriers to well-being

15. Principle 4: Coordinated Care • Integrate care across the community • Use information technology • Asthma registry • Electronic health record • Performance and outcomes measures • Accountability • Refer to specialist, if needed • Transition teens to adult care

16. Care Coordination: Key Components • Visit planning, referral services, follow-up • Assists with equipment needs (eg, local suppliers for environmental controls, spacers, nebulizers, oximeters) • Collaborates with other providers (eg, specialists, school nurse, etc) • Maintains a centralized database (paper or electronic) of local resources • Connects families to support networks • Family-to-family health information centers (F2F HICs) • Community asthma education • Smoking cessation programs (patient, family)

17. Care Coordination: Collaboration/Co-managementwith Specialists • Bridges to service • Between primary care and specialist • Between multiple specialists and medical home • Ensure referral data sent and visit accomplished • Access to specialist records (letter, fax, electronic) • Regular phone/e-mail dialogue regarding patient care • Specialty follow-up (hospital/ED follow-up, labs, etc)

18. Registry and Records:Knowing Who Needs Care • Registry can be paper or electronic • Notebooks  Excel  Access  EMR • Alerts schedulers to need for more time for visit • Assures key data to specialist for consult • Tracks referrals and specialist reports • Prompts pre-visit contacts • Data management for flu shots, ACP on chart • Data recall for self-assessment of care quality

19. Electronic Records Make Asthma Care Easier • Chart is never “lost” • Permits “tracking” of asthma visits, both acute and planned • Medication doses, strengths, refill dates are recorded • Specialty consults are easily accessed • Asthma plan, allergies are on chart • Asthma education printouts available

20. Principle 5: Quality and Safety • Patient-centered, evidence-based care • Establish the asthma diagnosis • Provide asthma education for patient self-management • Prescribe and adjust medications • Inhaled corticosteroids are preferred for persistent symptoms • Stepwise treatment based on age • Develop a written asthma management plan

21. AAP Quality and Safety Resources • Chapter Alliance for Quality Improvement (CAQI) www.aap.org/member/chapters/caqi/ • Education in Quality Improvement for Pediatric Practice (EQIPP) http://eqipp.aap.org/ • Medical Home for Pediatric Primary Care • Asthma — Diagnosing and Managing in Pediatrics • CME offered, MOC Part 4 available • Medical Home Chapter Champions Program on Asthma www.medicalhomeinfo.org/national/mhccpa.aspx

22. Principle 6: Enhanced Access • Pediatrician availability to assess, classify, and monitor asthma severity and control • Reduce disparities in processes and outcomes in asthma care • Socioeconomic • Racial/ethnic • Geographical

23. Ready Access • Accept Medicaid, many insurers • Evening, weekend, and holiday office hours for asthma flares • 24-hour advice nurses (to the ED or not?) • Translation phone • Privacy protection for teens (cigarettes, THC) • ADA accessible physical plant and parking area • Policy on transition to adult care (age, process, list of adult providers)

24. Principle 7: Appropriate Payment • Added value provided to patients with asthma who receive care in a medical home • Adequate fees • Bundled payments • Accountable care organizations

25. Reimbursement for Asthma Management

26. Recruitment—Yes, YOU! • One family in five has a CSHCN • Asthma is one of most common chronic condition in pediatrics • Parents, insurers, government are demanding quality improvement in care systems • Planned, supported care is more fun to deliver! • Where do you want to start?

27. MHCCPA Project Advisory Committee Members • Chuck Norlin, MD, FAAP, Chairperson • Julie Katkin, MD, FAAP • Jennifer Lail, MD, FAAP • John Meurer, MD, MBA, FAAP • Matthew Sadof, MD, FAAP • Jim Stout, MD, FAAP Parent Representative • Karen VanLandeghem, MPH Liaisons • Rhonda Hertwig, CPNP • Marie Mann, MD, FAAP

28. Chapter Champion Regional “Networks”

29. MHCCPA Web Page http://medicalhomeinfo.org/national/mhccpa.aspx

30. Thank You! Questions? Program Contact: Chelsea Rajagopalan Program Manager AAP Division of Children with Special Needs 800/433-9016, ext 4311 crajagopalan@aap.org