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

1. State Name: Ohio Practice Name: Pediatricenter of Greater Cleveland Team Members:Brad Weinberger, Darlene Hrdlicka, Denise Marzano Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation

3. Progress Summary Since Learning Session 1 • 3 physicians consistently using encounter form • 2 offices consistently using encounter form • Asthma Action Plan standardized • Educational materials – handouts, website • Aerochambers dispensed in office; MAs trained on usage • Different solutions necessary for different offices

4. Strengths Percentage of patients with flu vaccination (or recommendation)

5. Weaknesses Percentage of patients 5 years of older in whom spirometry is scheduled or has been obtained within last 1-2 years

6. Improvement Increased use of Asthma Action Plans Percentage of patients with asthma action plan that was either updated or reviewed with family at point of care Increased use of Educational Materials Percentage of patients in which self-management materials were provided and explained to family

7. Optimal Control is Elusive

8. PDSA Title: Improve recognition of asthmatics Plan: Still difficult to identify asthmatics (poor documentation, MAs not asking, poor self-identification). Improve self-identification by families/parents. Do: Generate signs in waiting room/lobby. Study: to be continued Act: to be continued PDSA Cycles

9. 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:Pediatricenter AAP Who (population):6 patients Who (executes):BW, BF, KU Where: Pediatricenter BB Results: slight feedback, form modified TEST 4 What: Parents hand to MA w/ f/u plan Who (population):3 patients Who (executes): BW Where: BH Results: Easier on MD to handle, reliable TEST 4 What: Who (population): Who (executes): Where: When: TEST 3 What: Pediatricenter AAP Who (population):2 patients Who (executes):BW Where:BB Results: very good, easy to use TEST 3 What: MD hands to MA Who (population): 2 asthmatics Who (executes): BW Where:BH When: cumbersome, time-consuming TEST 3 What: Who (population): Who (executes): Where: When: TEST 2 What: AAP Merck Who (population): 2 patients Who (executes): BW Where: BB/BH Results: do not agree with TEST 2 What:: AAP in exam room Who (population): 2 asthmatics Who (executes):BW Where: BH – exam room Results: easier to fill out, need to get copy made TEST 2 What: AAP (blank) w/ each encounter form Who (population):3 asthmatics Who (executes): BW Where:BH/BB Results:??? TEST 1 What:AAP - Maine Who (population) 2 patients: Who (executes): BW Where: BB/BH Results: comprehensive, not specific to practice TEST 1 What:: Location of AAP Who (population): 1 pts Who (executes):BW Where:BH – dispensed in front desk Results:workflow cumbersome TEST 1 What: AAP in each room Who (population):3 asthmatics Who (executes): BW Where: BB Results: Not always in room, error prone Construction of AAP Logistics of AAP Improve Reliability

10. Asthma patients identified by MA during check-in At time of check-in, form handed to parents to complete while waiting for appointment Office Flow Document Family brings plan to front desk to be copied, plans f/u Asthma dx identified during chart prep; CQN encounter form placed into chart Patient not ID’d prior to encounter, physician must get Encounter form and work through w/ parent Office Visit - Prework Asthma action plan completed/reviewed in room prior to discharge along with e-prescribing Medication/spacer technique reviewed by MD or MA Physician reviews answers and completes remaining sections; exam performed During Office Visit Completed form is left in room for doctor to review Handouts given to patients; referred to website for supp. materials :”Dx of asthma” should be noted in PMHx component of chart Follow up arranged; including testing (PFTs)/referrals Green = Strength Red = Weakness Form is left on MD desk for later data entry prior to scanning into EMR Post Visit Activities EQIPP forms later scanned into EMR Data entry into EQIPP by physician

11. Copy of Your CQN Encounter Form

12. Different offices have different logistics, therefore individual strengths and weaknesses Standards across offices need to be (slightly) relaxed at times Staff training critically important Making the right thing the easy thing is best Key Learnings

13. Barriers and Successes • Team not as strong as we would like (illness, multiple offices, lack of clinical manager) • Identification of asthmatics poor • No registry • Inconsistent use of flags in medical charts • Education of staff difficult due to personnel changes • Success: • Asthma Action Plan Standardized • Educational materials developed, made more accessible

14. Future Plans • Asthma Action Plans for all physicians • Educational materials provided to all offices • Asthma Encounter Form post-EQIPP • ? Flag charts of asthmatics • Implementation of EMR in (?near) future will hopefully improve registry capabilities/streamline development of Asthma Action Plans