Chapter Quality Network (CQN) Asthma Pilot Project Our Present and Our Future Sandra Miller, MD Oregon Chapter Physician Leader Judy Dolins, MPH Director,

Chapter Quality Network (CQN)Asthma Pilot Project

Our Present and Our Future

Sandra Miller, MD Oregon Chapter Physician Leader

Judy Dolins, MPHDirector, Department of Community Chapter and State

Principle Investigator, Chapter Quality Network Asthma Pilot Project

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.

Sandra Miller, MD Disclosure

Judy Dolins Disclosure

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

National goals at the practice level

Changes in asthma care practices and child health outcome

Successful implementation of practice system change

Clinician investment and commitment to quality improvement work

Transparency and sharing of improvement data

Increased clinician demand for CQN programming

National goals at the chapter level

Increased capacity for quality improvement work

Governance group engagement

Sustain QI work at the chapter level

Key partnerships focused on improvement work

Funding and will for continued quality efforts

Increased chapter demand for CQN programming

Improvement Work

Improvement WorkImprovement WorkContinuous tests

of change

SustainabilitySustainabilityImbed in everyday work

Scale Up & SpreadScale Up & SpreadTaking local improvement

And actively disseminating itacross a chapter and/or practice

Our First 6 months

CQN Asthma Pilot Sites MAINE

OHIO

OREGON

ALABAMA

How are we doing at the National Level?

Practice System Changes

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MD NP

National Oregon

Percent of eligible providers collecting data at point of care

How are we doing at the National Level?

Practice System ChangesRegistry Implementation Status

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Practices with a Registry Practices without aregistry

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Oregon

How are we doing at the National Level?

Practice System ChangesOptions for Practices without a Registry

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Using an Excel database asalternative

Actively discussing/ exploringregistry

Not discussing/ exploringregistry

National Oregon

How are we doing at the National Level?

Practice System ChangesDegree of belief that workflows for collecting data for eligible patients/opportunities at point of care are highly reliable

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Oregon

How are we doing at the National Level?

Measures of Asthma Care Practices and Health Outcome

Key Measure Goal Alabama Maine Ohio OregonNational Average

% of patients with 1 or more asthma-related ED or Urgent Care Visits within the past 12 months 0% 21% 20% 35% 24% 25%

% of patients with 1 or more hospitalizations within the past 12 months 0% 5% 4% 7% 6% 6%

% of patients well controlled 90% 57% 68% 64% 51% 60%

% of patients with optimal asthma care 90% 75% 71% 71% 80% 74%

% of patients with key asthma indicators used when considering an asthma diagnosis 90% 91% 96% 80% 75% 86%

% of patients ages 5 and older in which spirometry is used to establish a asthma diagnosis 90% 63% 61% 61% 56% 60%

% of patients in which a validated instrument is used to determine the current level of asthma control 90% 99% 93% 99% 99% 98%

% of patients in which reasons for lack of asthma control is identified when asthma control is "not well controlled" or "very poorly controlled" 90% 96% 100% 94% 93% 96%

% of patients ages 5 and older where spirometry is scheduled to be tested or results have been obtained within the last 1-2 years 90% 59% 62% 67% 64% 63%

% of patients in which the stepwise approach is used to identify treatment therapy and adjust or maintain therapy based on asthma control 90% 99% 97% 99% 98% 98%

% of patients with asthma ages 6 months and older who have received a flu shot or flu shot recommendation within the past 12 months 90% 93% 98% 93% 94% 95%

% of patients who have a current written asthma action plan explained to them at this visit 90% 82% 78% 79% 85% 81%

% of patients in which self-management education materials (in addition to the asthma action plan) are provided and explained to the patient and family 90% 81% 84% 83% 74% 81%

% of patients for whom a follow-up appointment to monitor asthma control is recommended 90% 95% 89% 94% 95% 93%

Optimal Care

>70% of patients have “optimal” asthma care (all of the following)

• assessment of asthma control using a validated instrument

• stepwise approach to identify treatment options and adjust therapy

• written asthma action plan • patients >6 mos. of age with

flu shot (or flu shot recommendation)

Optimal Asthma Care

National Project (All Chapters)

0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Oregon = 80%

Self-Management

Oregon = 74%

National Project (All Chapters)

0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Use of a Validated Instrument

Oregon = 99%

National Project (All Chapters)

0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Hospitalizations

Oregon = 6%

National Project (All Chapters)

0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Patients Well-Controlled

Oregon = 51%

National Project (All Chapters)

0%10%20%30%40%50%60%70%80%90%

100%

1004

1440

1672

1461

1685

1763 0 0 0 0 0 0 0

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

How are we doing in Oregon?

• 11 practices with high level knowledge of QI processes and implementation

• Increase in use of action plans

• NHLBI guideline use in managing asthma

• Increased use of spirometry

• Increased familiarity with registry concepts

• Use of validated screening instruments

• Using PDSA to overcome barriers

Optimal Asthma Care

Asthma Action Plans

Self Management

Next Six Months   

• Improve • Sustain• Grow

Improve   

• Practices will continue to review their current office flow

• Changes should be refined

• Opportunities for ongoing changes should be identified

• Key Driver Goals

Sustain

• Practices should review current processes with a view to sustain changes made during the project

• Consider how to continue to motivate staff, physicians, and patients 

• Consider how to make changes part of the NORMAL flow, not an exception

• Consider how the practice will function AFTER CAQI

Grow    

• Practices should involve all practitioners in change

• Practices should consider how to spread change to other areas of focus (ie obesity, ADHD)

• Practices should consider how to spread change to other practices