CQN Asthma Pilot Project Chapter Narrative Report: 90 Day Goals October 2009 – January 14, 2010 Alabama January 2010

This 18-month CQN Asthma Program is supporting 12 Alabama practices in learning how to implement the latest guidelines from the National Heart Lung and Blood Institute (NHLBI)/National Asthma Education and Prevention Program (NAEPP) by providing tools, resources and technical support to lead a quality improvement effort. Alabama Practices who are participating in this QI project are receiving 30 MOC credits toward the ABP Maintenance of Certification (MOC) Part IV performance in practice credit for completing the project. While this project provides educational resources, the Chapter also has access to a Quality Improvement Consultant from (QIC) the Cincinnati Children’s Hospital Medical Center. The QIC is assisting practices in making system-based changes that improve asthma care within a medical home. Practices also have access to the Academy’s Education in Quality Improvement in Pediatric Practice (EQIPP) asthma module for data collection with the national office providing monthly data reports to the chapter’s leadership team and practices for feedback on practice performance. Chapter Leadership Structure: The Alabama Chapter-AAP has formed a Chapter Leadership Team comprised of a physician leader, two asthma experts and a project manager to lead the CQN Asthma Project and build a sustainable QI infrastructure for the Chapter. At the practice level, the 12 participating practices have formed a quality improvement core team comprised of a lead physician, a clinical/nursing staff person, and an administrative staff person. The lead physician recruited their other practice providers to participate in this QI project. Practices are participating in 4 chapter-led CME learning sessions to support measurable improvements in asthma care. Monthly action period calls with the chapter leadership team, the practice QI core team, the Academy, and the quality improvement consultant review and share performance data and QI methods to lead practice change consistent with asthma guidelines, while a listSERV connects peer led learning opportunities. The Physician Leader provides support by coaching practices through the process. Through this initiative the AL Chapter-AAP will gain knowledge to support QI activities and projects in members’ practices and develop a sustainable improvement structure within the Chapter. Alabama CQN Asthma Pilot Project

4 ALABAMA Marshall County Pediatric Clinic- Guntersville Infants and Children's Clinic- Florence Bessemer Health Center/Jefferson Co.-Birmingham University Medical Center Pediatrics- Tuscaloosa Partners in Pediatrics- Montgomery The Charles Henderson Child Health Center- Troy USA Dept. of Pediatric & Adolescent Medicine-Mobile Dothan Pediatric Clinic Pediatric Associates of Auburn Huntsville Pediatric Associates Pediatric Clinic, LLC-Opelika Pediatric Associates of Alexander City

Global Aim We will build a sustainable quality improvement infrastructure within the Alabama Chapter-AAP to achieve measurable improvements in the health outcomes of children within our member practices. Specific Aim From April 2009 to November 2010, we will lead a quality improvement collaborative and achieve measurable improvements in asthma outcomes with the participating 10 to 15 practices by implementing the National Heart, Lund and Blood Institute (NHLBI) asthma guidelines. Alabama Chapter-AAP Individualized Aim Statement SECTION 1 (AIMS)

Goal: 90% of the CQN Asthma Pilot Practices will achieve 80% perfect care by September Goal: 90% of the CQN Asthma Pilot Practices will use a structured encounter form 90% of the time by September Outcome Goal: 90% of the CQN Asthma Pilot Practices will reach 80% of patients “well controlled” by September What is Optimal Asthma Care? Optimal Asthma Care - % of patients with all of the following: patients with assessment of asthma control using a validated instrument patients which stepwise approach is used to identify treatment options or adjust therapy patients with asthma action plan patients 6 months and older with a flu shot or flu shot recommendation Alabama Chapter-AAP Individualized Aim Statement SECTION 2 (GOALS)

Long Term Goals Goal: All CQN Asthma Pilot Practices will use a population based registry Goal: 90% of the CQN Asthma Pilot Practices using a population based registry will achieve 90% perfect care by August 2012 Other Action Items: The CQN Asthma Pilot Practices will submit annual follow-up data in August 2011 and August 2012, with the Chapter Team providing quarterly check-in/follow-up calls/ s. The CQN Asthma Pilot Practices will host an Asthma QI Project sharing session/summit at the Chapter’s 2011 Spring Meeting in April The chapter will push out results of the CQN project and lessons learned on QI infrastructure to Chapter members through a variety of communication efforts: newsletter tips, case studies, etc. The chapter will collaborate with Alabama Medicaid Agency and Blue Cross Blue Shield of Alabama to design and fund a second phase of pilot practices based on results of this quality improvement project. Alabama Chapter-AAP Individualized Aim Statement SECTION 3 (LONG TERM GOALS)

8 Progress October 2009 through January 14, Day Goals: November 2009 to January practices, 63 pediatricians, 30 clinical/administrative staff Practices have formed QI core teams and are engaged in monthly practice action calls with the chapter leadership and the QI national team Alabama practices met 5 of the 13 goals in just three months of data collection: use of a validated instrument to determine current level of asthma control Patients in which reasons for lack of asthma control is identified when asthma control is ‘not well controlled’ or ‘poorly controlled’ stepwise approach is used to identify treatment and treat or maintain therapy based on asthma control use of flu shot for patients over the age of 6 months and follow up appointment to monitor asthma

% of patients with use of a validated instrument to determine current level of asthma control

% of patients in which reasons for lack of asthma control is identified when asthma control is “not well controlled” or “poorly controlled”

% of patients where a stepwise approach is used to identify treatment and treat or maintain therapy based on asthma control

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

% of patients for whom a with follow-up appointment to monitor asthma control is recommended

% of Patients with Optimal Asthma Care

Number of patient encounters in EQIPP entered increased from 393 to 493 in just one data cycle

% of patients who have a current written action plan explained to them at this visit

90 Day Goal Progress: November 2009 to January 2010 Key Driver: Sustainable & Accountable Leadership Focused on Health Outcomes QI component is embedded in the Chapter strategic plan and part of the Chapter Balanced Scorecard report Expansion of the Chapter QI committee to include UAB Department of Pediatrics AL Chapter-AAP is a member of the Alabama Healthcare Improvement and Quality Alliance (AHIQA) an Alabama Medicaid Agency multi-stakeholder group to provide a venue for collaboration and coordination of healthcare quality activities across organizations and healthcare settings using evidence-based measures (2 pediatricians currently serving on this committee one of which is participating in the CQN Asthma Pilot Project News articles in the Chapter Newsletter (J. Wiley) to communicate progress of the CQN Asthma Project

90 Day Goal Progress: November 2009 to January 2010 Key Driver: Create Partnerships to Promote Children’s Health Care Quality Partner with the UAB Department of Pediatrics, the Alabama Primary Care Association, the Alabama Department of Public Health ALL Kids program, the Alabama Medicaid Alabama Healthcare Improvement and Quality Alliance to apply for a CHIPRA Grant (January 2010) AL Chapter-AAP is member of the Alabama Asthma Coalition (the Alabama Department of Public Health recently received a $5 M multi-year grant to track hospitalizations due to asthma, hire a full time asthma educator and a full time epidemiologist)

90 Day Goal Progress: November 2009 to January 2010 Key Driver: Attractive Motivators and Incentives Working with the Alabama Chapter-AAP Pediatric Council to drive the message of quality care and enhanced rate structure Educated health providers on medical home concept Three pediatric practices participating in the BCBS Medical home pilot (two of which are participating in the CQN project)

90 Day Goal Progress: November 2009 to January 2010 Key Driver: Measure Performance and Share Data Educate CQN Asthma team members on registry options –Topic at the LS1 –Topic on the monthly period action calls –Correspondence given to CQN practices –listSERV sharing Hold monthly action period calls to review data with 12 practice teams to review chapter and practice data CQN Encounter form retrofitted to practices and shared on the listSERV

90 Day Goal Progress: November 2009 to January 2010 Key Driver: Participation in an Organized Quality Improvement Effort Chapter hosted the first learning collaborative on September 14-18, 2009 prior to the Fall annual conference (12 hour CME) where 100% of the practice core team members participated All QI practice core team members attended the LS2 on January 14, 2010 via web with one practice presenting (3 hour CME) 12 practices with 63 pediatricians participating in the CQN project Identified two asthma experts to work with the project team Holding monthly action period calls with 12 practice teams with 100 percent participation to date

22 What’s Next? 90 Day Goals: February 2010 to April 2010

Next 90 Day Goals: February 2010 to April 2010 Key Driver: Sustainable & Accountable Leadership Focused on Health Outcomes AL Chapter-AAP will participate in the Alabama Healthcare Improvement and Quality Alliance (AHIQA) planned meetings on January 21, March 18, May 20, July 15, Oct 21 and Dec 18 Alabama Chapter-AAP QI committee to review and provide feedback on CHIPRA core measures as part of Medicaid and SCHIP programs and report out at the AHIQA meeting on January 18, 2010 Research funding resources for the sustainability of the quality improvement project within the Chapter

Next 90 Day Goals: February 2010 to April 2010 Key Driver: Create partnerships to Promote Children’s Health Care Quality Chapter staff to review the Vermont Child Health Improvement Program (VCHIP) model to develop a template for an improvement partnership Collaborate with universities, public and private stakeholders to create a sustainable improvement partnership to optimize the health of Alabama’s children.

Next 90 Day Goals: February 2010 to April 2010 Key Driver: Attractive Motivators and Incentives Schedule LS3 for April 15, 2010 (8 hr CME) Engage payors in the redesign of rewards: Identify pediatricians to serve on the Alabama Medicaid Agency Patient 1 st Advisory Committee to redefine concept of Medical Home to move the Alabama program to the next level. Alabama is participating in a TA grant from the National Academy of State Health Policy (NASHP) to advance medical home initiative.

Next 90 Day Goals: February 2010 to April 2010 Key Driver: Measure Performance and Share Data Research registry options for the CQN practices Survey CQN practices on EMR and registry use -- share results with team members Encourage peer shared learning on registry options – EMR component or other data base Connect with the Alabama Asthma Coalition to develop data surveillance tool to collect hospitalizations due to asthma related illness Review unfiltered data for each practice and coach as indicated

Next 90 Day Goals: February 2010 to April 2010 Key Driver: Participation in an Organized Quality Improvement Effort Continue to hold monthly period action calls with the practices, monthly leadership calls with the national QI team Plan for the LS3 scheduled for April 15, 2010 at Sandestin Develop a webpage on the Chapter website to highlight the CQN Asthma project and the work of the Chapter QI committee

Current Needs and Priorities Identify registry options for practices Assist CQN practices on spirometry issues – use of spirometry, purchase options, clinical issues Continue to coach practices around use of encounter forms Coach identified practices in the use of a written asthma action plan Encourage all practice providers to sign the IRB consent form to reveal practice identifier data

Challenges/Opportunities/Learnings Registries – identify 3 – 5 practices who are early adopters to introduce registry functions in their practices Encourage identified practices to increase their denominator Identify asthma education materials and resources and place on the Chapter website