Welcome to the UPIQ/Asthma Program Learning Collaborative - Team Lead Call #2 June 13, 2017

Agenda Welcome – Diane Liu, Director of UPIQ Core Measures (April/May data info to date) Full April/May data results shared during July TLC Data due by 15th but submit sooner for your benefit Upcoming webinars (MOC reminder) Next Steps

Participating Practices Welcome to all of you. Please take a moment and type into the chat box your name and those attending with you. Dawn will be monitoring the chat box and unmuting us for discussion, but as a reminder, we ask you mute yourselves if there is background noise. Before we review the core measures, I want to take a moment and thank you for your engagement. Both Dawn and Gabi, your QI coaches, have emphasized the outstanding willingness on your end to improve aspects of the asthma care you deliver to your patients.

1. Asthma Severity Documented Numerator: Those in the denominator whose severity* was documented in the encounter note* Denominator: All patients seen during the measurement period for asthma (newly diagnosed or already on medication) Goal: 80% Data Source: EMR or manual chart review *updated problem list, template reflecting ICD10 code, etc. *severity specified (mild intermittent, persistent – mild, mod, severe) Guidelines reflect identifying severity at initial diagnosis – how can we help make this a meaningful measure for your practice? Though Asthma severity is required when billing ICD10 codes, it should be documented in the encounter note at every visit. This facilitates communication between clinicians and members of the patients’ care team. *** Percentage of children with asthma whose asthma severity was documented during the defined measurement period. This reflects every visit – since severity is the billable factor we may inappropriately assume there is no improvement to make; however we are asking that severity is documented in the encounter notation. This facilitates communication about the patient for any health team member reviewing the patient’s chart encounters

May Report:

2. Control Assessment & Documentation Numerator: Those in the denominator who have control status assessed by a validated screening tool and documented in the note Denominator: All patients seen during the measurement period for asthma who are on an asthma medication of any type* Goal: 80% Data Source: EMR or manual chart review *medication reconciliation The percentage of children with asthma whose control has been assessed with a validated tool during the defined measurement period. Examples of tools include ACT, TRACK, and ATAQ.

ACT Tests & Categories Control Tool (Age) Score for Well Controlled Not Well Controlled Very Poorly Controlled Childhood Asthma Control Test C-ACT (4 to 11 years) 20 or greater 13 to 19 12 or less Asthma Control Test ACT (12+ years and adults) 16-19 15 or less ACT http://www.thoracic.org/members/assemblies/assemblies/srn/questionaires/act.php Schatz M, Sorkness CA, Li JT et al. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol 2006; 117: 549-56. Available from: http://www.jacionline.org/article/S0091-6749(06)00174-6/fulltext Schatz M, Kosinski M, Yarlas AS et al. The minimally important difference of the Asthma Control Test. J Allergy Clin Immunol 2009; 124: 719-23. Available from: http://www.jacionline.org/article/S0091-6749(09)01245-7/fulltext Kaiser’s asthma treatment guideline and ACT scoring https://www.ghc.org/static/pdf/public/guidelines/asthma.pdf

May Report:

May Report:

3. Inhaled Corticosteroid (ICS) Numerator: Those in the denominator appropriately prescribed an ICS Denominator: All patients seen during the measurement period for asthma with a classification severity level of persistent asthma Goal: 80% Data Source: EMR or manual chart review Based on current asthma guidelines All patients with persistent asthma should be prescribed an ICS Percentage of children with persistent asthma that were prescribed inhaled corticosteroids (ICSs) during the defined measurement period. Include prescriptions from elsewhere (e.g. ED).

May Report:

4. Asthma Action Plan (AAP) Numerator: Those in the denominator with a ‘current’* asthma action plan on file Denominator: All patients seen during the measurement period for asthma Goal: 80% Data Source: EMR or manual chart review *within the past 6-12 months Asthma pts need to have a current Asthma action plan on file to support communication with 3rd parties such as the school or other caregivers. The definition of current means a plan that has been updated in the past 6=12 months. Percentage of children with asthma whose asthma action plan was updated during the defined measurement period. DOH had AAP – we’ll try again. Include in the ppt How do we define ‘current’ – practices to determine how they were appropriately update AAP in the record

May Report:

Timeline Review – upcoming webinars for MOC June 21 – Pulmonary Function Tests by Chee Tan, MD July – Listen to supplemental August – Listen to supplemental Sept 26 – Pharmacologic review by clinical pharmacist Oct 24 – Parent perspectives by Gina Pola-Money, Director of Utah Family Voices

Using Asthma-related Devices David C. Young, PharmD Professor, College of Pharmacy University of Utah Recorded June 1, 2017

Types of EMR used by participating practices Participating Practice Maliheh Free Clinic - Family Medicine Athena Mountainlands CHC - Family Medicine Wellsprings Pediatrics MountainStar Ogden Pediatrics ECW Neighborhood CHC.Inc - Family Practice Utah Valley Pediatrics - Spanish Fork Utah Partners for Help South Jordan Health Care - Pediatrics EPIC Utah Pediatric Clinic Central Orem Clinic help2/iCentra Utah Navajo Health System - Family Practice NexGen Blackstar Pediatrics Practice Fusion

Thank you & Next Steps Remain in contact with your coach (by visit or phone) Test cycles of change (plan to share your ideas) PDSA templates for project management QI Teamspace entry space available Keep celebrating improving together IHI Webinar “How to Beat the Boring Aspects of QI” Tomorrow Wed June 14th at 2p.m. MST (noon EST) Submit your data for feedback Connect with each other ask questions – we’re a learning community!

Contact us at info@upiq.org The UPIQ Team Diane Liu, MD FAAP Director Chuck Norlin, MD FAAP Past Director Gabi Baraghoshi, RN MPH QI Specialist Dawn Bentley, RN BSN Contact us at info@upiq.org