What is an asthma registry? n A list of patients with asthma n A source of data for asthma management  individual patient level  individual provider level  clinic level  community (multi-clinic) level n A tool to incorporate guidelines into practice n How is a registry different than an electronic medical record?

How can registries be used? n Database (flowsheet) for clinical encounters n Tracking care of individual patients n Feedback to providers n Recalling patients for follow-up n Identifying patients who need added support n Measuring clinic performance n Meeting data requests from funders n Measuring community-level asthma control

Types of registries n Paper-based n Computer-based  DEMS  CDEMS  PECS  Improving Chronic Illness Care  Dozens more!

What is in an asthma registry

n Demographics n Co-existing conditions n Environmental exposures n Medications n Asthma control tools n Self management actions n Education provided n Services provided n Referrals n Outcomes

Registry content n Review elements in CDEMS n Question: how to determine severity?  computed  provider determined  combination n Hints for using registry  mini-manual  severity classification chart  steroid dosing chart  self-management goal list (next slide)  others?

Self-management goals Environmental n Reduce tobacco exposure n Quit smoking n Eliminate roaches n Remove pets from home n Wash sheets in hot water n Put on bedding covers n Reduce moisture in home n Eliminate mold Medical n Use preventive medicine every day n Monitor for asthma symptoms n Use inhalers effectively n Use action plan and peak flow meter n Provide action plan to school or childcare

Registry content n Add medication list including dosing? n Other?

Moving data: how do want to do it? Find last registry note in chart Place note in chart Review and update note Transfer note to data entry staff Enter data and print new note

Reports: what do you want? n Level of report  All patients  Subsets of patients: which?  By provider  Within clinic  Across clinics (entire collaborative) n Confidentiality

Reports: what do you want? n Asthma summary report (see handout) n List of patients with visit in time period X n List of patients on X med n List of patients with X health condition n List of patients receiving/not receiving X service n List of patients with X outcome n List of patients with X outcome and with/without Y service

Reports: what do you want? n Recall reports: Lists of patients with:  mild intermittent stable asthma to be seen in 4-6 months  persistent stable asthma to be seen in 3-4 months  newly prescribed controller to be seen in 1 month  acute exacerbation to be seen next day

Other registry issues? n Dealing with multiple chronic conditions n Other?