Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation State Name: Alabama Practice Name: Huntsville Pediatric Associates Team Members: Katie Gunter, MD Cathy Radzinski, LPN, BBA Robin Riggs, Practice Manager

Progress Summary Since Learning Session 1 Asthma pt’s identified through report run in practice management system All 7 physicians entering Data into EQIPP monthly Protocols implemented for phone triage nurses regarding influenza vaccination, medication refills and follow-up OV for asthma patients Asthma action plan written and installed on EVERY desktop in patient areas All nursing staff trained in use of spirometry machine Report run in practice management system to ID asthma pt’s needing spirometry (criteria=>5 yrs of age and no spirometry in past 12 months) Researched registry options. Currently working with RMD to implement registry at HPA

TEST 1 What:CQN Encounter Form Who (population):asthma pts Who (executes): Dr. Gunter Where:HPA When:Sept. 23, 2009 PD SA TEST 2 What:Revised Encounter Form Who (population):asthma pts. Who (executes): ALL 7 MD’s Where:HPA When:Oct. 1, 2009 PD SA TEST 3 What:Encounter Form-Entering Data Who (population):MD’s Who (executes):MD’s Where:HPA When:By Equipp Deadline PD SA TEST 1 What:Train Nurses in use of machine Who (population):Clinical Nursing Staff Who (executes):Cathy Radzinski, Teri Franklin Where:Treatment Room When:Jan. 17, 2009 PD SA TEST 2 What:Spirometry Who (population):asthma pts. Who (executes):nurse with MD orders Where:Treatment Room When:at sick or well visit PD SA TEST 3 What:Spirometry schedule Who (population):asthma pts. Who (executes):MD/nurses Where:immunization clinic When: schedule q day 9a or 1:30 p in immunization clinic PD SA TEST 1 What:Develop office Asthma Action Plan Who (population):asthma pts. Who (executes):Asthma CQN Team Where:Dr. Gunter clinic hours When: October 1, 2009 PD SA TEST 2 What:Asthma Action Plan Word Doc with drop down installed on all MD Desktops Who (population):asthma pts. Who (executes):all MD’s Where:clinic When:Beginning 10/15/2009 sick visit PD SA TEST 3 What:Blank Asthma Action Plan installed for MD’s to “fill in blanks” on their own (can choose from this or drop-down version) Who (population):asthma pts Who (executes):MD’s Where:clinic When: well or sick visits PD SA CQN Encounter FormSpirometryAsthma Action Plan PDSA Ramps

Difficulty d/t # of asthma pts. Not all asthma pts. have action plan Nurses not always catching asthma patients at visit Nurses and MD’s need to do better at listing “asthma” to problem list

Huntsville Pediatrics CQN Encounter Form F:\Patient Asthma Questionnaire CQN Encounter Form 2010.rtf

Key Learnings  Reassessing and revising asthma action plan and workflows to maximize compliance and asthma control.  The importance of scheduling follow-up visits for asthmatic patients.

Barriers and Successes Barriers: Time required to learn and follow workflows. Identifying and following up with EVERY asthma patient. EMR lacks adequate reporting functionality and does not interface with our spirometry machine. Successes: Increase spirometry use. Full buy-in on use of CQN Encounter Form by all seven physicians at HPA. Full participation by these seven physicians in data gathering and creation of PDSA’s.

Other Information Improve on distribution of educational materials for asthma patients at every visit. In particular: -asthma triggers -using inhalers correctly Need more frequent review on asthma care and management with nursing staff.

Future Plans Implement registry to assist in tracking asthma patients. Improve asthma education by providing additional information regarding asthma, triggers, and management of symptoms. Purchase new EMR that will contain registry functions, enable practice to write their own templates and interface with spirometry machine. Continue PDSA cycles in respect to workflows.