Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation State Name: Ohio Practice Name: Pediatricenter of Greater Cleveland Team Members: Brad Weinberger, Darlene Hrdlicka, Denise Marzano

Progress Summary Since Learning Session 1 3 physicians consistently using encounter form 2 offices consistently using encounter form Asthma Action Plan standardized Educational materials – handouts, website Aerochambers dispensed in office; MAs trained on usage Different solutions necessary for different offices

Strengths Percentage of patients with flu vaccination (or recommendation)

Weaknesses Percentage of patients 5 years of older in whom spirometry is scheduled or has been obtained within last 1-2 years

Improvement Percentage of patients with asthma action plan that was either updated or reviewed with family at point of care Increased use of Asthma Action Plans Increased use of Educational Materials Percentage of patients in which self-management materials were provided and explained to family

Optimal Control is Elusive

PDSA Cycles PDSA Title: Improve recognition of asthmatics  Plan: Still difficult to identify asthmatics (poor documentation, MAs not asking, poor self- identification). Improve self-identification by families/parents.  Do: Generate signs in waiting room/lobby.  Study: to be continued  Act: to be continued

TEST 1 What:AAP - Maine Who (population) 2 patients: Who (executes): BW Where: BB/BH Results: comprehensive, not specific to practice PD SA TEST 2 What: AAP Merck Who (population): 2 patients Who (executes): BW Where: BB/BH Results: do not agree with PD SA TEST 3 What: Pediatricenter AAP Who (population):2 patients Who (executes):BW Where:BB Results: very good, easy to use PD SA TEST 4 What:Pediatricenter AAP Who (population):6 patients Who (executes):BW, BF, KU Where: Pediatricenter BB Results: slight feedback, form modified PD SA TEST 1 What:: Location of AAP Who (population): 1 pts Who (executes):BW Where:BH – dispensed in front desk Results:workflow cumbersome PD SA TEST 2 What:: AAP in exam room Who (population): 2 asthmatics Who (executes):BW Where: BH – exam room Results: easier to fill out, need to get copy made PD SA TEST 3 What: MD hands to MA Who (population): 2 asthmatics Who (executes): BW Where:BH When: cumbersome, time-consuming PD SA TEST 4 What: Parents hand to MA w/ f/u plan Who (population):3 patients Who (executes): BW Where: BH Results: Easier on MD to handle, reliable PD SA TEST 1 What: AAP in each room Who (population):3 asthmatics Who (executes): BW Where: BB Results: Not always in room, error prone PD SA TEST 2 What: AAP (blank) w/ each encounter form Who (population):3 asthmatics Who (executes): BW Where:BH/BB Results:??? PD SA TEST 3 What: Who (population): Who (executes): Where: When: PD SA TEST 4 What: Who (population): Who (executes): Where: When: PD SA Construction of AAPLogistics of AAP Improve Reliability PDSA Ramps

Office Flow Document Asthma patients identified by MA during check-in At time of check-in, form handed to parents to complete while waiting for appointment Completed form is left in room for doctor to review :”Dx of asthma” should be noted in PMHx component of chart Asthma action plan completed/reviewed in room prior to discharge along with e-prescribing Medication/spacer technique reviewed by MD or MA Form is left on MD desk for later data entry prior to scanning into EMR Office Visit - Prework During Office Visit Post Visit Activities EQIPP forms later scanned into EMR Data entry into EQIPP by physician Follow up arranged; including testing (PFTs)/referrals Physician reviews answers and completes remaining sections; exam performed Asthma dx identified during chart prep; CQN encounter form placed into chart Handouts given to patients; referred to website for supp. materials Patient not ID’d prior to encounter, physician must get Encounter form and work through w/ parent Green = Strength Red = Weakness Family brings plan to front desk to be copied, plans f/u

Copy of Your CQN Encounter Form

Key Learnings  Different offices have different logistics, therefore individual strengths and weaknesses  Standards across offices need to be (slightly) relaxed at times  Staff training critically important  Making the right thing the easy thing is best

Barriers and Successes Team not as strong as we would like (illness, multiple offices, lack of clinical manager) Identification of asthmatics poor –No registry –Inconsistent use of flags in medical charts –Education of staff difficult due to personnel changes Success: –Asthma Action Plan Standardized –Educational materials developed, made more accessible

Future Plans Asthma Action Plans for all physicians Educational materials provided to all offices Asthma Encounter Form post-EQIPP ? Flag charts of asthmatics Implementation of EMR in (?near) future will hopefully improve registry capabilities/streamline development of Asthma Action Plans