AAP Chapter Quality Network Maine AAP Asthma Pilot Project Augusta, Maine April 9, 2010

Introductions National AAP –Judy Dolins, MPH, Laura Conley, MHSA, Peter Margolis, MD, MPH Maine AAP –Amy Belisle, MD, Aubrie Entwood, Barbara Chilmonczyk, MD, Mike Ross, MD, Rhonda Vosmus, RRT-NPS, AE-C, Paula Gilbert, Kathryn Engel Asthma Educators Practice Teams

Participating Practices Kennebec Pediatrics, Augusta Franklin Health Pediatrics, Farmington Lake Region Pediatrics, Windham Maine Coast Pediatrics, Ellsworth Intermed Pediatrics, Portland and Yarmouth Bowdoin Pediatrics, Brunswick BBCH Pediatric Clinic, Portland CMMC Pediatrics, Lewiston Medical Home Sites Husson Pediatrics, Bangor Winthrop Pediatrics Westbrook Pediatrics Allergy and Asthma Associates of Maine

Objectives of Today’s Meeting Review Goals for National and State AAP Highlight First 90 Days of Project Review March Data for Maine Discuss QI Sustainability at Chapter and National Level Introduce Groups to Motivational Interviewing Continue work with Asthma Educators and Self Management Support Learn the Value of Spirometry Create 90 Day Goals

Games Prize for “Best Theme Song” for Project Prize for “Best Slogan” for Pilot Prize for “Asthma Device” Worksheet Prize for Physicians who read all 5 Spirometry cases properly Prize for Groups with a New Registry since the Pilot started- Maine Coast and CMMC

Chapter Quality Network (CQN) Asthma Pilot Project Our First Six Months Amy Belisle, MD Physician Leader, Maine AAP Judy Dolins, MPH Director, Department of Community Chapter and State Principle Investigator, Chapter Quality Network Asthma Pilot Project

Amy Belisle’s Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. Disclosure Statement Judy Dolin’s Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity

National goals at the practice level  Changes in asthma care practices and child health outcome  Successful implementation of practice system change  Clinician investment and commitment to quality improvement work  Transparency and sharing of improvement data  Increased clinician demand for CQN programming

National goals at the chapter level  Increased capacity for quality improvement work  Governance group engagement  Sustain QI work at the chapter level  Key partnerships focused on improvement work  Funding for continued quality efforts  Increased chapter demand for CQN programming

Improvement Work Continuous tests of changeSustainability Imbed in everyday work Scale Up & Spread Taking local improvement And actively disseminating it across a chapter and/or practice Our First 6 months

CQN Asthma Pilot Sites MAINE OHIO OREGON ALABAMA

How are we doing at the National Level? Practice System Changes Percent of eligible providers collecting data at point of care

How are we doing at the National Level? Practice System Changes Registry Implementation Status

How are we doing at the National Level? Practice System Changes Options for Practices without a Registry

How are we doing at the National Level? Practice System Changes Degree of belief that workflows for collecting data for eligible patients/opportunities at point of care are highly reliable

How are we doing at the National Level? Measures of Asthma Care Practices and Health Outcome Key MeasureGoalAlabamaMaineOhioOregon National Average % of patients with 1 or more asthma-related ED or Urgent Care Visits within the past 12 months 0%21%20%35%24%25% % of patients with 1 or more hospitalizations within the past 12 months 0%5%4%7%6% % of patients well controlled 90%57%68%64%51%60% % of patients with optimal asthma care 90%75%71% 80%74% % of patients with key asthma indicators used when considering an asthma diagnosis 90%91%96%80%75%86% % of patients ages 5 and older in which spirometry is used to establish a asthma diagnosis 90%63%61% 56%60% % of patients in which a validated instrument is used to determine the current level of asthma control 90%99%93%99% 98% % of patients in which reasons for lack of asthma control is identified when asthma control is "not well controlled" or "very poorly controlled" 90%96%100%94%93%96% % of patients ages 5 and older where spirometry is scheduled to be tested or results have been obtained within the last 1-2 years 90%59%62%67%64%63% % of patients in which the stepwise approach is used to identify treatment therapy and adjust or maintain therapy based on asthma control 90%99%97%99%98% % of patients with asthma ages 6 months and older who have received a flu shot or flu shot recommendation within the past 12 months 90%93%98%93%94%95% % of patients who have a current written asthma action plan explained to them at this visit 90%82%78%79%85%81% % of patients in which self-management education materials (in addition to the asthma action plan) are provided and explained to the patient and family 90%81%84%83%74%81% % of patients for whom a follow-up appointment to monitor asthma control is recommended 90%95%89%94%95%93%

Optimal Care >70% of patients have “optimal” asthma care (all of the following) assessment of asthma control using a validated instrument stepwise approach to identify treatment options and adjust therapy written asthma action plan patients >6 mos. of age with flu shot (or flu shot recommendation)

Optimal Asthma Care Maine = 71%

Self-Management Maine = 84%

Use of a Validated Instrument Maine = 93%

Hospitalizations Maine = 4%

Patients Well-Controlled Maine = 68%

CQN-MAINE Franklin Health Pediatrics- Farmington Intermed Pediatrics- Portland BBCH Pediatric Clinic- Portland Allergy and Asthma Associates-Portland Westbrook Pediatrics- Westbrook Maine Coast Pediatrics- Ellsworth Bowdoin Medical Group-Brunswick Husson Pediatrics- Bangor Lake Region Primary Care- Windham Kennebec Pediatrics- Augusta Winthrop Pediatrics- Winthrop CMMC Pediatrics, Lewiston

Global Aim Specific Aim Maine’s Aim Statement Global Aim We will build a sustainable quality improvement infrastructure within our chapter 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 improving use of the NHLBI/NAEPP guidelines and the documentation of quality care.

Maine’s Aim Statement Goal: 90% of practices will achieve 70% optimal care on patients seen by September Goal: 90% of practices use a structured electronic or paper asthma encounter tool 80% of the time by September Outcome Goal: 90% of practices will have at least a yearly ACT score documented in 50% of their patients > 4 years old by September 2010.

Maine’s Aim Statement: Long Term Goals Goal: All practices involved in this collaborative will continue to use a population based registry beyond the time of this grant. Goal: The AH! Asthma Health evidence based asthma tools will be used by member practices. Goal: Certified asthma educators will be available to all member practices. Goal: A committee of AAP members experienced in quality improvement will be charged with infrastructure development in the organization; this will include identifying funding sources for activities. We will have semiannual reporting of QI activities at Maine AAP Fall and Spring conferences for all of its members. Goal: The Maine AAP will partner with MaineHealth, MaineCare, the Maine CDC, Maine based Health Insurers and other organizations interested in child health improvement (such as the Maine Lung Association, the Maine Immunization Collaborative or the Maine Children's Association) to develop a sustainable approach to quality improvement in our organization.

27 Maine’s First 90 Days Spread work of AH! Program in Maine to all 4 AAP groups Sent Asthma Flip Charts (750) Tool kits (55) Medication Charts (214) Learning Sessions at CMMC (Sept) Teleconference in January Engaged statewide asthma educators in project- 4 Attended Learning session and 25 aware of project

Maine’s First 90 Days Coached practices on data and PDSA cycles- 100% of groups submitted 1st PDSA on time Communicated with Senior Leadership- 45 letters sent out to leadership of practices regarding project and need for registry; 5 monthly newsletters sent out Identified ACT form for kids less than 4: TRACK Worked with Patient Centered Medical Home Committee to Identify Asthma Quality Indicators Started to form state AAP QI Committee

Updated asthma encounter forms- both paper and electronically

Updating EMR forms One of challenges is looking at different EMRs in state and figuring out how we can work together to incorporate NHLBI asthma guidelines and EQIPP measures into the templates By updating templates, would help us collect data from all physicians in group including those not doing EQIPP Logician, EPIC, Allscripts, EClinicalworks, etc. Husson Pediatrics (Logician/Meridios), Mike Ross, MD : – Used Cincinnati Children’s for a physical template – Added aspects from Ah!Asthma form, CAQI encounter form, and GE-CCC- asthma. – Added specific obs terms to interface with our registry – 2-tabbed form: Asthma follow-up & Asthma diagnosis

Stepwise Approach Maine = 97%

Flu Shot Recommendation Maine = 98%

Asthma Action Plan Maine = 78%

Spirometry Maine = 62%

Maine’s 90 Day Goals Feb 2010-April Develop QI committee with Maine AAP 2. Work on spirometry/peak flow implementation 3. Organize Learning Session 3- April 9 th in Augusta 4. Increase monthly EQIPP entries by 10% each month for the next 3 months 5. Have 75% of practices with a registry by May 2010

Asthma Care a Year From Now Healthier patients and empowered families Engaged providers and staff employing asthma guidelines including physicians not involved in EQIPP, encourage “spread” within practice Utilizing electronic records to improve quality Efficient office systems that benefit from planned care Reduced cost Continue Partnerships with PCMH & Maine Asthma Council Engage Senior Leaders and Healthcare Organizations Reach out to Northern Maine and Family Practice groups to spread Asthma QI Close the Quality Gap and provide the best care for every patient, every time