Chapter Quality Network (CQN) Asthma Pilot Project Team Progress Presentation State Name: Ohio Practice Name: Primecare Pediatrics Team Members: Dave Trebb, Lisa Rector, Susie Bunner

Progress Summary Since Learning Session 1 Modification and implementation of CQN form Establishment of office “protocols” Standardized form for asthma medication refills during phone triage Team acceptance/familiarization of NAEPP Guidelines Utilization of AAP, NCH teaching/education tools, asthma action plans Increased use of spirometry with acceptable and reproducible results

EQIPP Trends

% of Patients > 5yrs in which spirometry is scheduled or results obtained in the past 1-2 years

% of Patients who have an Asthma Action Plan explained to them at this visit

% of Patients With Optimal Care

Validated instrument Reasons identified for lack of control Stepwise approach Flu shots Education materials

TEST 1 What:CQN form Who (population):Trebb/Bunner Patients Who (executes):Trebb/Bunner Where:Primecare When:1-2 weeks PD SA TEST 2 What:CQN form Who (population):All Who (executes):MD;s/NP’s Where:Primecare When:1-2 weeks PD SA TEST 3 What:CQN Form Revised Form Who (population):Trebb/Bunner Who (executes):Trebb/Bunner Where:Primecare When:1-2 weeks PD SA TEST 4 What:CQN Revised Form Who (population):All Who (executes):MD’s/NP’s Where:Pimecare When:1-2 weeks PD SA TEST 1 -Baseline Data What:Spirometry results Who (population): Select patients Who (executes):4 LPN’s Where:Primecare When:1-2 weeks PD SA TEST 2 -PFT Educator What: Spirometry results Who (population): LPN’s Who (executes):LPN’s Where:Primecare When:1 day PD SA TEST 3 What:Spirometry results Who (population):All Who (executes):LPN’s Where:Primecare When:1-2 weeks PD SA TEST 4-PFT Educator What:Spriometry results Who (population):LPN’s Who (executes):LPN’s Where:Primecare When:1 day PD SA TEST 1 What:ICD-9 code list Who (population):All patients last 2 years Who (executes):Corporate Office Where: When: PD SA TEST 2 What: Identify asthmatics Who (population):All Who (executes):Front office Where:Primecare When:1-2 weeks PD SA TEST 3 What :Identify prescheduled asthmatics Who (population):All Who (executes):Sue Where:Primecare When:1-2 weeks PD SA TEST 4 What: Identify asthmatics Who (population):All Who (executes):MD’s/LPN’s/NP’s Where:Primecare When:ongoing PD SA CQN FormSpirometryIdentification of asthmatics PDSA Ramps

Office Flow Document

CQN Encounter Form ASTHMA ENCOUNTER Provider Name: ___________________________________Date of Visit: ____ / ____ / ____ Patient Name: _____________________________________Date of Birth: ____ / ____ / ____ ____ Well visit ____ Asthma visit ____ Other sick visit 1. How many days of school/daycare has your child missed due to asthma in the past 6 months? ____# of days 2. How many days have you (or spouse) missed due to your child's asthma in the past 6 months? ____# of days 3. How many times has your child visited the Emergency Room or Urgent Care Center due to asthma in the past 12 months? ____# of times 4. How many times has child been admitted to hospital due to asthma in the past 12 months? ____# of times 5. How comfortable are you in your ability to manage your child's asthma, rated on a scale of 1-10? (Please circle) Not comfortable = = Very Comfortable 6. During the past week, at times other than before exercise, how often did your child use a fast-acting or quick-relief medication? ____not at all ____less than 1 time per day ____1-3 times a day ____4 or more times a day ____not sure 7. When are your child's asthma symptoms worse? (Check all that apply) ____winter ____spring ____summer ____fall ____during exercise 8. How often does asthma limit your child's activities? ____not at all ____a little of the time ____some of the time ____most of the time ____all of the time 9. Over the previous 2 to 4 weeks, how frequently has your child experienced episodes of cough, shortness of breath, wheezing, or reduced activity due to asthma during the DAY? ____ ≤ 2 days per week ____ > 2 days per week but not daily ____daily ____throughout the day 10. Over the previous 2 to 4 weeks, how frequently has your child experienced episodes of cough, shortness of breath, wheezing, or waking up due to asthma during the NIGHT? ____ ≤ to 2 times per month ____ 3-4 times per month ____ > than 1 time per week but not nightly ____often 7 times per week 11. How would you rate your child's asthma control during the past month? ____ not controlled at all ____ poorly controlled ____somewhat controlled ____well controlled ____completely controlled

CQN Form page 2 See separate form

Key Learnings  Identification of asthmatics at time of visit is crucial  All team members buy in and participate for “optimal care”  Willingness of MD’s, NP’s and LPN’s to learn  Consistency and standardization is key to success  Small changes over time  Importance of asthma rechecks  Registry would help

Barriers and Successes No EMR No registry Time/workforce constraints Patient non-compliance Providers slow to institute changes Improved identification of asthmatics Engagement of office Standardization of care, education, teaching, PFT’s Increased use of diagnostic spirometry Increased parental satisfactions Improved care

Future Plans Registry and EMR Continued education of staff by RT, asthma educators Strive towards meeting established goals