Quality Improvement Chapter Resources District Meeting V & VI Lake Geneva, Wisconsin July 22 – 25, 2010 Judith C Dolins, MPH Acting Associate Executive Director Director, Department of Community, Chapter and State Affairs Judith C Dolins, MPH Acting Associate Executive Director Director, Department of Community, Chapter and State Affairs

Why be involved in QI activities? State of Children’s Health Care Pay for Performance ABP Maintenance of Certification, Part IV Maintenance of Licensure Chapter and membership value

Gap in Children’s Healthcare Only 42% of children receive appropriate care compared to 54% of adults* Gaps are widespread even across the best institutions Care is worse for poor, minority and uninsured kids * Mangione-Smith R, DeCristofaro AH, Setodji CM, Keesey J, Klien DJ, Adams JL, Schuster MA, McGlynn EA. The quality of ambulatory care delivered to children in the United States. The New England Journal of Medicine 2007; 357(15):

MOC is here! Designed FOR and BY Pediatricians MOC Committee designed a flexible program Easily tailored to your practice Evolving into a more continuous process

ABP Approved QI Projects 6: AAP National Office 11 AAP Chapters (OH, NM, OR, UT, VT) 6 Statewide projects 15 Single Children’s Hospitals, Departments of Pediatrics 9 Perinatal Networks 5 Children’s Hospital Networks 2 Disease Network 2 National Medical Societies 2 Local Foundations 2 Blue Cross Blue Shield

What is the AAP doing to help chapters with quality improvement work?

Chapter Alliance for Quality Improvement (CAQI) Provides technical assistance to help chapters build QI infrastructure Monitors chapter needs Shares tools to support QI project implementation Quality Network (CQN) Develop targeted QI programs for implementation through the Chapter Quality Network (CQN)

Chapters and QI Interest and momentum for QI is growing Chapters need help building infrastructure to support QI amongst member practices Chapters cannot undertake QI work by themselves

AAP Chapter Role in QI

Chapter Quality Network (CQN) Asthma Pilot Project Aims to build a network of AAP chapters and enhance their ability to spread the NHLBI/NAEPP asthma guidelines. Specific Objectives Include: Develop chapter led learning communities to support measureable improvements in asthma care Collaborate with AAP Chapters to collect and analyze improvement data through EQIPP Build chapter capacity to support member practice activities through partnerships and relationships at the state level

CQN Asthma Pilot Project MAINE OHIO OREGON ALABAMA 11 Practices 59 Clinicians 13 Practices 72 Clinicians 13 Practices 101 Clinicians 12 Practices 50 Clinicians 49 Practices 282 Clinicians

Registry Implementation

Optimal Care Percent of patients with all of the following: validated instrument used to assess asthma control, stepwise approach used to identify treatment options or adjust therapy, patients 6 months or older with a flu shot or flu shot recommendation, patients with an asthma action plan, 82%

Use of a validated instrument Percent of patients in which a validated instrument is used to determine the current level of asthma control, 97%

Stepwise Approach Percent of patients in which the stepwise approach is used to identify treatment therapy and adjust or maintain therapy based on asthma control, 99%

Flu Shot Percent of patients in which self-management education materials (in addition to the asthma action plan) are provided and explained to the patient and family at any visit, 84% Percent of patients with asthma ages 6 months and older who have received a flu shot or flu shot recommendation within the past 12 months, 95%

Asthma Action Plan Percent of patients who have an updated written asthma action plan that was reviewed and discussed at this visit, 86%

Self-Management Percent of patients in which self-management education materials (in addition to the asthma action plan) are provided and explained to the patient and family at any visit, 85%

Commitment to Quality No Change in my commitment to QI work, 9% More committed to QI work, 91%

Practice Perspective: Value of Program Components Average Rating, Scale of 1 – 5. 1 = Not valuable, 5 = very valuable

Chapter Team Perspective: Value of Program Components Average Rating, Scale of 1 – 5. 1 = Not valuable, 5 = very valuable

Inputs & Learnings Quality Improvement Expertise Data Collection, Reporting and Analysis Curriculum and Tool Development Program Management Learning Collaborative Facilitation Building capacity and reputation to support membership in QI Chapters can lead large scale improvement networks! Chapters and practices find value in CQN programming Chapters find value and need in measuring population-based care Steady growth leads to transformation

CQN: A Network of Chapters ChapterQualityNetwork(CQN) Collaborative Facilitation Data Aggregation & Reporting Chapter QI Training Curriculum & Tool Development Project Management

Impact of Quality Improvement on Member Value

Sustaining Chapter Efforts Bi-annual conference call highlighting little known or new tools. An opportunity for practices to share new knowledge or ask questions regarding areas of challenge More robust support for individuals and groups interested in QI, support for other areas of study/work (obesity, ADD, etc) Expansion of registry capacity Improve communication between practices Share knowledge and resources between practices and physicians Ongoing discussions with CQN practices about issues, problems, solutions over time QI committee will gather information of QI projects in the sate and make determinations as to future projects