1. Welcome to the UPIQ/Asthma Program
Learning Collaborative - Team Lead Call #2
June 13, 2017

2. Agenda Welcome – Diane Liu, Director of UPIQ
Core Measures (April/May data info to date)
Full April/May data results shared during July TLC
Data due by 15th but submit sooner for your benefit
Upcoming webinars (MOC reminder)
Next Steps

3. Participating Practices
Welcome to all of you. Please take a moment and type into the chat box your name and those attending with you. Dawn will be monitoring the chat box and unmuting us for discussion, but as a reminder, we ask you mute yourselves if there is background noise.
Before we review the core measures, I want to take a moment and thank you for your engagement. Both Dawn and Gabi, your QI coaches, have emphasized the outstanding willingness on your end to improve aspects of the asthma care you deliver to your patients.

4. 1. Asthma Severity Documented
Numerator: Those in the denominator whose severity* was documented in the encounter note*
Denominator: All patients seen during the measurement period for asthma (newly diagnosed or already on medication)
Goal: 80%
Data Source: EMR or manual chart review
*updated problem list, template reflecting ICD10 code, etc.
*severity specified (mild intermittent, persistent – mild, mod, severe)
Guidelines reflect identifying severity at initial diagnosis – how can we help make this a meaningful measure for your practice?
Though Asthma severity is required when billing ICD10 codes, it should be documented in the encounter note at every visit. This facilitates communication between clinicians and members of the patients’ care team.
***
Percentage of children with asthma whose asthma severity was documented during the defined measurement period.
This reflects every visit – since severity is the billable factor we may inappropriately assume there is no improvement to make; however we are asking that severity is documented in the encounter notation. This facilitates communication about the patient for any health team member reviewing the patient’s chart encounters

5. May Report:

6. 2. Control Assessment & Documentation
Numerator: Those in the denominator who have control status assessed by a validated screening tool and documented in the note
Denominator: All patients seen during the measurement period for asthma who are on an asthma medication of any type*
Goal: 80%
Data Source: EMR or manual chart review
*medication reconciliation
The percentage of children with asthma whose control has been assessed with a validated tool during the defined measurement period. Examples of tools include ACT, TRACK, and ATAQ.

7. ACT Tests & Categories Control Tool (Age) Score for Well Controlled
Not
Well Controlled
Very
Poorly Controlled
Childhood Asthma Control Test C-ACT
(4 to 11 years)
20 or greater
13 to 19
12 or less
Asthma Control Test ACT
(12+ years and adults)
16-19
15 or less
ACT
Schatz M, Sorkness CA, Li JT et al. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol 2006; 117: Available from: 
Schatz M, Kosinski M, Yarlas AS et al. The minimally important difference of the Asthma Control Test. J Allergy Clin Immunol 2009; 124: Available from: 
Kaiser’s asthma treatment guideline and ACT scoring

8. May Report:

9. May Report:

10. 3. Inhaled Corticosteroid (ICS)
Numerator: Those in the denominator appropriately prescribed an ICS Denominator: All patients seen during the measurement period for asthma with a classification severity level of persistent asthma Goal: 80% Data Source: EMR or manual chart review
Based on current asthma guidelines All patients with persistent asthma should be prescribed an ICS
Percentage of children with persistent asthma that were prescribed inhaled corticosteroids (ICSs) during the defined measurement period. Include prescriptions from elsewhere (e.g. ED).

11. May Report:

12. 4. Asthma Action Plan (AAP)
Numerator: Those in the denominator with a ‘current’* asthma action plan on file
Denominator: All patients seen during the measurement period for asthma
Goal: 80%
Data Source: EMR or manual chart review
*within the past 6-12 months
Asthma pts need to have a current Asthma action plan on file to support communication with 3rd parties such as the school or other caregivers. The definition of current means a plan that has been updated in the past 6=12 months.
Percentage of children with asthma whose asthma action plan was updated during the defined measurement period.
DOH had AAP – we’ll try again. Include in the ppt
How do we define ‘current’ – practices to determine how they were appropriately update AAP in the record

13. May Report:

14. Timeline Review – upcoming webinars for MOC
June 21 – Pulmonary Function Tests by Chee Tan, MD
July – Listen to supplemental
August – Listen to supplemental
Sept 26 – Pharmacologic review by clinical pharmacist
Oct 24 – Parent perspectives by Gina Pola-Money, Director of Utah Family Voices

15. Using Asthma-related Devices
David C. Young, PharmD
Professor, College of Pharmacy
University of Utah
Recorded June 1, 2017

16. Types of EMR used by participating practices Participating Practice
Maliheh Free Clinic - Family Medicine
Athena
Mountainlands CHC - Family Medicine
Wellsprings Pediatrics
MountainStar Ogden Pediatrics
ECW
Neighborhood CHC.Inc - Family Practice
Utah Valley Pediatrics - Spanish Fork
Utah Partners for Help
South Jordan Health Care - Pediatrics
EPIC
Utah Pediatric Clinic
Central Orem Clinic
help2/iCentra
Utah Navajo Health System - Family Practice
NexGen
Blackstar Pediatrics
Practice Fusion

17. Thank you & Next Steps
Remain in contact with your coach (by visit or phone)
Test cycles of change (plan to share your ideas)
PDSA templates for project management
QI Teamspace entry space available
Keep celebrating improving together
IHI Webinar “How to Beat the Boring Aspects of QI”
Tomorrow Wed June 14th at 2p.m. MST (noon EST)
Submit your data for feedback
Connect with each other ask questions – we’re a learning community!

18. Contact us at info@upiq.org
The UPIQ Team
Diane Liu, MD FAAP
Director
Chuck Norlin, MD FAAP
Past Director
Gabi Baraghoshi, RN MPH
QI Specialist
Dawn Bentley, RN BSN
Contact us at