1. The Chronic Care Model in CQN System Framework for Great Asthma Care

2. How to produce continuous, enduring improvements in care for a population? Appreciation for care as a system Flexible improvement model Sequential building of knowledge –Testing changes on a small scale –Spread of improvements to similar sites Efficient and effective use of data –Usefulness not perfection Tom Nolan, PhD

3. What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo Focus L Provost, API

4. What change can we make that will lead to improvement? Change Concept: a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement. L Provost, API

5. Conceptual, Vague Strategic Specific Actionable Ideas Decision support Use a template Create an encounter form that includes assessment of control Incorporate CQN form into flow and try it on two patients next Monday Moving from Concepts to Ideas

6. Simplified Care Model Registry Templates for planned care –(e.g., structured encounter form) Protocols to standardize care –Standard Protocols –Nursing Standing Orders –Defined Care team roles Self-management support strategies

8. CQN Hi-Leverage Changes Use Template (encounter form) for Planned Care Implement ‘registry’ to identify and manage children with asthma Use Protocols Adopt Self-management Support Strategies

9. Chronic Care Model/CQN High Leverage Changes RegistryTemplateProtocolsSelf Management Support Health SystemAddressed by each chapter in CQN Delivery System Design  Determine staff workflow to support registry use  Determine staff workflow to support use of template  Monitor use of template  Determine staff workflow to support protocols, including standing orders  Monitor use of protocols Determine staff workflow to support SMS Provide training to staff in SMS techniques Document & monitor patient progress toward goals Decision Support  Use registry to manage patient care and support population management  Select template tool from registry or create a flow sheet  Use template with all patients  Select and customize evidence- based protocols to office  Use protocols with all patients  Assess and document asthma severity and control  Establish visit frequency protocol Clinical Information Systems  Select and install a registry tool  Populate registry with patient data  Routinely maintain registry data  Ensure registry updated each time template used Self Management Support  Obtain patient education materials (e.g., asthma action plans)  Set patient goals collaboratively  Use Asthma Management plans Community  Link with community resources (schools, service organizations)

10. Key Driver: Employing Protocols 1.Use NHLBI evidence-based guidelines at point of careDetermine staff workflow to support guideline use (i.e., protocols including standing orders) 2.Use protocols with all patients 3.Monitor use of protocols

11. Key Driver: Planned Care Assess and document asthma severity and control Prescribe appropriate asthma medications and monitor overuse of beta agonists Use Asthma Management plans Establish visit frequency protocol Assess and treat co-morbidities Assess, counsel, and prevent exposure to environmental triggers

12. Key Driver: Self-management Support  Provide training to staff in SMS techniques  Set patient goals collaboratively  Determine staff workflow to support SMS  Obtain patient education materials (e.g., asthma action plans)  Document and monitor patient progress toward goals  Link with community resources (schools, service organizations)

13. Monitoring the Process Monthly reports at practice, chapter and national level To inform where you need to focus improvement activities/PDSA’s Requires work and planning– a few huddles a week to plan, study and identify new theories

14. Overcoming Challenges Ask questions of Collaborative faculty Share challenges on Listserv Find links, tools and resources on the Extranet Request consultation from another practice team

15. Putting It All Together Create a strong practice team Clarify what you are are trying to accomplish Try high-leverage changes Measure progress Refine and customize changes Share and integrate learning