1. Maine AAP Amy Belisle, MD, Mike Ross, MD Aubrie Entwood, Barbara Chilmoncyzk, MD Rhonda Vosmus, RRT-NPS, AE-C, Paula Gilbert

2. “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.”

3. 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

4. Maine November EQIPP Data 50% Optimal Care (increase from 45% in Oct) 50% (6/12) Maine Practices using a registry 65% Encounters used a validated instrument 90% Flu Shot Recommended 70% Used an Asthma Action Plan 90% Stepwise Approach Used Number of encounters increased 21% From 220 (October) to 281 (November)

5. 5 Maine’s Last 90 Days Spread work of AH! Program in Maine to other AAP groups: Sent Asthma Flip Charts (632), Tool kits (55), and Medication Charts (214) Alabama=191 flip charts, 12 toolkits & 36 med charts Maine=231 flipcharts, 13 tool kits & 88 med charts Ohio=160 flip charts, 17 toolkits & 51 med charts Oregon= 100 flipcharts, 13 toolkits & 39 med charts Engaged statewide asthma educators in project- 4 Attended Learning session and 25 aware of project

6. Maine’s Last 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; 2 monthly newsletters sent out Identified ACT form for kids less than 4: TRACK http://www.asthmatracktest.com/ Worked with Patient Centered Medical Home Committee to Identify Asthma Quality Indicators Started to form state AAP QI Committee

7. Updated asthma encounter forms- both paper and electronically

8. 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 inluding 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

9. Diagnosing Initial Degree of Severity  Questions shift automatically based on age of patient  Severity Assessment based on 2007 guidelines  Allows for a diagnosis to be assigned directly from the form  Utilizes Cincinnati Children’s mask/mouthpiece educational checklist

10. Online Resource:

11. Some of the EMR metric prompts Prompts provider to investigate other aspects of control (ER visits, school days missed, hospitalizations, spirometry) Investigates family’s degree of comfort with asthma Encourages provider to provide further patient education –Quick-link to asthma-related patient educational materials/handouts Questions: Contact Michael Ross, MD FAAP, Husson Pediatrics, EMMC mross@emh.org for details mross@emh.org

12. Maine’s Next 90 Days 1. Develop QI committee for Maine AAP 2. Work on spirometry/peak flow implementation 3. Organize LS3 4. Utilize data to help sustain changes, continue to engage practices 5. Integrate non-EQIPP docs into the project