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Ohio Chapter, AAP CQN Asthma Pilot Project: Shared Vision

Ohio Chapter, AAP CQN Asthma Pilot Project: Shared Vision. Cooper White M.D. 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. Functional - School Attendance

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Ohio Chapter, AAP CQN Asthma Pilot Project: Shared Vision

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  1. Ohio Chapter, AAP CQN Asthma Pilot Project: Shared Vision Cooper White M.D.

  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. Functional -School Attendance -Sports and Activities -Improved Sleep - Family Dynamics Clinical Hospitalizations ER Visits Use of Inhaled Steroids - Asthma Action Plans - Patient Education Satisfaction -Access to Care -Positive relationship with provider -Empowerment -Peace of Mind Costs Hospital Costs Medication Costs Outpatient Costs Caretaker’s Work Loss

  4. LPCG “Perfect” and “Near Perfect” Asthma Care

  5. LPCG Scorecard

  6. Ohio’s Quality Improvement Strategic Plan • CQN Asthma Collaborative • Concerned About Development Collaborative • Ohio AAP Practice Management Committee

  7. Collaboratives • Multiple Teams (engaged and motivated) • Focused subject • Identified gaps • Expert advisors, shared learning • Rapid cycle improvement • Specified targets • Data collection and sharing • Free flow of ideas • Structured support

  8. Collaborative Successes • 2001 OSF Healthcare: ADEs reduced from 4/1000 doses to <1/1000 doses • 1999 BPHC: 2 HbA1c tests/yr, increased 300%, 30,000 patients enrolled in registry care. • 2003 VA: Waiting time reduced from 60.4 days to 28.2 days • 1996 Nash Healthcare: Adult ICU ventilator time reduced by 34%, VAP reduced by 50% • Cincinnati Children’s PHO: Asthma, >80% Perfect care

  9. Defining the Gap: Asthma • Affecting nine million children, childhood asthma is the most common serious pediatric chronic disease. The incidence of pediatric asthma continues to grow; it accounts for 14.7 million missed school days a year and 44% of all asthma hospitalizations[1] [1] American Academy of Allergy, Asthma and Immunology. http://www.aaaai.org/media/resources/media_kit/ asthma_statistics.stm

  10. What About Ohio? • Overall prevalence: 10-12% of all children (2005), 7th highest in the nation • 19.5 % of Afro-Americans (2004) • 14.2% Appalachian children (2004) • 14,285 children in Summit County, 7 asthma deaths (2006) • $759,559,847.10 hospital charges (2001) • Mortality 3/100,000 (black), 1.2/100,000 (white)

  11. What can we do? • During August 2007, under the auspices of the National Heart, Lung, and Blood Institute (NHLBI) the National Asthma Education and Prevention Program (NAEPP) issued the first comprehensive update in a decade of asthma guidelines for the diagnosis and management of asthma (NHLBI asthma guidelines). The guidelines emphasize the importance of asthma control and introduce new approaches for monitoring asthma. The AAP recognizes that increased exposure to the new guidelines coupled with implementation support will decrease gaps in care and help move towards optimal care for children with asthma.

  12. Guideline Compliance • “An intervention to enhance compliance … will need to address … barriers…” Prim Care Respir J 2007 Dec; 16(6): 369-77 • “Adherence to recommended guidelines in asthma/COPD was low.” Pharmacoepidemiol Drug Saf. 2009 May; 18(5):393-400. • “Guideline nonadherence was widespread…” Health Serv Res 2001 Jun; 36(2): 357-71 • “Physician prescribing of asthma pharmacotherapy does not adequately comply with EPR-2 treatment guidelines.” Ann Allergy Asthma and immunology 2008 Mar; 100(3): 216-21

  13. MAINE OREGON OHIO ALABAMA CQN Impact

  14. Ohio Chapter CQN Aims Global Aim • By working with individual practices, institutions, health systems and payers, we will build a sustainable quality improvement infrastructure within the Ohio Chapter to achieve measurable improvements in the health outcomes of children within our member practices. Specific Aim • From April 2009 to November 2010, we will lead a quality improvement collaborative and achieve measurable improvements in asthma outcomes with the participating 10 to 15 practices by implementing the NHLBI guidelines with as many patients receiving “optimal care” in their medical home, as possible.

  15. Ohio Chapter CQN Goals Goals 90 % of participating practices will achieve: • 75% optimal care by June 2010, and 90% optimal care by November 2010. • Use of a structured visit form for 90% of asthma patients by November 2010. • A 25% reduction in asthma related hospitalizations in year 2011 compared to 2010. • Provision of written, video or verbal instructions in the use and technique of administering inhaled medicines for 90% of asthma patients by November 2010. • Well Controlledstatus for 80% of asthma patients by November 2010.

  16. Long Term Goals • Goal: Participating practices will continue to collaborate with quarterly data sharing and show sustainable improvement through 2011. • Goal: Based on knowledge and experience gained in this CQN Asthma Pilot Project, and in conjunction with state agencies and established health systems, the Ohio Chapter will develop regional collaborative networks prior to the end of the pilot in November, 2010 to bring sustainable quality improvement in asthma care to as many of Ohio’s children as possible in 2011 and beyond. • Goal: The Ohio Chapter will create the infrastructure to support the development of collaborative networks, using registry based care and rapid cycle improvement to improve care of Ohio’s children with chronic conditions other than asthma. Further, the chapter will support the development and dissemination of coaching techniques to aid practices in these efforts.

  17. Optimal Care >90% of patients have “optimal” asthma care (all of the following) • assessment of asthma control using a validated instrument • stepwise approach to identify treatment options and adjust therapy • written asthma action plan • patients >6 mos. of age with flu shot (or flu shot recommendation)

  18. Change Concepts • Engaging Your Asthma QI Team and Your Practice *The QI team and practice is active and engaged in improving practice processes and patient outcomes • Using a Registry to Manage Your Asthma Population *Identify each asthma patient at every visit *Identify needed services for each patient *Recall patients for follow-up

  19. Change Concepts • Using a Planned Care Approach to Ensure Reliable Asthma Care in the Office *Care team is aware of patient needs and work together to ensure all needed services are completed • Developing an Approach to Employing Protocols * Standardize Care Processes * Practice wide asthma guidelines implemented • Providing Self management Support * Realized patient and care team relationship

  20. Key Driver Diagram

  21. The Story of Improvement • Kim Spoonhower will discuss some of the work improving care in the Lewis H. Walker Cystic Fibrosis Center at Akron Children’s Hospital.

  22. Asthma Care a Year From Now • Healthier patients • Empowered families • Engaged providers and staff • Efficient office systems that are capable of delivering the right care, to those who need it, all the time • Adequate information systems, capable of supporting the above goals • Reduced cost

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