Rock Hill Pediatrics Asthma Appropriate Care July 29, 2012

1. Rock Hill Pediatrics Asthma Appropriate Care July 29, 2012

2. Background • June 2010 – all physicians and APPs polled to solicit feedback on metrics to be included in the Appropriate Care Measure Set for CHS Quality Goal setting • Mirrors the core measure sets that have been in place in acute care facilities • Four disease states were selected: Diabetes, Ischemic Vascular Disease, Heart Failure, and Asthma • Consistently listed as priority areas for quality reporting by CMS, Medicaid, National Quality Forum, and others • Nearly all metrics presented in the poll appear on national quality indicator lists • Beginning in 2011, process measures for four disease states were first tracked and reported system-wide

3. Delphi Poll Questionnaire

4. Appropriate Care Process Bundles

5. Asthma Appropriate Care Metric The percentage of patients who received appropriate ambulatory care for asthma, reported on a quarterly basis Data Source Abstraction of a random sample of patient charts from the five physician networks

6. Data Sampling – Asthma Inclusion Criteria FM, IM, peds, and pulm patients with age ≥ 5 years at the time of the encounter and have one of the following diagnosis codes: 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, or 493.92 Base Population Querying Patients meeting above criteria that received a disease diagnosis in IDX within the previous 18 mos. and seen in the previous 3 mos. for any reason are eligible for sampling Sampling Methodology Representative across practices and volume of disease states seen, using a modified JCAHO sample size Exclusion Criteria Patients diagnosed with reactive airway disease, bronchiolitis, or chronic bronchitis

7. Data Collection Methodology • Leveraged electronic information when available by pre-populating online data collection tool when possible • Information manually validated by auditor • 12,000+ charts abstracted each quarter during a 5-week time span

8. Appropriate Care: All or None Measurement Rationale • Measure of the care a patient should receive • Provides a system perspective that focuses on process • More sensitive scale for assessing improvements • Mirrors acute facility measure for Core Measures Success Factors • Small measure set for each disease • Improving processes for documentation • Adoption of Point of Care Reminders (Cerner EMR Health Maintenance Module) Berwick and Nolan. 2006 American Medical Association

9. Small Measure Set • 3 metrics • Controller Medication for Persistent Symptoms • Assessment of Daytime/Nocturnal Symptoms • Influenza Vaccination • All or None concept

10. Improving Processes for Documentation • Physician Networks are composed of practices who are in various states of EMR migration (paper, hybrid, “fully” integrated) • Regardless of state, all have experienced challenges with addressing and documenting care measures • Flowsheets developed to assist paper-charting practices and prepare them for EMR implementation • Point of Care alerts released for EMR-charting practices

11. Assessment of Symptoms

12. Assessment of Symptoms

13. Point of Care Alerts – Health Maintenance

14. Pending Alerts

15. Satisfied Expectations

16. Assessment of Symptoms

17. Rock Hill Pediatrics Success Factors • Narrow focus • 1 disease state, 3 measures • Physician Champion • Practice Manager support • Standard Processes • Practice-based Quality Improvement • Culture supportive of continual learning and progress • COMPETITIVE!

18. Maintenance of Certification – Asthma Appropriate Care • Practice-wide improvement effort lends itself to Part IV MOC - Physician Participation in a QI Project • Attestations in progress for 8 physicians!