Leveraging Asthma Registries for Improved Patient Management and Outcomes

1. Asthma Registries Jim Stout, MD, MPH Professor of Pediatrics University of Washington (With thanks to Jim Krieger MD, MPH)

2. Disclaimer • 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. • I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

3. What is an asthma registry? • A list of patients with asthma • A source of data for asthma management • A tool to incorporate guidelines into practice • How is a registry different than an electronic medical record?

4. Types of registries • Paper-based • Computer-based • Excel • Access • And beyond…

5. Odessa Brown Children’s Clinic • Originally a safety net clinic for Seattle’s African American community • Still a safety net clinic, though much more diverse • 4 pediatricians, 2 nurse practitioners • A satellite of Children’s Hospital (and a clinical teaching site for UW and other programs) • Four “chronic illness” programs: • Sickle Cell Clinic • Asthma Clinic • AD/HD clinic • Childhood overweight clinic

6. Getting started • Asthma hospitalizations in last year • Use first discharge diagnosis • (Find the right person or department) • Asthma ED visits • Use first discharge diagnosis • Pharmacy data (if available) • Especially frequency of albuterol fills • Support this effort at the practice level • Billing department

7. How is our registry used? • Recalling patients for follow-up • Identifying patient sub-sets for additional support • Performance feedback to providers

11. Using Registries to Measure Improvement • IS: • Designed to help your team and other teams learn • For proactive, population-based management • Like a growth curve: it’s not where you are, but where you are going • IS NOT: • Designed for criticism or punishment • Supposed to end (it should be sustainable) • The medical record Source: NICHQ

12. Reports for QI - Run Chart • Definition: A visual representation of data plotting a measurement over time • Best Use: To monitor a process over time, allowing focus on vital changes over time observed • To Construct: • Label y axis with measurement scale • Label x axis with time scale • Plot data in order and connect points • Label changes -- annotate graph Source: NICHQ

13. QI Tools - Run Chart Process Change Source: NICHQ

17. Suggested Core Measures • Children with persistent asthma will experience an average of 12 or more symptom-free days in a two week period • Providers will classify asthma severity or control at 95% or more of asthma visits • 95% or more of patients with persistent asthma will be treated with maintenance anti-inflammatory medications • 95% or more of asthma visits for patients with persistent asthma will include an “up-to-date” written asthma management plan • Among children 5 years and older, 95% will receive pulmonary function testing at planned asthma visits • 95% or more of patients will have an environmental assessment • Hospitalizations and ED visits for asthma

22. Integrate Data Collection into Daily Work • Let your structured encounter from be your data collection form (this is the fastest and easiest way to improve measures!) • Clearly define roles and responsibilities for ongoing data collection • Share reports with those who collect it, and those who generate it (patients, providers, support staff)  Source: NICHQ

23. Integrate Data Collection into Daily Work • Let your structured encounter from be your data collection form (this is the fastest and easiest way to improve measures!) • Clearly define roles and responsibilities for ongoing data collection • Share reports with those who collect it, and those who generate it (patients, providers, support staff)  Source: NICHQ