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Chapter Quality Network (CQN)Asthma Pilot Project
Our Present and Our Future
Sandra Miller, MD Oregon Chapter Physician Leader
Judy Dolins, MPHDirector, Department of Community Chapter and State
Principle Investigator, Chapter Quality Network Asthma Pilot Project
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.
Sandra Miller, MD Disclosure
Judy Dolins Disclosure
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
National goals at the practice level
Changes in asthma care practices and child health outcome
Successful implementation of practice system change
Clinician investment and commitment to quality improvement work
Transparency and sharing of improvement data
Increased clinician demand for CQN programming
National goals at the chapter level
Increased capacity for quality improvement work
Governance group engagement
Sustain QI work at the chapter level
Key partnerships focused on improvement work
Funding and will for continued quality efforts
Increased chapter demand for CQN programming
Improvement Work
Improvement WorkImprovement WorkContinuous tests
of change
SustainabilitySustainabilityImbed in everyday work
Scale Up & SpreadScale Up & SpreadTaking local improvement
And actively disseminating itacross a chapter and/or practice
Our First 6 months
How are we doing at the National Level?
Practice System Changes
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MD NP
National Oregon
Percent of eligible providers collecting data at point of care
How are we doing at the National Level?
Practice System ChangesRegistry Implementation Status
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Practices with a Registry Practices without aregistry
National
Oregon
How are we doing at the National Level?
Practice System ChangesOptions for Practices without a Registry
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Using an Excel database asalternative
Actively discussing/ exploringregistry
Not discussing/ exploringregistry
National Oregon
How are we doing at the National Level?
Practice System ChangesDegree of belief that workflows for collecting data for eligible patients/opportunities at point of care are highly reliable
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
High Moderate Low
National
Oregon
How are we doing at the National Level?
Measures of Asthma Care Practices and Health Outcome
Key Measure Goal Alabama Maine Ohio OregonNational Average
% of patients with 1 or more asthma-related ED or Urgent Care Visits within the past 12 months 0% 21% 20% 35% 24% 25%
% of patients with 1 or more hospitalizations within the past 12 months 0% 5% 4% 7% 6% 6%
% of patients well controlled 90% 57% 68% 64% 51% 60%
% of patients with optimal asthma care 90% 75% 71% 71% 80% 74%
% of patients with key asthma indicators used when considering an asthma diagnosis 90% 91% 96% 80% 75% 86%
% of patients ages 5 and older in which spirometry is used to establish a asthma diagnosis 90% 63% 61% 61% 56% 60%
% of patients in which a validated instrument is used to determine the current level of asthma control 90% 99% 93% 99% 99% 98%
% of patients in which reasons for lack of asthma control is identified when asthma control is "not well controlled" or "very poorly controlled" 90% 96% 100% 94% 93% 96%
% of patients ages 5 and older where spirometry is scheduled to be tested or results have been obtained within the last 1-2 years 90% 59% 62% 67% 64% 63%
% of patients in which the stepwise approach is used to identify treatment therapy and adjust or maintain therapy based on asthma control 90% 99% 97% 99% 98% 98%
% of patients with asthma ages 6 months and older who have received a flu shot or flu shot recommendation within the past 12 months 90% 93% 98% 93% 94% 95%
% of patients who have a current written asthma action plan explained to them at this visit 90% 82% 78% 79% 85% 81%
% of patients in which self-management education materials (in addition to the asthma action plan) are provided and explained to the patient and family 90% 81% 84% 83% 74% 81%
% of patients for whom a follow-up appointment to monitor asthma control is recommended 90% 95% 89% 94% 95% 93%
Optimal Care
>70% 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)
Optimal Asthma Care
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Oregon = 80%
Self-Management
Oregon = 74%
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Use of a Validated Instrument
Oregon = 99%
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Hospitalizations
Oregon = 6%
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Patients Well-Controlled
Oregon = 51%
National Project (All Chapters)
0%10%20%30%40%50%60%70%80%90%
100%
1004
1440
1672
1461
1685
1763 0 0 0 0 0 0 0
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
How are we doing in Oregon?
• 11 practices with high level knowledge of QI processes and implementation
• Increase in use of action plans
• NHLBI guideline use in managing asthma
• Increased use of spirometry
• Increased familiarity with registry concepts
• Use of validated screening instruments
• Using PDSA to overcome barriers
Improve
• Practices will continue to review their current office flow
• Changes should be refined
• Opportunities for ongoing changes should be identified
• Key Driver Goals
Sustain
• Practices should review current processes with a view to sustain changes made during the project
• Consider how to continue to motivate staff, physicians, and patients
• Consider how to make changes part of the NORMAL flow, not an exception
• Consider how the practice will function AFTER CAQI