chapter quality network asthma pilot project team progress presentation

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Chapter Quality Network Asthma Pilot Project Team Progress Presentation Alabama AAP Chapter University Medical Center Heather Taylor, Beth Smith, Cindy Hannah

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Chapter Quality Network Asthma Pilot Project Team Progress Presentation. Alabama AAP Chapter University Medical Center Heather Taylor, Beth Smith, Cindy Hannah. Progress Summary Since Learning Session 1. Adapted Encounter Form and used stepwise approach until all providers using form - PowerPoint PPT Presentation

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Page 1: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

Chapter Quality Network Asthma Pilot Project

Team Progress Presentation

Alabama AAP ChapterUniversity Medical Center

Heather Taylor, Beth Smith, Cindy Hannah

Page 2: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

GLOBAL CQN AIMWe will build a sustainable quality improvement infrastructure within our practice to achieve measurable improvements in asthma outcomesSpecific Aim From fall 2009 to fall 2010, we will achieve measurable improvements in asthma outcomes by implementing the NHLBI guidelines and making CQN’s key practice changes

Measures/Goals

Outcome Measures: >90% of patients well controlled

Process Measures >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)

>90% of practice’s asthma patients have at least an annual assessment using a structured encounter form

Engaging Your 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

Using a Planned Care Approach to Ensure Reliable Asthma Care in the Office * CQN Encounter Form * 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

Key Drivers

Interventions

Form a 3-5 person interdisciplinary QI Team

Formally communicate to entire practice the importance and goal of this project

Meet regularly to work on improvement

All physicians and team members complete QI Basics on EQIPP

Collect and enter baseline data

Generate performance data monthly

Communicate with the state chapter and leaders within the organization

Turn in all necessary data and forms

Attend all necessary meetings and phone conferences

Select and install a registry tool

Determine staff workflow to support registry use

Populate registry with patient data

Routinely maintain registry data

Use registry to manage patient care & support population management

Select template tool from registry or create a flow sheet

Determine workflow to support use of encounter form at time of visit

Use encounter form with all asthma patients

Ensure registry updated each time encounter form used

Monitor use of encounter form

Select & customize evidence-based protocols for your office

Determine staff workflow to support protocol, including standing orders

Use protocols with all patients

Monitor use of protocols

Obtain patient education materials

Determine staff workflow to support SMS

Provide training to staff in SMS

Assess and set patient goals and degree of control collaboratively

Document & Monitor patient progress toward goals

Link with community resources

CQN Asthma Project Practice Key Driver Diagram Version 2.0

Page 3: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

Progress Summary SinceLearning Session 1

• Adapted Encounter Form and used stepwise approach until all providers using form

• Developed and implemented protocol for distribution of encounter forms

• Developed protocol for phone triage of asthma patients, med refills, and follow-up visits

• Designed/tested/implemented simplified Asthma Action Plan (English version; now testing Spanish version)

• Building teaching resources (posters, inhaler demonstrators, parent/patient handouts)

Page 4: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

EQIPP Graph 1

• % of patients with optimal asthma care

Page 5: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

EQIPP Graph 2

• % of patients in which validated instrument was used to determine current control

Page 6: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

EQIPP Graph 3

• % of patients in which stepwise approach is used

Page 7: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

EQIPP Graph 4

• % of patients with flu shot recommendation

Page 8: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

EQIPP Graph 5

• % of patients with written asthma action plan

Page 9: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

PDSA Cycles

• PDSA Title: Use of Encounter Form in Clinic– Plan: Have nurse give form to patient to fill out at

time of triage– Do: Initially tested process with only Beth and

Heather’s patients; then spread clinic-wide– Study: Discovered problems with double-sided

format, font size, patients filling out MD section– Act: Created 2-page form and placed it on nursing

desktops so it could be printed out, made adjustments in font size; plan to incorporate MD section in new EHR template

Page 10: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

P D

S A

Test 1What: Using double-sided formWho: Patients/ProvidersWho (executes): Beth, H TaylorResults: Patients filled out both sides of form; nurses found it easier to print form from desktop when needed

P D

S A

Test 2What: Using 2- page formWho: Patients/ProvidersWho (executes): Beth, H TaylorResults: Less patients filling out MD portion (though still occurring); works better to print from desktop

P D

S A

Test 3What: Using 2-page formWho: Patients/ProvidersWho (executes): All providersResults: Less patients fill out MD section when given specific instructions; all providers using form

PDSA Ramps:Use of Encounter Form

Page 11: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

P D

S A

Test 1What: ID of asthma patientsWho: Clinic teamWho (executes): Beth, H TaylorResults: Queried EHR for list; started going through list and tagging patients in electronic chart; too tedious – didn’t get far

P D

S A

Test 2What: ID of asthma patientsWho: Clinic teamWho (executes): Beth, CindyResults: Went through schedule day before and tagged asthma patients; worked well unless they were out/busy/forgot

P D

S A

Test 3What: ID of asthma patientsWho: Clinic teamWho (executes): EveryoneResults: Established protocol for who gets form and when; works well unless student nurse or floater nurse is putting patients back

PDSA Ramps:ID of Asthma Patients

Page 12: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

Office Flow DiagramAsthma Patients ID’d by placing “sticky note” in EHR (day before) or by nurse review of diagnosis list (at time of visit)

Nurse gives form to parent to fill out after getting vital signs

Parent fills out form while waiting for MD

During the visit, MD discusses form with parent/patient

MD enters parent answers into EHR; fills out MD section of form

Information is entered into EQIPP by provider at earliest convenience

Form is scanned into EHR Parent answers not getting recorded in EHR; MD not completing provider section

Forms being held by providers

Not all patients getting forms

Page 13: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation
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Page 17: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

Key Learnings

• It is essential to QI project success to have group buy-in from the beginning.

• Have to have protocol/process for orienting new staff, residents to asthma project.

Page 18: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

Barriers and Successes• Barriers

– Time!– Tight resources – in terms of both staff and funding– Staffing changes

• Successes– Patients have seemed to really appreciate the new action

plans, new education push– Nurses feel better prepared to handle triage calls from

asthma patients– Residents feel better prepared to take care of asthma

patients– Everyone is now on the same page in terms of our asthma

patients

Page 19: Chapter Quality Network  Asthma Pilot Project Team Progress Presentation

Future Plans

• Spirometry• New EHR• Expanded education resources