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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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Chapter Quality Network Asthma Pilot Project
Team Progress Presentation
Alabama AAP ChapterUniversity Medical Center
Heather Taylor, Beth Smith, Cindy Hannah
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
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)
EQIPP Graph 1
• % of patients with optimal asthma care
EQIPP Graph 2
• % of patients in which validated instrument was used to determine current control
EQIPP Graph 3
• % of patients in which stepwise approach is used
EQIPP Graph 4
• % of patients with flu shot recommendation
EQIPP Graph 5
• % of patients with written asthma action plan
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
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
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
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
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.
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
Future Plans
• Spirometry• New EHR• Expanded education resources
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