Asthma Registries

1. Asthma Registries Measurement is an important aspect of quality improvement In this session we’re going to talk about some techniques and tools for you to measure and track your progress on any quality improvement indicator you want Use measurement to track progress on processes of care and outcome s also use it on a smaller scale within your PDSA cyclesMeasurement is an important aspect of quality improvement In this session we’re going to talk about some techniques and tools for you to measure and track your progress on any quality improvement indicator you want Use measurement to track progress on processes of care and outcome s also use it on a smaller scale within your PDSA cycles

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

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 For our purposes, to show changes over time, a run chart is extremely useful It’s pretty simple, just have time across the bottom, and whatever you’re measuring on the y axis, and plot the measurements monthly (or weekly) good visual display indicate when you made a process change or implemented a change For our purposes, to show changes over time, a run chart is extremely useful It’s pretty simple, just have time across the bottom, and whatever you’re measuring on the y axis, and plot the measurements monthly (or weekly) good visual display indicate when you made a process change or implemented a change

13. QI Tools - Run Chart I’ve shown all of you examples of run charts with your data, but this is just another example the time (maybe in weeks here) is across the bottom, and the percentages of whatever you’re measuring are plotted weekly and connected to display the change over time You might also draw a horizontal line to represent your goal -- so in this example, 80% might be the goalI’ve shown all of you examples of run charts with your data, but this is just another example the time (maybe in weeks here) is across the bottom, and the percentages of whatever you’re measuring are plotted weekly and connected to display the change over time You might also draw a horizontal line to represent your goal -- so in this example, 80% might be the goal

14. Specify a BalancedSet of Measures Three Types of Measures: Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result? Process Measures: Voice of the workings of the system; Are the parts / steps in the system performing as planned? Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures?

18. 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

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) 

24. 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)