Using a Registry to Manage Asthma Population

1. Using a Registry to Manage Asthma Population James Wiley, MD Physician Leader, Alabama AAP Chapter Stephen Pleatman, MD Pediatrician, Suburban Pediatric Associates, Inc. Board Member, Ohio Valley Primary Care Associates, L.L.C. Cincinnati, Ohio AAP Chapter Quality Network Asthma Initiative Alabama Chapter-Learning Session 1 September 17, 2009

2. James Wiley, MD “I have the following financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity:” Research Support from: Speakers’ Bureau: Glaxo Smith Kline and Behavioral Diagnostics Co. It is my obligation to disclose to you (the audience) that I am on the Speakers Bureau for Glaxo Smith Kline and Behavioral Diagnostics Co. However, I acknowledge that today’s activity is certified for CME credit and thus cannot be promotional. I will give a balanced presentation using the best available evidence to support my conclusions and recommendations.”

3. Stephen Pleatman, MD 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.

4. What is a registry? A registry is a list of patients and their relevant clinical data that can be sorted by a condition or set of conditions in order to improve and monitor the care of the population Adapted from Improving Chronic Illness Care; www.improvingchroniccare.org

5. Importance of Registry to CQN Asthma Initiative

6. Registries: Facts vs. Fears Fear: “Why is a registry vital to quality improvement efforts?” Fact: Planned, population-based care cannot be done without knowing your patient population and related key clinical data. Fact: Primary care teams that implement registries are more likely to improve processes of care and outcomes for populations with chronic conditions. Fact: Teams with registries are less likely to lose patients to follow-up, and more likely to improve patient satisfaction as care improves. Adapted from Improving Chronic Illness Care; www.improvingchroniccare.org

7. Registries: Facts vs. Fears Fear: “I don’t need anyone telling me how to practice! I’m doing just fine with my patients!” Fact: Surveys show that providers consistently under- estimate the number of patients with chronic disease in their practice. Fact: Surveys show that providers consistently over- estimate their performance on quality measures for chronically ill patients. Fact: Knowing your population of patients will help address this disparity. Adapted from Improving Chronic Illness Care; www.improvingchroniccare.org

8. Registries: Facts vs. Fears Fear: “It’s just more work during our already hectic day!” Fact: Using a patient summary form from a registry will actually reduce charting time and make the visit run more smoothly. Fact: The form gives a snapshot of past care, reminders of needed care and planning for future care, all at the time of the visit. Fact: Teams with registries feel better prepared for visits since they have the patient information when they need it. Adapted from Improving Chronic Illness Care; www.improvingchroniccare.org

9. Registries: Facts vs. Fears Fear: “This will cost me a fortune and there’s no return on investment!” Fact: Implementing a registry is simple, and there are economies of scale as you add more patients. Fact: Registries facilitate population-based care, which improves outcomes and patient satisfaction. Fact: Planned care via the registry generates visits that are typically of higher intensity, while reducing unexpected visits for acute exacerbations. Adapted from Improving Chronic Illness Care; www.improvingchroniccare.org

10. Ideal Features of a Registry • Guides clinical care first, measurement second! • Quick to implement • Simple to use • Data entry simple and efficient • Incorporates other automated data sources • Stratifies patients by complexity/severity Adapted from Improving Chronic Illness Care; www.improvingchroniccare.org

11. Alabama Registry Strategy • CQN Asthma Project specific • Address the specific data points of this project • Compatible with variety of computer platforms • Support providers in treatment settings and supplement individual patient medical records • Partner with university settings • University of South Alabama • University of Alabama at Birmingham • others

12. Cincinnati Case Study:Using Asthma Registry/Data to Drive Improvement