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Rock Hill Pediatrics Asthma Appropriate Care July 29, 2012

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Rock Hill Pediatrics Asthma Appropriate Care July 29, 2012. Background. June 2010 – all physicians and APPs polled to solicit feedback on metrics to be included in the Appropriate Care Measure Set for CHS Quality Goal setting

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  • June 2010 – all physicians and APPs polled to solicit feedback on metrics to be included in the Appropriate Care Measure Set for CHS Quality Goal setting
  • Mirrors the core measure sets that have been in place in acute care facilities
  • Four disease states were selected: Diabetes, Ischemic Vascular Disease, Heart Failure, and Asthma
  • Consistently listed as priority areas for quality reporting by CMS, Medicaid, National Quality Forum, and others
  • Nearly all metrics presented in the poll appear on national quality indicator lists
  • Beginning in 2011, process measures for four disease states were first tracked and reported system-wide
asthma appropriate care
Asthma Appropriate Care


The percentage of patients who received appropriate ambulatory care for asthma, reported on a quarterly basis

Data Source

Abstraction of a random sample of patient charts from the five physician networks

data sampling asthma
Data Sampling – Asthma

Inclusion Criteria

FM, IM, peds, and pulm patients with age ≥ 5 years at the time of the encounter and have one of the following diagnosis codes: 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, or 493.92

Base Population Querying

Patients meeting above criteria that received a disease diagnosis in IDX within the previous 18 mos. and seen in the previous 3 mos. for any reason are eligible for sampling

Sampling Methodology

Representative across practices

and volume of disease states seen,

using a modified JCAHO sample size

Exclusion Criteria

Patients diagnosed with reactive airway disease, bronchiolitis, or chronic bronchitis

data collection
Data Collection


  • Leveraged electronic information when available by pre-populating online data collection tool when possible
  • Information manually validated by auditor
  • 12,000+ charts abstracted each quarter during a 5-week time span
appropriate care all or none measurement
Appropriate Care: All or None Measurement


  • Measure of the care a patient should receive
  • Provides a system perspective that focuses on process
  • More sensitive scale for assessing improvements
  • Mirrors acute facility measure for Core Measures

Success Factors

  • Small measure set for each disease
  • Improving processes for documentation
  • Adoption of Point of Care Reminders (Cerner EMR Health Maintenance Module)

Berwick and Nolan. 2006 American Medical Association

small measure set
Small Measure Set
  • 3 metrics
    • Controller Medication for Persistent Symptoms
    • Assessment of Daytime/Nocturnal Symptoms
    • Influenza Vaccination
  • All or None concept
improving processes for documentation
Improving Processes for Documentation
  • Physician Networks are composed of practices who are in various states of EMR migration (paper, hybrid, “fully” integrated)
  • Regardless of state, all have experienced challenges with addressing and documenting care measures
  • Flowsheets developed to assist paper-charting practices and prepare them for EMR implementation
  • Point of Care alerts released for EMR-charting practices
rock hill pediatrics success factors
Rock Hill Pediatrics Success Factors
  • Narrow focus
    • 1 disease state, 3 measures
  • Physician Champion
  • Practice Manager support
  • Standard Processes
  • Practice-based Quality Improvement
  • Culture supportive of continual learning and progress
maintenance of certification asthma appropriate care
Maintenance of Certification – Asthma Appropriate Care
  • Practice-wide improvement effort lends itself to Part IV MOC - Physician Participation in a QI Project
  • Attestations in progress for 8 physicians!