Agenda

1. Welcome to A Quality Collaborative for Improving Hospitalist Compliance with the AAP Bronchiolitis Guideline (B-QIP) Project! Shawn Ralston, MD, FAAP & Matthew Garber, MD, FHM, FAAP, Expert Leader Co-Chairs & Quality Improvement Advisors Kelly Burlison, QIDA Manager Liz Rice-Conboy, QuIIN Manager Hospital Orientation Call July 16, 2013

2. Agenda

3. QuIIN and VIP Network Overview • The Quality Improvement Innovation Networks (QuIIN) is a home for pediatric quality improvement networks at the AAP. • Consists of practicing pediatricians who use quality improvement methods to test tools, interventions, and strategies in order to improve healthcare and outcomes for children and their families • A practical working lab for pediatricians to test how improvements can be implemented in everyday pediatric practice prior to widespread dissemination • Like to be on the cutting-edge of practice innovations • AAP members with an interest, or experience in quality improvement • The Value in Inpatient (VIP) Network is the inpatient network of QuIIN • Ask that lead physicians join QuIIN if not already a member. To join, visit http://quiin.aap.org

4. B-QIP Overview • This quality improvement project has the broad goal of exploring which tools and resources best improve the quality of care for children admitted to the hospital with bronchiolitis. • Our proxy for quality of care is compliance with the AAP bronchiolitis clinical practice guideline and our specific target areas are overuse of: • bronchodilators, • corticosteroids, • chest physiotherapy, • chest radiography and • continuous pulse oximetry • And also tracking the underuse of • secondhand smoke exposure screening and intervention.

5. Project Aims By April 2014, 22 teams will improve the care of children with bronchiolitis by increasing compliance with the AAP clinical practice guideline on bronchiolitis, specifically including the following goals: • Decrease the overall usage of bronchodilators for patients admitted with bronchiolitis by 50% • Decrease the overall usage of systemic corticosteroids for patients admitted with bronchiolitis by 50% • Decrease the overall usage of chest physiotherapy for patients admitted with bronchiolitis by 50% • Decrease overall usage of chest radiography for inpatients with bronchiolitis by 50% • Achieve 90% compliance with the usage of an “objective method of assessment” of response to bronchodilators in patients admitted with bronchiolitis. For this project, an objective method of assessment is interpreted to mean a respiratory score. • Achieve 90% compliance with the implementation of an institutional policy on conversion from continuous pulse oximetry to intermittent pulse oximetry when children admitted for bronchiolitis no longer require supplemental oxygen. • Achieve 90% compliance with screening and intervention for secondhand smoke exposure in children admitted with bronchiolitis.

6. Further discussion of an “objective method of assessment” • Achieve 90% compliance with the usage of an “objective method of assessment” of response to bronchodilators in patients admitted with bronchiolitis. For this project, an objective method of assessment is interpreted to mean a respiratory score. • See the WARM Score as an example.

7. 22 Teams in 12 States Elmhurst, NY Elmhurst Hospital Ctr Rochester, NY Rochester General Hospital Madison, WI American Family Children’s Hosp Children’s Hosp, UIC (Chicago) Rush Univ Med Center (Chicago) Northwestern Lake Forest Hosp(Lake Forest) Loyola Univ. Medical Ctr(Maywood) Silver Cross Hosp(New Lenox) Five Illinois hospital sites Ann Arbor, MI Mott Children’s Hospital Mountain View, CA Lucile Packard Children’s Hospital – Packard at El Camino Morristown, NJ Goryeb Children’s Hospital Morgantown, WV West Virginia University Ashville, NC Mission Children’s Hospital Durham, NC Duke Univ. Greensboro, NC Moses Cone Albuquerque, NM Univ. of New Mexico Children’s Hospital Topeka, KS Stormont-Vail HealthCare Witchita, KS Wesley Medical Center Cleveland, OH Fairview Hospital & Rainbow Babies and Children’s Hospital Gaineville, GA Northeast Georgia Med Ctr Pensacola, FL Sacred Heart Hospital

9. High Level Project Timeline

10. Prework Data Collection

11. Important Points • Cannot begin prework until consent form is completed by all team members • Submit to Elizabeth Rice-Conboy (ericeconboy@aap.org, fax: 847/434-8000) by July 15, 2013 • Your team’s involvement in the B-QIP collaborative may need your local hospital/university IRB to review the already approved AAP IRB protocol. • Please contact Liz for a copy of AAP IRB application and approval letter

12. Pre-work Data Collection Requirements Mark your Calendar: July 25, 12 noon Central/1 p.m. Eastern for the QIDA Orientation Webinar Data cycles open in QIDA: July 29th Due July 31, 2013 • Pre-Project Surveyhttps://www.surveymonkey.com/s/BQIP-PreProjectSurvey

13. Data Collection Requirements Chart Review: Complete by Sept. 30, 2013 Each data cycle consists of 20 eligible charts (or 100% of eligible charts per month cycle) and an aggregate chart tool that notes the number of charts transferred to the PICU. Data cycles and due dates: • Cycle 1, January 2013, Open: July 29th, Due: Sept. 30th. Must close this cycle before entering Cycle 2. • Cycle 2, February 2013, Open: July 29th, Due: Sept. 30th. Must close this cycle before entering Cycle 3. • Cycle 3, March 2013, Open: July 29th, Due: Sept. 30th. Must close this cycle before entering Cycle 4.

14. Data Collection Requirements, cont’d To continue with the interrupted time series QI model, three more data cycles will be entered for B-QIP. The cycles will represent the peak seasonal diagnosis of bronchiolitis. • Cycle 4, January 2014, Open: January 20th, Due: Feb. 28, 2014. Must close this cycle before entering Cycle 5. • Cycle 5, February 2014, Open: Close of Cycle 4, Due: March 30, 2014. Must close this cycle before entering Cycle 6. • Cycle 6, March 2014, Open: Close of Cycle 5, Due: April 30, 2014.

15. Pre-Project Survey • Completed with input from entire team • Assess current systems in place and current practices • Deadline: July 31, 2013 https://www.surveymonkey.com/s/BQIP-PreProjectSurvey

16. Monthly Progress Report • The monthly progress report will be due on the 30th of the month for August 2013 through April 2014. • The SurveyMonkey survey will assess your team’s: • Activities • Aims • Goals • Use and integration of the change package • Challenges and Celebrations in implementing and following through with the project • Mostly open-ended responses requested

17. Chart Review Log Sheet Example Do not submit to AAP – internal document only

18. Chart Review Data Collection Tool

19. Chart Review Data Collection Tool – cont’d

20. Introduction to the Quality Improvement Data Aggregator (QIDA)

21. Accessing QIDA • To access QIDA, go to the following URL: http://qidata.aap.org/quiinblitis • For AAP members, you will use your AAP log-in and password to access the site • For non-AAP members, an AAP log-in has been created for you and that information has been emailed to you and sent from qidata@aap.org

22. Accessing QIDA Continued

23. QIDA System • There are three main areas in QIDA: Project Home, Workspace and My Group/Groups

24. Project Home Tab • On the Project Home page, there are 3 main areas: Data Collections Tools, Project Surveys and My Documents

25. Project Home-Data Collection Tools • Under this section, you will be able to analyze data by clicking the analyze data button

26. Project Home-Data Collection Tools Continued • Once you click analyze data, you can analyze data by either viewing a snapshot of current results or by generating real time run charts

27. Project Home-My Documents • This area is for any user to upload any pertinent project documents for future reference such as a PDSA worksheet or data collection tool. You can upload as many documents as you wish and they can be any type of format such as a Word document or Excel spreadsheet

28. Project Home-System Alerts • On the right hand side of the Project Home, there are certain alerts. If QIDA is going to be down for any reason, an AAP alert will appear. The Project Alerts will not be used in B-QIP. The data collection status is a snapshot of the status of the current monthly data collection.

29. Workspace Tab • The Workspace area has two main areas: project headers where relevant project documents will be housed and a message board area where project team members can pose questions to other teams and faculty

30. Workspace-Project Headers • You will need to expand each header to get all project documents housed in that particular section

31. Workspace-Project Headers Continued • Under each header, any document with blue text can be opened/saved

32. Workspace-Message Board • In the Message Board area, team members can post questions for other team members/faculty

33. My Group Tab • For a non-group administrators, you will have a tab labeled My Group. This area will show your team members and current status on data collection. You will have the ability to email your project team if needed.

34. Group Administrators QIDA Webinar • Group administrator training on data collection in QIDA: • July 25th at 12:00 Noon CT/1 pm ET • To register for this GoToWebinar, please go to this link: https://www3.gotomeeting.com/register/920890414

35. B-QIP Resources Resources to support B-QIP Teams include: • QIDA website (workspace and data collection) • Orientation packet • Change Package • Listserv for all B-QIP team members • Coaches -- hospitalist peers that can assist in problem solving and applying changes (to be assigned in August)

36. B-QIP Coaches • The B-QIP Project Planning Group has identified hospitalists who have content expertise and applied experience in hospital settings related to improving care for patients with bronchiolitis. These hospitalists will be considered B-QIP Coaches and will be available for questions and resources by phone and email to B-QIP hospital teams. Jeffrey S. Bennett, MD, FHM, FAAPKentucky Children’s Hospital Matthew Garber, MD, FHM, FAAPUniversity of South Carolina Michele Lossius, MD, FAAP Shands Hospital for Children, University of Florida

37. B-QIP Coaches…cont’d • Michelle M. Marks, DO, FAAPCleveland Clinic Children’s Clinic • Grant Mussman, MD, FAAPCincinnati Children’s Hospital • Jeanann Pardue, MD, FAAPEast Tennessee Children’s Hospital • John A. Pope, MD, MPH, FAAPScottsdale Healthcare • Shawn Ralston, MD, FAAPDartmouth Hitchcock Medical Center • Susan Walley, MD, FAAPChildren’s of Alabama

38. B-QIP is approved for ABP MOC Part 4! • Difference between Lead Physician and Hospital Team Participants • Every site must have a designated “Lead Physician” to attest to the participation for MOC credit of all other physicians at the site Next Steps for Local Physician Leaders • Share the ABP Q&A Document with other physicians at your hospital site to assist in their decision to participate • Send Liz Rice-Conboy the names of all participating physicians in your practice by July 31, 2013 • Sign Local Leader Acknowledgement Form stating you understand your responsibilities as local leader by July 31, 2013 • Please contact Liz for any ABP MOC Part 4 questions, or refer to the email sent via the B-QIP listserv on July 9

39. ABP MOC Part 4 cont’d • Please find the following resources on ABP MOC Part 4 credits in your B-QIP Project Orientation Packet • ABP MOC Part 4 Q&A • Local Leader Instructions • Instructions for Submitting Attestation Forms • Sample Attestation Form • Standards for Physician Participation • Local Leader Acknowledgement Forms

40. Important Dates and Next Steps

41. Project Contacts

42. Questions