Pediatric Asthma Care Management
The Children’s Health Foundation supports pediatricians in the delivery of top quality pediatric asthma care and proactive management of the population of children with asthma. 100% of the 125 pediatrician members of CHF attended training on the current NIH/NHLBI clinical asthma guidelines, and pledged participation in a rigorous asthma care management improvement initiative which included measurement of six clinical care metrics and utilization of a newly developed pediatric asthma patient registry ®. Within months, these pediatricians achieved great improvements in their practice and treatment of children with asthma.
After one and two years of rapid cycle adoption of practical tools and workflows, transparent measurement and continuous improvement, the 125 pediatricians collectively raised the bar on pediatric asthma care to a level rarely matched anywhere in the country.
In 2009, the Children’s Health FoundationA [CHF] launched an Asthma Care Management Improvement Initiative to utilize and measure the National Heart, Lung, and Blood Institute (NHLBI) guidelines for asthma care with the following goals:
- Improve the overall health of the pediatric asthmatic population
- Provide better preventative services to children with asthma
- Reduce asthma related Emergency Department (ED) utilization and hospitalization associated with exacerbation of inadequately managed asthma
- The 125+ pediatrician members of CHF delegated physician and clinical staff leaders within their private practices to collaborate in partnership with quality and process engineering staff of CHF to execute a formal asthma care management improvement initiative. The aim of this effort is to raise the level of asthma care for children by building capacity and competence in pediatric practices for population management and application of current asthma clinical guidelines.
Children’s Health Foundation Pediatric Asthma Registry
Pediatrician providers of the Children’s Health Foundation recognized limitations in the flexibility of existing EMR systems to capture clinically useful information for managing children with asthma. Further, EMRs have limited effectiveness at reporting clinical information across prioritized populations.
CHF pediatrician leaders developed a simple web interfaced Pediatric Asthma Registry with data import capabilities from some Electronic Medical Record (EMR) systems to fill the need for tracking meaningful clinical data. The CHF Pediatric Registry enables pediatricians to identify children with asthma, assign an asthma severity classification per NHLBI guidelines, and enter encounter-based updates on key clinical actions and measures including:
- The patient’s asthma severity classification
- If asthma controller medication was prescribed and/or denied
- Date(s) of patient’s asthma well visit(s) (maintenance visit)
- Date(s) that the patient’s written asthma action plan was created, reviewed or updated
- Date(s) that spirometry testing was performed and/or denied or unsuccessful
- Date(s) that child received flu vaccination and/or denied, etc.
- Date(s) that an environmental trigger assessment was performed, reviewed or updated
Other optional measures:
- Level of asthma control per NHLBI Asthma Guidelines
- Controller medication compliance and reasons
- Type of educational offerings provided or recommended
The CHF Pediatric Registry enables pediatricians to identify children with asthma, assign an asthma severity classification per NHLBI guidelines, and enter encounter-based updates on key clinical actions and measures.
CHF’s Pediatric Asthma Registry is now effectively integrated into the care delivery workflows of twenty-eight pediatric practice sites and contains clinical information on over 10,500 pediatric asthma patients. Care Management reports are provided for these patients to highlight which elements of care are due (Ex: action plan, spirometry, flu shot, etc.) to assist practices with proactively scheduling appropriate care.
Within just months, CHF practices achieved remarkable improvement across the clinical care metrics and have sustained this high level of care through 2010, 2011 and 2012 while growing the registry population. Results include:
- >5,500 additional patients with current action plan (938% increase) in first 2 years
- >4,800 additional patients with proactive asthma maintenance “well” visit (832% increase) in first 2 years
- >3,000 additional patients with appropriate spirometry testing (546% increase) in first 2 years
These clinical measures are indicators of improved health outcomes. Data shows that Foundation practices maintain lower ED and hospitalization rates than comparison pediatric practices.
CHF is cognizant that effectiveness and sustainability of clinical improvements are critical to the success of pediatric practices.
The Children’s Health Foundation is pleased that this effective and proven CHF Asthma Care Management program is endorsed by the American Board of Pediatrics as an Established Quality Improvement Project demonstrating competence in systematic measurement and improvement in patient care. Participation in this program credits CHF members with 40 points toward the Performance in Practice (Part 4) requirement for Pediatrician Maintenance of Certification (MOC).
CHF’s approach to quality improvement engages pediatricians and practice personnel in the development and implementation of rapid cycle tests and resulting best practices. The CHF Asthma Care Management Improvement Initiative (ACMII) has included engagement of twenty-eight pediatric practice sites, and includes the following benefits:
- Training on NIH/NHLBI clinical asthma guidelines and associated interventions
- Satisfaction of 40 points toward the Performance in Practice (Part 4) requirement for Pediatrician Maintenance of Certification (MOC) through the American Board of Pediatrics
- Access and input to abundant asthma care workflows, tools and resources collaboratively developed and tested for over three years by 125+ pediatricians
- Utilization of a web-based pediatric asthma registry with EMR interfaces for tracking and reporting key asthma care indicators of evidence-based clinical guidelines that are not supported by EMR systems
- Real-time reports for providers showing patient-level care status across multiple clinical measures (Ex: current (or overdue) on asthma well visit, asthma action plan, spirometry, etc.)
- Quarterly reporting at practice and provider level for multiple asthma clinical measures
- Clinical asthma education and training by physician experts in areas including: spirometry administration, spirometry interpretation, environmental impacts, etc.
- Analytical and process engineering support from CHF’s highly qualified staff, including on-site training, tailored tool development and data management assistance
We are pleased to offer use of the Pediatric Asthma Registry and other tools of the CHF Asthma Care Management program to pediatricians via participation in the Children’s Health Foundation. Participants in the Children’s Health Foundation Asthma Care Management Improvement Initiative should meet the following criteria:
- Licensed pediatrician or pediatric provider (MD, DO, PNP)
- Interested in proactive, comprehensive pediatric asthma care
- Willing to identify and flag patients with asthma and classify their severity per NHLBI guidelines
- Willing to record up to seven key clinical asthma data elements for asthma patients in the course of office visits and/or telephone encounters
- Willing to designate a provider “champion” and a clinical staff or office staff person(s) for each participating site as an “implementation specialist” responsible for printing registry reports off the web interface, and potentially entering asthma visit data if not on interfaced EMR system.