VERMONT ASTHMA LEARNING COLLABORATIVE Sponsored by the Vermont Blueprint for Health and the Vermont Department of Health Asthma Program
Nancy Lefebvre Lefebvre, Sandra Robinson and Miriam Sheehey Blueprint Practice Facilitators
VERMONT ASTHMA LEARNING COLLABORATIVE 2012-13
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A LEARNING COLLABORATIVE Modeled after Institute for Healthcare Improvement The
Breakthrough Series. IHI uses criteria to select topics for its Breakthrough Series: Current prevailing practice deviates from best scientific knowledge Improvements would result in lower costs and better quality Improvement has been demonstrated by some organizations (IHI, 2003)
Content presented in support of National Asthma Education and
Prevention Program Expert Panel Report 3 – Guidelines for the Diagnosis and Treatment of Asthma (2007) AND National Jewish Health (Denver (Denver, CO) The Asthma Toolkit
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WHY ASTHMA? Current asthma p prevalence in Vermont is 11% for adults,
9% for children (BRFSS, 2010) Vermont asthma prevalence is approximately 2% higher
than the national average (BRFSS, (BRFSS 2010) People in Vermont with asthma report: Well controlled: 29% adults, 21% youth ≤17 yo Not well controlled: 56% adults, 7 1% youth ≤17 yo Poorly controlled: 15%% adults, 8% youth ≤17 yo (Vermont Asthma Callback Survey, 2008-10)
Data used with permission from Caitlin Dayman, Asthma Program Epidemiologist, Vermont Department of Health
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WHY ASTHMA? 52% of people in Vermont with Asthma had no routine
asthma visit in past year 48% of youth ≤17 yo with asthma report ever having an asthma action plan 32% of adults with asthma report ever having an asthma action plan (Vermont Asthma Callback Survey, 2008-10)
Data used with permission from Caitlin Dayman, Asthma Program Epidemiologist, Vermont Department of Health
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A LEARNING COLLABORATIVE AIM: To improve adherence to evidence based guidelines in
primary care management of asthma To utilize documentation tools to guide evidenced-based care
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A LEARNING COLLABORATIVE Planning g team from Blueprint p and VDH Funding support from both organizations (limited
budget) Primary care practices (Pediatrics, Family Practice and Internal Medicine) recruited by Blueprint Practice Facilitators and Project Managers who were already engaged in process improvement work with the practices
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A LEARNING COLLABORATIVE Each practice assembled a multi-disciplinary team Series of 3 all-day learning sessions over a 6 month
time period Action p periods between learning g sessions Conference calls between learning sessions for monthly contact Category 1 CME awarded No registration fee Presenters were volunteers (or small honorarium) Each team assigned a facilitator
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A LEARNING COLLABORATIVE Measures of Success: Measures selected by planning team: (modeled
after National Jewish program) Assessment of severity Assessment of control Asthma A th action ti plans l completed l t d
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A LEARNING COLLABORATIVE Measures of Success: Baseline, manual retrospective record review of 10% of asthma panel or minimum of 50 records Random R d selection l ti b by counting ti every 10th patient ti t from printout of asthma panel Second record review conducted in month 4 and recommended quarterly thereafter Tools and support provided for data collection, data entry and display
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A LEARNING COLLABORATIVE Shared learning g Expert presentations on “actionable items” in primary care NAEPP Guidelines G id li (pulmonologist) ( l l i t) Pharmacotherapy (pharmacist) Spirometry p y ((respiratory p y therapists) p ) Family perspective (Mom, patient) Asthma Triggers (allergist) Panel P l di discussion i – group visits i it Role play- asthma education visit
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A LEARNING COLLABORATIVE Shared learning Peer presentations (at learning session #2 and #3) 5p practices; 3 p pediatrics, 2 family y medicine Challenges, successes “Dude, we all suck” All improved !!!
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A LEARNING COLLABORATIVE Process/system y changes g that were made in
primary care practices: Identify the asthma panel! Development of asthma visit templates Planned visits for asthma management Workflow redesign to include assessment of control
and completion of asthma action plans More patients prescribed controller medications, b based d on severity it Spirometry in office Asthma educator in practice VERMONT ASTHMA LEARNING COLLABORATIVE 2012-13
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RESULTS: PRACTICE #1 Vermont Asthma Learning Collaborative 2012 Practice #1 -Pediatrics Assessment of Severity (sample=50)
Vermont Asthma Collaborative 2012 Practice #1 - Pediatrics Assessment of Control (sample =50) 50 45 40 35 30 25 20 15 10 5 0
50 45 40 35 30 25 20 15 10 5 0
Feb-12 Intermittent
May-12
Aug-12
Nov-12
Persistent - mild
Persistent - moderate
Feb-13
F b 12 Feb-12
M 12 May-12 ACT
Persistent - severe
ATAQ
A Aug-12 12
N 12 Nov-12
F b 13 Feb-13
Asthma Control Questionnaire
Vermont Asthma Learning Collaborative 2012 Practice #1 - Pediatrics Asthma Action Plan in Chart (sample=50) 50 45 40 35 30 25 20 15 10 5 0
Feb-12
VERMONT ASTHMA LEARNING COLLABORATIVE 2012-13
May-12
Aug-12
Nov-12
Feb-13
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RESULTS: PRACTICE #2 90 80 70 60 50 40 30 20 10 0
V Vermont t Asthma A th L Learning i Collaborative C ll b ti 2012 Practice #2 - Pediatrics Assessment of Severity Sample = 90
Feb-12 Intermittent
May-12 Persistent - mild
Aug-12
Nov-12
Persistent - moderate
V Vermont t Asthma A th L Learning i C ll b Collaborative ti 2012 Practice #2 - Pediatrics Assessment of Control Sample = 90
90 80 70 60 50 40 30 20 10 0
Feb-13
Feb-12
May-12
Persistent - severe
Aug-12
Nov-12
Feb-13
ACT
Vermont Asthma Collaborative 2012 Practice #2 - Pediatrics Asthma Action Plan in Chart Sample = 90
90 80 70 60 50 40 30 20 10 0 Feb-12
VERMONT ASTHMA LEARNING COLLABORATIVE 2012-13
May-12
Aug-12
Nov-12
Feb-13
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RESULTS: PRACTICE #3 V t Asthma A th L i C ll b ti 2012 Vermont Learning Collaborative Practice #3 - Pediatrics Assessment of Severity (sample=50)
V t Asthma A th L i C ll b ti 2012 Vermont Learning Collaborative Practice #3 - Pediatrics Assessment of Control (sample = 50) 50 45 40 35 30 25 20 15 10 5 0
50 45 40 35 30 25 20 15 10 5 0
Feb-12 Intermittent
May-12 Persistent - mild
Aug-12
Nov-12
Persistent - moderate
Feb-12
Feb-13
May-12 ACT
Persistent - severe
ATAQ
Aug-12
Nov-12
Feb-13
Asthma Control Questionnaire
Vermont Asthma Learning Collaborative 2012 Practice #3 - Pediatrics Asthma Action Plan in Chart (sample=50) 50 45 40 35 30 25 20 15 10 5 0
Feb-12
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May-12
Aug-12
Nov-12
Feb-13
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RESULTS: PRACTICE #4 Vermont Asthma Learning Collaborative 2012 Practice #4 – Family Practice Assessment of Severity (Sample =50) 50 45 40 35 30 25 20 15 10 5 0
Vermont Asthma Learning Collaborative 2012 Practice #4 – Family Practice Assessment of Control (Sample = 50) 50 45 40 35 30 25 20 15 10 5 0
Feb 12 Feb-12 Intermittent
May 12 May-12 Persistent - mild
Aug 12 Aug-12
Nov 12 Nov-12
Persistent - moderate
Feb 13 Feb-13
Feb 12 Feb-12
May 12 May-12
Aug 12 Aug-12
Nov 12 Nov-12
Feb 13 Feb-13
ACT
Persistent - severe
Vermont Asthma Learning Collaborative 2012 Practice #4 – Family Practice A th Asthma A Action ti Plan Pl (Sample (S l = 50) 50 45 40 35 30 25 20 15 10 5 0 Feb-12
VERMONT ASTHMA LEARNING COLLABORATIVE 2012-13
May-12
Aug-12
Nov-12
Feb-13
16
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LESSONS LEARNED: What gets measured, gets improved measurement needs to continue for improvement to
continue and/or to hold the gain
It is important p to make it easy y to do the right g thing g Start small – do something!
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NEXT STEPS: Repeat Learning Collaborative Fall/Winter 2012-13 Add measures: Spirometry in past 12 months Flu vaccine in past 12 months
9 practices enrolled Southern location Spiff up spreadsheet – upon completion of data entry,
data “automagically” populates a graph Intent is to monitor performance for 2 years – tools provided to track data
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RESOURCES: http://www.ihi.org http://www.nationaljewish.org/professionals/education/feature/asth
ma-toolkit/ t lkit/ http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
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