Asthma Standardization BACKGROUND Asthma is a common pediatric

Asthma Standardization

BACKGROUND • Asthma is a common pediatric chronic condition that affects approximately 7 million children • We currently have over 5, 000 children with asthma in our primary care clinics • Only approximately 50% of our patients with asthma indicate that their asthma is well-controlled • Only slightly over 50% of our patients with persistent asthma who take controller medications, have the appropriate prescriptions for medications

Asthma Standardization Key Driver Diagram (KDD) Population Gen Peds Medicaid population with asthma Health System Increase the percentage of children requiring controller meds that have appropriate prescriptions for these meds from 54% to 80% by Q 4. Community Family Project leaders: Lisa Crosby DNP, APRN-CNP, Jennifer de Klerk, MSN, RN BSN Drivers Key Drivers Global Aim (Family I should Voice) have a Effective, continuous and controller appropriate use of prescribed medicine on medications by patient hand because I Decrease in asthma ED know it is utilization and admissions. Patients family understands important. difference between rescue I know which and controller medications medication is SMART Aim and why medicine was which prescribed I can help reach those who are yet to be reached Proactive identification of patients in need of medicine Reliable contact and communication with patient and family Revision Date: 10/2517 Interventions (LOR #) Weekly reporting of refills on controllers written in the past week (% of 3 or less) Automate the process where appropriate Standardized refill process to review level of asthma control, last controller refill Pharmacy Utilization : Asthma Outreach Alternative methods of follow-up (phone, telehealth, groups, in-community) : When I come, the Clinic/Care works well. Clear and standardized roles and responsibilities – everyone knows what they are supposed to do Mutual asthma plan development Legend Note: LOR # = Level of Reliability Number, Potential intervention Active intervention Adopted/Abandoned intervention

CHANGE WE ARE TRYING (PDSA) Date PDSA Cycle Driver from KDD: Pharmacy Utilization PLAN Objective Week of May 7, 2018 CYCLE 1 Prediction & Measure Enrolling in pharmacy delivery will ensure that patient has controller medication at home Offer pharmacy delivery to a patient with persistent asthma on a controller Steps of Plan (To-do List) Controller medication in the home for the patient DO (Did the test go according to In progress the plan? ) STUDY (What did you learn? ) ACT (Adapt, Adopt, Abandon)

Percentage in Last 3 Months Goal Baseline Control Limits May 18, n=838 Apr 18, n=858 Mar 18, n=862 Feb 18, n=872 Jan 18, n=898 Dec 17, n=903 Nov 17, n=890 Oct 17, n=855 Sep 17, n=870 Aug 17, n=885 Jul 17, n=875 Jun 17, n=863 May 17, n=849 Apr 17, n=856 Mar 17, n=865 Feb 17, n=853 Jan 17, n=832 Dec 16, n=823 Nov 16, n=788 Oct 16, n=766 Sep 16, n=790 Aug 16, n=799 Jul 16, n=805 100% Percentage of general pediatric persistent asthmatics needing controllers MEASURES AND RESULTS that have a med order for a controller in the previous three months 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

CONTACT US TEAM MEMBERS Last Name First Name Role Crosby* Lisa Clinical Manager De Klerk Jennifer FPC Clinical Manager Morehous John Medical Director Chigaga Esi Provider Lead Heist Abby FPC team Adler Devin PPC team Thulin Ann PPC Team Kleiman Julie PPC Clinical Manager Burkhardt Mary Carol Medical Director Samaan Zeina Medical Director Szumlas Greg Physician Lead Berenguer Monserate HPC Team Mahaffey Jaime Asthma Care Coordinator High Kristy Asthma Care Coordinator