The percentage of pediatric visits during which children with asthma received optimal care improved 80% during the fourth phase of the Chapter Quality Network (CQN) Asthma Project (see graphic).
The project works at the practice, chapter and national levels to improve quality of care and outcomes for children with asthma using evidence-based guidelines. Pediatricians, practices and chapters from Georgia, Kentucky and California Chapters 2 and 4 used quality improvement (QI) methodology to set goals, assess barriers, test interventions and processes, work toward embedding changes into their workflow and track their progress using a registry.
“The response to the project has been overwhelmingly positive,” said Brad C. Weselman, M.D., FAAP, project physician leader from the Georgia Chapter. “I think the chapter has learned that providers are very amenable to the adoption of quality improvement techniques in their practices and were able to see the value to the team approach taken.”
Some of the keys to the success of the project included a timely, clinically relevant topic, a clear pathway to optimal asthma care and minimal disruption to practice flow, Dr. Weselman added.
The CQN Asthma Project defined optimal asthma care by pediatricians as assessing asthma control, using a stepwise approach to identify treatment options or adjust treatment, having an up-to-date asthma action plan and ensuring children with persistent asthma are taking a controller medication.The CQN Asthma Project defined optimal asthma care by pediatricians as assessing asthma control, using a stepwise approach to identify treatment options or adjust treatment, having an up-to-date asthma action plan and ensuring children with persistent asthma are taking a controller medication.
The CQN focuses on building capacity in AAP chapters to provide relevant quality improvement projects for member practices that result in improved care and outcomes at a population level.
CQN Asthma Phase 4 participants uploaded more than 19,000 patient records into the Academy’s National Asthma Registry and completed more than 5,000 patient encounters. Practice teams focused on identifying all children with asthma through billing queries and then obtaining data on care processes and child health outcomes through a web-enabled registry.
CQN projects have consistently demonstrated improvements in physician adherence to national pediatric guidelines. Physicians in earlier CQN asthma projects report sustaining system-wide changes in practice while seeing reduced emergency department use among patients. They also report sustained use of project tools and QI methods. Six months post-collaborative, more than 80% of participating pediatricians reported continued use of the CQN asthma clinical tools, and 77% reported that they continued developing QI goals for their practices.
“CQN was an opportunity to serve and support our participating members in a meaningful and consequential way,” said Tomás Torices, M.D., executive director of California Chapter 2. “While you may know the therapeutic steps to take with every case of asthma, the CQN Asthma Project dissects optimal asthma care with such emphasis that practices invariably improve the care provided to their patients after implementing these QI processes.”
Participation in a CQN collaborative has produced additional quality improvement activities in several states, Dr. Weselman said.
“I thoroughly enjoyed the project and would certainly participate again,” he said.
The Georgia Chapter has embarked on three additional CQN projects addressing attention-deficit/hyperactivity disorder, mental health/substance use and Bright Futures as well as a project on HPV vaccination, Dr. Weselman said. (See sidebar.) In addition, he has begun development of a new Maintenance of Certification project focusing on comprehensive adolescent well care.
“I hope the QI movement continues to take hold in Georgia, and CQN Asthma Phase 4 was a huge boost to our efforts,” Dr. Weselman said.
The CQN Asthma Phase 4 project was supported by an educational grant from GlaxoSmithKline.
New CQN projects address ADHD, substance use, immunizations
Two new Chapter Quality Network projects have been launched to address attention-deficit/hyperactivity disorder (ADHD) and adolescent substance use/mental health.
The Arkansas, Georgia, Ohio and Texas chapters and New York Chapters 1 and 2 are working together this year to improve care for children with ADHD. Participating pediatricians are making changes to improve adherence to guideline-based diagnosis processes that incorporate regular patient follow-ups as well as optimizing treatment plans that include proper medication titration and appropriate behavior therapy. The project is funded by an independent grant from Pfizer Inc.
Chapters in Utah, Connecticut and Georgia also have begun working together to increase the use of validated screening tools for adolescent substance use, successful brief intervention techniques and referral to treatment. This project is funded by support from the Conrad N. Hilton Foundation.
Finally, development has begun on a CQN project that will provide the opportunity for six chapters to participate in a collaborative to improve immunization rates in young children. Applications for this project will be available in mid-2016. The project is supported by an independent grant from Pfizer Inc.
All CQN projects provide the opportunity for participating physicians to receive American Board of Pediatrics Maintenance of Certification Part 4 credit.