Tomorrows Clinicbased Asthma Management Program

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Tomorrows Clinic-based Asthma Management Program

• Adam Baus, MA, MPH
• West Virginia University Dept. of Community
  Medicine
• Office of Health Services Research

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• This presentation was supported by
  Grant/Cooperative Agreement Number
  U59/CCU324180-03 from the Centers for Disease
  Control and Prevention.
• Its contents are solely the responsibility of the
  authors and do not necessarily represent the
  official views of the Centers for Disease Control
  and Prevention.

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OHSR Quality of Care

• Establishment/integration of electronic patient
  registries
• Developing an office flow
• Overcoming common barriers to implementation
• Focusing on using data to target care
• Evidence-based guideline education for providers
  and staff provided by chronic disease educators

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The Idea
Improved Health Outcomes
Self-Management
Targeted Care
Enhanced Care Tracking
Provider / Staff Education
Patient Registry
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Registry Quality Improvement Tool

• Progress Note quick reference for patient care
  indicators

• Guidelines/Graphs used in patient education

• Reporting Tool create population and
  patient-level reports, and reminder letters

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Chronic Disease Educators

• Provide feedback on patient registry summary
  reports
• Provide educational sessions on asthma, diabetes
  and cardiovascular health to providers and health
  center staff
• Offer self-management workshops for patients with
  chronic disease

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Site Map Health Centers with Electronic Patient
Registries

• Mostly FQHCs
• Many in the Health Disparities Collaborative

• In 2004, WV FQHCs served
• 292,849 patients (gt one million office visits)
• 49 below 100 federal poverty level
• 20 Medicaid beneficiaries
• 33 uninsured
• 49 low income uninsured

Source National Association of Community Health
Centers, Inc. 2006 Access to Community Health
Databook - West Virginia
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C-bAMP Sites
Hancock
Current Sites Monongalia Clay-Battelle Community
Health Services Hardy E.A. Hawse Health Center
(Mathias / Baker) Greenbrier Northern Greenbrier
Health Clinic Mercer Bluestone Health
Association
Brooke
Ohio
Marshall
Monongalia
Wetzel
Marion
Morgan
Pleas-
Berkeley
Tyler
ants
Preston
Jeff-
Mineral
Taylor
erson
Dodd-
Harrison
Hampshire
ridge
Barbour
Wood
Ritchie
Grant
Tucker
Hardy
Wirt
Lewis
Cal-
Gilmer
houn
Jackson
Upshur
Randolph
Mason
Roane
Braxton
Pendleton
Future Sites Monongalia Monongahela Valley
Association of Health Centers (Fairmont
Clinic) Ritchie Ritchie County Primary
Care Pendleton Pendleton Community Care
(Franklin / North Fork) Nicholas Camden on
Gauley Medical Center Berkeley Harpers Ferry
Family Medicine, Shenandoah Valley Medical
System Putnam FamilyCare Health Center
Webster
Clay
Putnam
Cabell
Kanawha
Nicholas
Pocahontas
Wayne
Lincoln
Boone
Fayette
Greenbrier
Mingo
Logan
Raleigh
Sum-
Wyoming
Monroe
mers
McDowell
Mercer
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Using Remote Support

• How it works
• Allows for increased, faster technical support

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Making Progress

• Registries being more fully implemented, and more
  patients being added

• Looking at Year 01 sites, we see improvements in
  some key measures
• Health Center A
• Asthma Action Plan (0 baseline, 25 18 months
  post)
• Rx for ICS (0 baseline, 17.2 18 months post)

• Health Center B
• Asthma Severity Level (4.8 baseline, 14.6 18
  months post)
• Tracking Albuterol Use (1.2 baseline, 11.2 18
  months post)

• Likely issues of documentation
• Aided by increased involvement with the chronic
  disease educators

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User Feedback from C-bAMP Participants

• Prompts additional questions to ask during
  patients office visits (both good bad)
• But, acknowledges that demonstrating outcomes
  measures (P4P) is gaining increasing importance
• Hopes that EMRs will solve their problems, but
  acknowledges than many have weak reporting
• Can you interface with our spirometry equipment?

• Works well as a guideline reminder
• Can you spit out a written asthma action plan?

• I love it. No complaints. It just works. Its a
  whole lot easier than trying to do it any other
  way.

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A few Developments

• On-line Journal of Nursing Informatics article
• Dr. Michael Romano Heidi Putman-Casdorph, DNSc

• Guidelines Resources tab

• Registry generated action plan

• NHLBI update, Summer 2007

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Using De-Identified Data to Track Outcomes
Measures

• 13 FQHCs have agreed to allow our office to host
  data for the PCA
• Asthma measures for pediatric and adult patients

• All C-bAMP sites have signed MOU allowing our
  office to abstract this data

• Allows for patient level analysis, and cohort
  tracking
• Cohort tracking important in evaluating
  effectiveness of the intervention

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The Long View

• Many health centers planning on making the
  transition to an EMR
• Were working with some EMR vendors to ensure
  population-level reporting
• Migrating registry data / Developing reporting
  applications

• WV FQHC Readiness for EMRs (Survey 09/2006)
• 86.7 response rate

• 7 FQHCs (26.9) using an EMR
• 6 different systems used
• 2 report paperless
• 3 have been using an EMR 0-6 months

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Contact Information

• Cecil Pollard, Director
• [phone] cpollard_at_hsc.wvu.edu
• Trisha Petitte, Assistant Director
• [phone] tpetitte_at_hsc.wvu.edu
• Adam Baus, Program Coordinator, Sr.
• [phone] abaus_at_hsc.wvu.edu
• Mary Swim, Applications Programmer
• [phone] mswim_at_hsc.wvu.edu
• Kelly Bailey, Research Assistant
• [phone] kabailey_at_hsc.wvu.edu
• Office website http//www.hsc.wvu.edu/som/cmed/oh
  sr