Clinicbased Asthma Management Program Overview and Updates

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Clinic-based Asthma Management Program
Overview and Updates

• Cecil Pollard, MA Adam Baus, MA
• West Virginia University Department of Community
  Medicine
• Office of Health Services Research

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• This presentation was supported by
  Grant/Cooperative Agreement Numbers
  U32/CCU322734, U50/CCU321344, and
  U59/CCU324180-02 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 Improvement

• Assisting primary care sites in establishing and
  integrating electronic patient registries
• Billing system data collection LabCorp interface
• Guiding primary care sites in overcoming common
  barriers to the integration of health information
  technology (HIT)
• Usability, leadership, organizational structure
  change, adequate training and technical support
• Guiding health care providers in using medical
  information as data
• Developing customized queries and reports
• Assisting community health centers in the HDC
• Evidence-based guideline education for providers
  and staff

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Focus on Asthma C-bAMP

• Designed to improve the capacity to track and
  treat patients with asthma.
• Developed by the WV-AEPP in cooperation with WVU
  PEDS, the WVU OHSR, and the WVAC.
• Based on the National Heart Lung and Blood
  Institute (NHLBI) (1999) National Expert Panel
  Report 2 and the Update to these guidelines
  (2002).
• Intervention involves two main components
• Use of CDEMS electronic patient registry to track
  the care of patients with asthma determining the
  extent to which providers adhere to NHLBI
  guidelines
• Provision of provider education, informed by
  reports from the electronic patient registry

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The Chronic Disease Electronic Management System
(CDEMS)

• CDEMS Developed by the Washington State DPCP.
  Modified by OHSR
• Addressing the Care Model
• Progress Note compiles info.
• Clinic-wide summary reports on health outcomes
  and progress in meeting quality improvement goals
• Lists of patients overdue for a visit, lab, other
  specialty service
• Reminders letters for overdue visits, labs,
  services
• Recommended guidelines / graphs used in patient
  education
• Facilitation of individual patient care planning

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CDEMS Tickler for Asthma
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Utility of Electronic Patient Registries

• Accustoms providers medical staff in using /
  treating patient medical records as data
• Tracking individual patient care
• Tracking clinic-wide patient care
• Acclimates providers medical staff in potential
  use of electronic medical records
• EMR compatible

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Health Centers with Established Electronic
Patient Registries, by Quarter
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Comprehensive Approach to Chronic Disease
Management

• Merging asthma patient registry into that used
  for diabetes and cardiovascular health conditions
  
• Opportunity for large expansion of C-bAMP
• Satellite health center of a Year 01 C-bAMP site
  took initiative to use CDEMS for asthma

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Map of Participating Sites

• OHSR on-line site map
• http//www.hsc.wvu.edu/som/
• cmed/ohsr/maps/ClinicMap.html

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CDEMS is One of Two Parts of the C-bAMP
Intervention

• WVU Dept. of Pediatrics is provided with baseline
  and quarterly clinic-level summary reports
• Reports include data on the six targeted outcome
  measures, plus two additional measures
• Review of CDEMS for
• changes in outcome measures
• targeted educational interventions

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The Six Targeted Outcome Measures

• Spirometry tests
• Preferred objective test in diagnosis of asthma
• Asthma severity classification
• Helps guide management and treatment
• Written Asthma Action Plan
• Provides for patient self-management
• Tracking of Albuterol Use
• Helps determine how well the disease is
  controlled
• Use of Inhaled corticosteroids
• Gold Standard medication for controlling
  symptoms
• Influenza vaccination documentation

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Additional Measures

• Tracking of ER visits and hospitalizations due to
  asthma
• Difficult in that clinics are reliant on hospital
  notification of patient admission
• Two-week symptom history
• For follow-up patients
• All Measures captured within the CDEMS C-bAMP
  Key Measures Report

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CDEMS Asthma Summary Report

• Demographics
• of visits, gender, ethnicity, insurance, age,
  smoking status
• Vitals
• Blood pressure, BMI
• Health Conditions (Asthma severity, lung
  conditions)
• Medications
• Services Education
• Labs
• Spirometry, Peak-Flow
• Special Measures
• ER Visits, Missed School/Work Days (past 30
  days), Symptom Free Days (past 14 days)

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Baseline Data for C-bAMP Sites (Year-long
Reporting)
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C-bAMP Key Measures, by QuarterYear 01 Health
Center A Full Implementation
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C-bAMP Key Measures, by QuarterYear 01 Health
Center B Slow Implementation
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Technology isnt Everything

• How is this technology being used?
• Used minimally?
• Quarter report submissions only
• Used more fully?
• Interest in expanding into other health
  conditions
• Query health outcomes, target patients overdue
  for office visits, or those with lab values
  outside of national guidelines
• Wide-spread clinic support and commitment is a
  necessity
• Clinic champion
• Clearly defined roles within the clinic
• Established office-flow

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Establishing an Office-Flow for CDEMS
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Steps Toward Full-Implementation
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OHSR Contact Information

• Cecil Pollard, Director
• [phone] cpollard_at_hsc.wvu.edu
• Trisha Petitte, Assistant Director
• [phone] tpetitte_at_hsc.wvu.edu
• Mary Swim, Applications Programmer
• [phone] mswim_at_hsc.wvu.edu
• Adam Baus, Program Coordinator, Sr.
• [phone] abaus_at_hsc.wvu.edu
• Bethany McCunn, Research Assistant
• [phone] bmccunn_at_hsc.wvu.edu
• Kelly Bailey, Research Assistant
• [phone] kbailey_at_hsc.wvu.edu