Associated Websites  
Asthma Tools from the Center for Healthcare Quality at Cinicnnati Children's Hospital Medical Center
CCHMC Special Needs Resources Directory
Tri State Child Health Services (PHO)
River Valley Pediatricians, Inc
Cincinnati Children's Hospital Medical Center
Institute for Healthcare Improvement

  About the PHO  
Philosophy History Personnel Programs Tri-State PHO Map

Achieve sustainable systems for medical practices to improve outcomes of pediatric populations.
Vision  :
To be a recognized leader in engaging community practices to achieve measurable improvement in the health outcomes of pediatric populations. To be a leading source of expertise and knowledge in Quality improvement, change management, use of information technology and the application of evidence in the achievement of independent medical practice objectives.

Team Characteristics:

  • Highly functional
  • Innovative
  • Highly effective
  • Mutually supportive
  • Focused
  • Aligned
  • Cost effective
  • Optimized
  • Knowledgeable
  • Continuously improving

In the health care industry, great things can happen when the hospital, primary care providers, specialists and payors work together toward a common goal.  One such case involves Cincinnati Children's Hospital Medical Center and the pediatric practices that are part of the hospital’s Physician Hospital Organization (PHO).

Keith Mandel, M.D., PHO vice president of Medical Affairs, Assistant Professor of Clinical Pediatrics, is leading a large-scale asthma improvement initiative that began in October 2003.  This initiative involves 38 community-based primary care practices and 160 pediatricians, affecting more than 13,000 children with asthma (approximately 30% of the regional asthma population).  Asthma was selected as the condition of focus due to high prevalence; high level of interest among practices; Cincinnati Children’s and payors; and the existence of evidence-based guidelines and related performance measures. 

To support and sustain improvement, the PHO negotiated a pay-for-performance (P4P) program with Anthem, one of the largest commercial payors in the region, to reward measurable improvement achieved at the network and individual practice levels for the entire asthma population – not just asthma patients enrolled with Anthem.  The P4P program components were fundamentally aligned with the primary improvement objectives of the asthma initiative.

Dr. Mandel notes that synergy was created by enhancing the reliability of capturing key process and outcome data, providing practices with actionable performance feedback reports, sharing transparent comparative practice data, having practices communicate successful improvement strategies directly to one another and rewarding improvement.  “These steps have led to high levels of engagement across practices and significant improvements in asthma care,” Dr. Mandel says.


Tri State Child Health Services, Inc: 

Name Role Email

Ellen Schafer

PHO Coordinator


Huiping Li

Senior Application Developer


Gerry Pandzik, R.N.

Director, Chronic Care Systems


Mike Taylor

Vice President, Revenue Cycle Management


Carl Donisi

Director, Clinical Operations


Anna Adams

Administrative Assistant


Susmita Das

Senior Application Developer









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Asthma Initiative:

The initiative has three primary objectives:

1. Achieve measurable improvement in evidence-based process and outcome measures for children with asthma.

2. Embed a higher level of improvement knowledge and capability within practices, thus enhancing long-term sustainability of improvement efforts.

3. Develop and spread models for engaging community physicians in improvement initiatives to practices within and beyond the region.

An essential first step was to identify the asthma population within each of the 44 pediatric practices.  Practices identified these patients via administrative data, supplemented by chart review to confirm diagnosis.  An electronic registry/database of the asthma population was then created and installed on a desktop computer at each practice.

At the same time, practices were also challenged with deploying the evidence-based decision support/data collection tool that was created to assess whether each patient was receiving particular aspects of asthma care (for example, flu shot, management plan, controller medications) and to evaluate patient outcomes (for example, frequency of daytime and evening symptoms, missed school days, admissions, emergency department visits, parent/patient confidence in managing disease).  Practices devised highly reliable strategies for capturing data on the key process and outcome measure at either the time of visit or between encounters.  The data was then loaded into the registry, thus allowing practices to generate actionable performance feedback reports to improve care.  As an example, each practice could access the registry to generate a list of their asthma patients not yet vaccinated against influenza.  Network meetings among practice “quality leadership team” members (physicians, nurses and practice manger) were invaluable in terms of sharing best practices across sites.

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Self Management Collaborative:

We launched the asthma self-management collaborative in April 2005 with 15 OVPCA practices, with the dual objective of pursuing evidence-based interventions that improve patient outcomes and enhancing the level of quality improvement knowledge and capability within practices.

Listed below are some of the asthma self-management improvement interventions that practices are focusing on:

Improvement Interventions

Patient/family knowledge/skills

Group visits

Care management

Planned care visits

Collaborative goal setting

Advocacy building/link with community resources

Provider training

Coordinating care with specialists


Parent Engagement:

As the next phase of the asthma initiative is focused on improving patient outcomes (e.g., school days missed), engaging patients/parents in the design of improvement interventions is essential.  We recently convened informational sessions on recruiting patient/parent input, with practices having the chance to view a PBS documentary of “real-life” examples of how this is occurring at Cincinnati Children’s. Potential approaches to recruiting patient/parent involvement in the asthma initiative have been identified and details will be shared. 

Tri-State PHO Map:

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