Achieve sustainable systems for medical practices to
improve outcomes of pediatric populations.
: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.
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
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
Child Health Services, Inc:
The initiative has three
1. Achieve measurable
improvement in evidence-based process and outcome measures for children with
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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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:
Planned care visits
Collaborative goal setting
Advocacy building/link with community resources
Coordinating care with specialists
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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