October 2004 Issue

We are looking forward to seeing everyone at the upcoming Learning Sessions in November.  The teams from southern Indiana will be meeting in Bloomington on November 18, 2004 and the teams from northern and central Indiana will be meeting in Indianapolis on November 19, 2004.  There is still time to register for your learning session – email Mary Jo Golubski at today!

For this issue of the newsletter, we thought it would be helpful for you to hear how one of the collaborative teams is progressing. Indiana University Medical Group has several teams participating in the central Indiana Asthma Collaborative.  One of them is the practice located at PCC 2nd floor led by Annmarie Thomas.  Annmarie has shared her experiences with implementing the chronic disease program and working with the collaborative.  She can relate to you better than I, how challenging and rewarding working with this program can be.  Thank you Annemarie for all the hard work you and your team have done these past months. 

So here is one’s team experience- I hope you can relate and try some of these great ideas—

We attended the first learning session as a team and assigned roles to our champion physician Dr Klausmeier, our site director and facilitator Cyndy Smith, and myself the asthma coordinator and daily operations Annmarie Thomas CRT.  This was very beneficial because we started on the same page and we all heard the same thing.  We set our goals that we wanted to accomplish with this program and continued to meet and throw around ideas back at our site. Our goals consist of all-

·        persistent asthmatics to be placed on a controller;

·        all persistent asthmatics to have an asthma action plan,

·        all persistent asthmatics have a documented self improvement goal,

·        a reduction in our ER, UVC and hospital visits by our asthmatics. 

We found that our first obstacle was to identify the asthmatics in our practice.  We did this by obtaining a list of names that are assigned to our doctors that have asthma from MDwise.  We started out small and intend to expand over time.  We started just with Dr Klausmeier’s patient’s which consisted of 100 patients.  We did a chart audit on this list of patients to see where we were and what we needed to work on.  We also took this time to start labeling the asthmatics charts with a bright neon pink sticker to indicate that the patient has asthma.  After our first month we started to report our findings, which have become very beneficial because it shows our improvement in different areas and how far we need to go in order to reach our goal.  The graphs that are filled out show us quickly were we are with this initiative. Since we do not use CDMS our reporting consists of downloading the template to my desktop and each month I can update my previous report from this and save it.  We then came up with the idea to place a bright neon pink post it note that had the imprint of three questions that help the doctor to classify the patient’s asthma at the time of the visit.  This was approved and sent to the printer.  We are now in the process of a PDSA cycle and trialing them.  We are placing them on the front of the encounter along with another note that states to remember to call the asthma educator if education is needed.   We just started this on 10/25/04 and it seems to be going well but we will follow it up with a chart audit after the first month to see how effective it was.  We are obtaining a forwards list from Regenstrief that tells us what asthmatics are coming in to see the doctor in the upcoming week which makes it easier to flag the charts with our post it notes.   At the time the patient is seen the asthma coordinator should be called to fill out an asthma action plan and to help the patient to set a self management goal.    Currently as I mentioned we are still doing PDSA cycles to trial our ideas.  The PDSA cycles have proved to work.  At first we ran into a lot of problems with our cycles because of our no show rate.  This encouraged us to get back to the drawing board and work out a plan that would work instead of quitting.  After several months of trial and error our management of our asthmatic patients has become more defined and we have started to fill in some of the areas that needed improvement. I encourage everyone to hang in there and take tiny steps; soon the tiny steps will pay off with changes in our processes.  Good Luck!