Improving Asthma and. Management with Spirometry 360

Transcription

1 Improving Asthma and COPD Diagnosis and Management with Spirometry 360 CIN Webinar March 28,

2 University of Washington Spirometry 360 Team Jim Stout, MD, MPH Principal Investigator t Dennis Burges Interactive Media Developer, Technical Support Karen Smith, MD imtr Medical Bonnie Rains Program Director Director 2

3 University of Washington Spirometry 360 Team Drew Martenson Respiratory Ben Hedrick Program Assistant sta t Therapist 3

4 Session Objectives Who we are Why spirometry training is needed Description of Spirometry 360 Program results Roles and expectations of practices and us, and (potentially) network leadership Consideration of next steps 4

5 Interactive Medical Training Resources (imtr) Based at University of Washington, Departments of Pediatrics, Medicine, Health Services Founded in 2006 to develop, disseminate and evaluate media-rich, interactive online training and feedback. Two product lines: Spirometry 360 and its related programs (i.e. Train the trainer ) and research (outcomes study, prediction study) Procedural Pediatric Sedation 5

6 Use of spirometry for asthma and COPD care in the primary care setting... is often missing in the U.S. enables accurate diagnosis and management of asthma, COPD, and less common conditions identifies patients with obstruction not otherwise identified by history and physical alone is easy to do poorly, but not hard to do well is a potent leverage tool for improving chronic care, thus reducing morbidity and lowering hospitalization and ED rates 6

7 Barriers to Performing Spirometry in Primary Care Lack of training for support staff and providers Lack of a spirometer (or its use) Lack of time (problems with work flow and lack of planned visits) 7

8 Some Indications for Use of Spirometry Diagnosis and severity assessment of asthma Follow up of asthma (especially when changing medications) Diagnosis and severity assessment of COPD Chronic bronchitis Chronic smokers Shortness of breath other chronic respiratory complaints 8

9 Training Matters 9

10 Mission of Spirometry 360 Improve the care delivered in general practice to patients with asthma and COPD Focus on properly performing and interpreting the spirometric maneuver, with a focus on planned care Emphasize reaching safety-net practice populations, where the burden of asthma and COPD is greatest Make our training available to geographically isolated practices 10

11 Spirometry 360 Activities Recruitment, pre-screening, enrollment Practice identifies their team (coaches, providers) Training begins: Spirometry Fundamentals tutorial, Learning Lab webinar series Feedback begins: baseline report, three monthly follow-up reports, 1:1 support as needed (phone, screen share) (Pilot project: Working with low-performing practices beyond end of Spirometry 360 course: what we re learning) 11

12 Spirometry 360 Timeline 12

13 Spirometry Fundamentals 13

14 Family Practice PROVIDER LEARNING LAB Faculty Greg Ledgerwood, MD Family Physician Eastern Washington Bruce Culver, MD Professor of Medicine Chief of UW Pulmonary Function Lab 14

15 Family Practice Learning Lab Session Objectives Identify obstruction vs. restrictive i patterns List the criteria for use of office spirometry in diagnosis and treatment of primary care respiratory problems Recognize and diagnose common obstructive lung conditions typically encountered in primary care Learn how to read a pre- and post-bronchodilator test Identify when a specialty referral is advisable based on office spirometry results Incorporate spirometry into a planned, preventive visit system 15

16 77 yr old Male Height: 68 Weight: 167lbs Polling Question #5 Does this former champion skier meet ATS criteria for a positive BD response? PRE-Bronchodilator A. Yes, because the FEF increased by 15% B. Yes, because the FEV1 increased by 280 ml Measurement Best %Pred C. Yes, because the FVC FVC(L) increased by 270 ml FEV1(L) FEV1/FVC FEF25-75(L/s) FET(s) Efforts: 3 FVC VAR: 110ml FEV1 VAR: 40ml POST-Bronchodilator Measurement Best %Chg FVC(L) FEV1(L ) FEV1/FVC FEF25-75(L/s) FET(s) Efforts: 3 FVC VAR: 70ml FEV1 VAR: 50ml D. No, but a trial of bronchodilators might be helpful anyway 16

17 Over-reading reading and Feedback Reports Over-reading and feedback are crucial to successfully performing spirometry. These activities represent 75-80% of the work involved in delivering Spirometry

18 Spirometry 360 Benchmarks Quantity of tests done, most practices come to us with limited use of spirometry Benchmark is > 10 tests per month 80% of practices meet this measure Quality of tests performed, most practices improve 15-25% over baseline Benchmark is > 60% passing tests (A-C) 75% of practices meet this measure 18

19 Two Stories of Success Urban FP practice in Tenderloin, SF Numerous efforts in past to jump start use of spirometry Many barriers to implementing Final result: extremely high rate, with 85% pass (good quality) rate Rural practice in Eastern Washington Brand new to spirometry, urgent need to serve a high-risk population Low performer early on, last month of program sent 92 tests, with a 68% pass rate 19

20 Spirometry 360 Feedback Reporting System 20

21 21 University of Washington March 14, 2012

22 22 University of Washington March 14, 2012

23 NETW Avg CLINIC NETW Avg CLINIC NETW Avg CLINIC NETW Avg CLINIC NETW Avg CLINIC NETW Avg CLINIC 23

24 Expectations and Roles of Spirometry 360 team Assist with screening and enrollment of practices Deliver course, report results Extra assistance to low performers of participating practices Provide four months of tests performed View Spirometry Fundamentals Attend relevant Learning Labs (clear schedule) Review feedback reports as a team 24

25 What Your Practices Can Expect Our three components of training and feedback, built on scientific evidence and QI principles CME and MOC credit Certificate of completion by a nationally recognized training program Help with using high-quality spirometry in routine care 25

26 Use a Team Each site should select a team champion/leader who: Schedules the team to meet monthly Assists team in discussing spirometry improvement SETS GOALS MEASURES PROGRESS Helps ensure that the time and resources needed to achieve the team s aims are available Facilitates spread of successful changes through the organization 26

27 Team Roles and Responsibilities All team members view Spirometry Fundamentals Team attend Learning Labs and participate p Meet at least monthly to: review feedback reports helps p you measure change review successes and challenges decide together on how to make the next incremental quality improvement change We recommend you work with a PDSA model Plan-Do-Study-Act 27

28 Chronic Care Asthma Visits Gain efficiencies by: Work as a team (delegate jobs and roles) Define and use an asthma-centric space Restructure work flow if needed Use a structured encounter form to assist quick and thorough documentation 28

29 Spirometry in Adults and Seniors Review medications your patient is taking: HBP meds might impact positioning of patient while doing spirometry Spirometry produces a valsalva-like maneuver and can result in syncope Remember, patients with moderate/severe COPD who are poorly controlled will often cough with maximal expiratory effort during spirometry Terminate test if dizzy or reported discomfort 29

30 Role of Spirometry with COPD ACP Clinical Practice Guideline (August 2011): All patients with symptoms suggestive of COPD should receive spirometry testing to CONFIRM the diagnosis of COPD Spirometry i t testing ti should be done at time of suspected diagnosis (with bronchodilator testing) Satisfies HEDIS measure pairing COPD and spirometry Spirometry should NOT be used to screen asymptomatic patients Ann Intern Med 2011;155; ; 30

31 Learning Lab Family Practice Track (Final dates pending) Coach Learning Lab I Provider Learning Lab 1 Coach Learning Lab 2 Provider/ Coach Combined Learning Lab Video Archived at: 31

32 Sending Us Tests to Over-read read by Mail Collect and copy all tests done during program-- August through December 2012 January and February your baseline You will receive mailers to send us data twice monthly Send us promptly on the 15 th and last day of each month Please redact (white out): patient name and date of birth 32

33 Sending Us Your Spirometry Tests Using EasyWare and Spirometry 360 Feedback Agent 33

34 If You Join Us. Enrollment timelines Choosing gpractices: Sufficient volume to warrant training Buy in, commitment, a spirometer, and Internet access. 34

35 What You Should Expect from Spirometry 360 Focused attention to your practices by our expert team Training by nationally recognized faculty More spirometry done in your practices for COPD and asthma patients (helps SPR HEDIS measure) Higher quality spirometry done, leading to more accurate diagnosis Highly satisfied providers Improved processes of chronic care delivery 35

36 Your Questions 36

37 Thanks for your time! 37