USAID Health Care Improvement Project

Transcription

1 IMPROVEMENT OBJECTIVE: Decrease asthma/copd morbidity and mortalityin affected adults and children through improved quality of asthma/copd case-management (ambulatory & hospital) Cross-cutting ambulatory and hospital asthma & COPD high-impact interventions Bronchodilator for active symptoms Inhaled steroid for all persistent asthma (tailored to severity) andmoderate-severe disease (FEV1< 60%) LABA and/or anti-cholinergic (FEV1< 60% or moderate-severe COPD) Identification & control triggers & risk factors Ambulatorymanagement of exacerbationand referral to hospital: oral or IV steroid, nebulized bronchodilator, oxygen if needed Patient self-management support AMBULATORY ASTHMA &COPD INDICATORS Process Indicator Numerator Denominator Source Frequency Collector AA-P1 AA-P2 % charts in which Chronic medications listis up to date % of patients seen for asthma/copd for whom asthma/copd classification status documented # charts with current updated list of chronic medications that matcheslatest visits treatments; asthma or reporting for whom updated classification status recorded in chart at last visit (for asthma: mild

2 AA-P3 AA-P4 AA-P5 % of patients for whom asthma control status documented (patientreported) % of patients seen for asthma/copd for whom treatment is adjusted to control/severity status % of patients with persistent asthma classification treated with controller medication intermittent vs. mild, moderate vs. severe persistent; For COPD: mild, moderate, severe, very severe IF spirometry available and documented) asthma for whom control status recorded in chart according to validated patient self-reported criteria (Asthma control test) asthma or reporting for whom medications are adjusted in line with control status (includes no adjustment if good control documented) # of patients with persistent asthma classification (or no classification) at visit for whom ICS (or leukotriene inhibitor) prescribed or continued within the reporting seen for asthma/copd in reporting for whom control status documented last visit excluding patients with mild intermittent classification

3 AA-P6 AA-P7 AA-P8 % of patients with moderate to severe (symptomatic)copd treated with LABA, anti-cholinergic or ICS Average #of non-eb medications prescribed for asthma/copd management at last visit COPD risk-factors (BMI, Diet), assessed & modification plan COPD in reporting prescribed LABA, anticholinergic or ICS (or any combination) Number of charts with asthma / reporting to whom at last visit were prescribed any medication except (for asthma: rescue inhaler, controller medication (inhaled steroid or montelukast), oral steroid, long acting methilxantans ; for COPD: (excepta)saba, LABA, inhaled antichol and b) ICS, long acting methilxantans or antibiotic combined with LABA and inhaled antichol) unless medication prescribed for co-morbid condition/symptom seen for COPD excluding patients with mild COPD seen for asthma/copd or

4 AA-P9 AA- P10 developed COPD triggers(pets, viral infections, dust, smoking environment), assessed & modification plan developed COPD in whom tobacco status assessed and specific counseling (treatment) provided (abstinence or tobacco cessation) OUTCOME for whom triggers or risk factors assessed and modification plan recorded in chart for whom triggers or risk factors assessed and modification plan recorded in chart for whom tobacco status assessed and specific counseling (treatment) provided reporting or reporting or reporting AA-O1 % patients who report good asthma control # patients seen for asthma in reporting for whom ACT questionnaire administered AND who have a score of 20 or higher on validated 5 item ACT patientquestionnaire in reporting who completed ACT questionnaire with results documented in chart or patient survey

5 AA-O2 % patients with asthma or COPD a requiring treatment for exacerbation in last six months # of patients with asthma or COPD followed in clinic treated for exacerbation in last 6 months (ambulatory management requiring oral steroids or hospitalization) followed for asthma or COPD in clinic or clinic registry Randomization Selection method should be agreed, written and distributed between QI team members from the beginning of QI interventions. Based on number of patients with respective disease seen in selected (weekly, biweekly, monthly ) it can be allmedical charts of patients with Asthma or Chronic Obstructive Pulmonary Diseasewho visited facility within past month or their random sample.