Asthma Care Quality Improvement: A Workbook for State Action. Module 2

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Asthma Care Quality Improvement: Workbook

Module 2: A Framework for State-Led Quality Improvement

Learning Objectives

Upon completion of Module 2, the user(s) will be able to:

Define the State's role in the asthma care quality improvement process and develop activities using a Plan-Do-Assess approach. States can play a strategic role in quality improvement by providing leadership, working in partnership, and implementing quality improvement to achieve better care for people with asthma.
Identify appropriate resources to help States reach their improvement goals. States need to locate available resources to use in quality improvement efforts.

1. Define the State's Role in the Asthma Care Quality Improvement Process and Develop Activities Using a Plan-Do-Assess Approach

Go to Module 2 in the Resource Guide. These sections discuss the State's role in fostering quality improvement in health care, present existing improvement models, and a define a new framework for asthma care quality improvement and a leadership role for States.
1. What existing programs in your State can you use to gather information on quality improvement? Do you have previous quality improvement programs at the State or community level which you can use to begin planning your asthma improvement efforts? Who in your State might be able to provide this information (such as experts in asthma, asthma care, and quality improvement)?
  
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2. Are there ongoing provider networks already involved in quality improvement in your State that might serve as the basis of a statewide quality improvement initiative for asthma care?
  
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3. What do you envision as the State's key leadership role in leveraging these existing programs and networks for asthma care quality improvement?
  
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General and clinical models of quality improvement are described in the Developing a Framework for State-Led Quality Improvement section of the Resource Guide. These models require collaboration in planning, setting goals, establishing appropriate measures, designing and implementing changes, gathering and analyzing data, and interpreting the results. What features of these models seem particularly relevant to your State?

Plan-Do-Study-Act model:

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IHI model:

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Chronic Care model:

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Federal models:

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A New Framework for State-Led Quality Improvement that uses elements of these models is described in the Resource Guide and illustrated in Figures 2.1, 2.2, and 2.3. This framework adapts the Plan-Do-Study-Act model into a Plan-Do-Assess improvement process comprising three stages:
The State takes a lead role in each stage.

Stage 1: Provide leadership. A key part of this stage is championing the need for improving care and creating a quality improvement vision.

Plan: Are there members of your staff with experience in quality improvement who can help plan this effort and identify potential partners?

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What other State officials can you call upon to collaborate in leading the asthma care quality improvement effort? Consider the governor, other elected officials, the Medicaid program director, health department director, school superintendent, social services director, and others whose programs serve large numbers of State residents with asthma.

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Can you identify ways to incorporate the case for asthma care quality improvement that you assembled in Module 1 into your planning efforts?

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Do: What is the best way to convene parties interested in improving asthma care? Are there existing advisory bodies or workgroups? Who are the key stakeholders that you would want to include? (These might be community organizations, providers, health plans, employers and other larger purchasers, as well as consumers.)

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Can you identify resources to help develop networks that support this effort in your State?

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Assess: How do you assess your planning efforts at this stage? Have you established an environment and partnerships with stakeholders that will foster quality improvement?

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What adjustments might be necessary?

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Stage 2: Work in partnership. This stage relies on the collaborative efforts of key stakeholders to develop a strategy, plan activities, develop possible solutions, and assess the potential pros and cons of these solutions before major implementation campaigns are begun.

Plan: The Centers for Disease Control and Prevention (CDC) supports asthma programs in many States through its National Asthma Control Program. (The CDC Web site has information and a link to these programs at http://www.cdc.gov/asthma.) Does your State already have an asthma plan that identifies problems/issues to consider and goals to address in developing a quality improvement strategy? Are there established processes in place that you can use or adapt?

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What does the quality improvement team envision as the starting point? For example, do you want to improve the quality of care among the entire population or among vulnerable subgroups you have identified? Do you want to focus on quality of care in physician practices? Do you want to focus on reducing asthma hospitalizations? Is there more than one priority to which the team wants to commit at this point?

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What steps need to be taken to design an initial intervention that addresses your priority area(s)?

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Do: How will the proposed intervention be tested? Is there existing evidence from the literature or from your key stakeholders you can use? Can you or other stakeholders conduct a small pilot study to get data?

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Which measures will be used to determine whether the proposed intervention is successful? What experts that you have identified can you contact for information on these measures?

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Assess: What do the results of the test show? Who can you call on to help interpret the results? Is there something else you might need to do to gather more data?

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Does analysis of the results seem to suggest that the quality improvement partnership needs to modify the intervention or find another solution? (Perhaps your analysis indicates that you may need to add measures to improve documentation of how well asthma is provided in your State). Or has another problem or critical issue emerged that you believe should be addressed instead?

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Stage 3: Implement improvement. This stage relies on the partnership to bring about change statewide and evaluate its outcomes.

Plan: What are the steps needed to implement the asthma quality improvement intervention statewide? Specify the roles and responsibilities that each partner in the quality improvement team has agreed to take on to bring about this change.

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Do: What are the methods and mechanisms the quality improvement team will use to spread the change to providers and others in the State? For example, will you use an advertising campaign, training programs, community outreach, other vehicles, or combinations?

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How will you measure the impact of this effort to spread change on patients and providers?

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Assess: How will the team evaluate the outcomes of the quality improvement effort, both successes and shortcomings? Is there a plan for modifying the intervention, based on ongoing evaluation, to assure continuous quality improvement?

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2. Identify appropriate resources to help States reach their improvement goals.

Go to Information Resources for Quality Improvement in the Resource Guide for a listing of some Federal programs and resources on quality improvement and quality of care, including asthma care.

Is your State using any of these resources? If so, how well have they worked for you?

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Visit the Web sites of the resources listed below. Jot down any ideas to help you plan, implement, and evaluate an asthma care quality improvement program.
- Institute for Healthcare Improvement (IHI model): http://www.ihi.org
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- Improving Chronic Illness Care (Chronic Care model): http://www.improvingchroniccare.org
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- National Healthcare Quality and Disparities Reports: http://www.ahrq.gov/qual/measurix.htm
  Ideas:
  
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- State Resources from the National Healthcare Quality Report (NHQR)
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- Healthcare Cost and Utilization Project databases: http://www.hcup-us.ahrq.gov
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- AHRQ evidence reports: http://www.ahrq.gov/clinic/epcix.htm
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- Diabetes quality improvement tool: http://www.ahrq.gov/qual/diabqualoc.htm
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- National Quality Measures Clearinghouse: http://www.qualitymeasures.ahrq.gov
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- Behavioral Risk Factor Surveillance System: http://www.cdc.gov/brfss
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- National Asthma Control Program: http://www.cdc.gov/asthma/NACP.htm
  Ideas:
  
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- National Asthma Survey: http://www.cdc.gov/nchs/about/major/slaits/nas.htm
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- National Asthma Education and Prevention Program: http://www.nhlbi.nih.gov/about/naepp
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