Agency

Time Frame

How Determined

Project Title and Description

Measures

Contact Info

NICHQ

Current, 1 year long

Not specified

AAFP – Improving Health Care for Children with Asthma:

There are 15 AAFP affiliated practices participating in a year-long effort to improve the quality of care for children with asthma in their practices. This collaborative has been made possible through an unrestricted education grant from Schering/Key.

none given

Bonnie Hammond

NICHQ

None given

Not specified

California Childhood Asthma Initiative:

The California Department of Health Services’ Childhood Asthma Initiative is a collaborative, community-based and clinic-based project to improve the quality of life of children with asthma less than five years of age and their families.

none given

Bonnie Hammond: Hammond9@u.washington.edu

NICHQ

Current, 2 years long

Not specified

EQUIS Asthma Project: Evaluating a Quality Improvement Strategy:

Sponsored by a grant from AHRQ, NICHQ is coordinating a collaborative learning experience for 39 primary care practices (split between Detroit and Greater Boston) to compare usual care with care during and after the implementation of a structured quality improvement intervention. This is a randomized-control trial; half of the practices receive the intervention training in year 1, the other half in year 2.

none given

Lisa Horvitz:

lhorvitz@nichq.org

NICHQ

Near future, 12 months long

Not specified

New York City Improving Childhood Asthma Care and Pediatric Preventive Services:

Sponsored by Community HealthWorks (CHW) of NYC Dept of Health through the Medical and Health Research Association of NYC (MHRA), this collaborative plans to include 20 pediatric practices in a twelve month initiative to adapt and apply proven methods in quality improvement to the specific needs of NYC based practices.

none given

Sabina Rubeck:

srubeck@health.nyc.gov

NICHQ

None given

Not specified

North Carolina Asthma eQIPP: North Carolina ’s Division of Medical Assistance is sponsoring pediatricians and their nurse practitioners who want to learn how they can improve the care for their patients with asthma. NICHQ will share the best available methods used by pediatricians around the country and evidence-based scientific knowledge about care for children with asthma. Using the online educational program eQIPP developed by the American Academy of Pediatrics and NICHQ, clinicians will learn and apply methods for changing care of asthma and spreading change within the practice.

None given

Erin Burgess:

Erin_burgess@unc.edu

RWJF

10/15/01-10/14/04

Not specified

Improving Asthma Care for Children:

Children’s Mercy Hospital/Truman Medical Center Family Health Partners Inc. Kansas City , MO

None given

Jay Portnoy, MD

jportnoy@cmh.edu

816-234-3097

RWJF

10/01/02-9/30/03

Not specified

Technical assistance and direction for Managing Pediatric Asthma: Improving Asthma Care for Children:

Center for Healthcare Strategies Supporting Organization Lawrenceville , NJ

None given

Patricia Barta MPH, RN

pbarta@chcs.org

609-895-8101

RWJF

10/01/01-9/30/04

Not specified

Managing Pediatric Asthma: Improving Asthma Care for Children

Multiple Sites: HealthNow NY, Inc Buffalo , NY

Contra Costa County Dept of Health Services Martinez , CA

Affinity Health Plan, Inc. Bronx NY

Monroe Plan for Medical Care, Inc Rochester , NY

None given

Phillip Smeltzer

Smeltzer.phillip@healthnow.org

716-887-8702

Donna Coit, RD, MPH

dcoit@hds.co.contra-costa.da.us

925-313-6905

Maura Bluestone

Mbluestone@TBHP.org

718-817-6670

Joseph Stankaitis MD, MPH

jstankaitis@monroeplan.com

716-256-8452

RWJF

10/01/01-9/30/04

Not specified

Managing Pediatric Asthma: Emergency Department Program: 2 sites:

Children’s Research Institute Washington, DC

Children’s Health System, Inc Milwaukee , WI

None given

Stephen Teach MD, MPH

steach@cnmc.org

202-884-5134

Kevin Kelly MD

kkelly@mcw.edu

414-266-6400

RWJF

1/1/02-12/31/04

Not specified

Allies Against Asthma: A Program to Combine Clinical and Public Health Approaches to Chronic Illness: 2 Sites

Children’s Health System, Inc Milwaukee , WI

Children’s Hospital of the King’s Daughters, Inc

Norfolk , VA

None given

John Meurer MD, MM

jmeurer@mcw.edu

414-456-4116

Cynthia Kelly MD

ckelly@chkd.com

757-668-6443

CHCS

None given

not specified

The Improving Asthma for Children Program:

Directed by the CHCS, a $3 million national initiative of the RWJF. The program’s goal is to improve the management of pediatric asthma in high-risk recipients of Medicaid and SCHIP under managed care. All projects are seeking to improve health-related quality of life of children with asthma, develop and sustain partnerships with key community stakeholders, and support the institutionalization of innovative clinical models in asthma care.

This is in conjunction with RWJF, at the sites listed above. Details of each program/site are available on www.chcs.org, or through contact

None given

Pat Barta, Deputy Director

pb@chcs.org

609-895-8101

IHI - Pursuing Perfection

Ongoing

Not specified

Implement the Planned Care Model for children with Asthma and achieve unprecedented improvement in clinical outcomes, patient satisfaction, timeliness of care, safety and equity. This project lists several measures with no results posted yet.

Cambridge Health Alliance

(1) # patients in asthma registry

(2) % persistent asthma patients on controller medications

(3) # missed days from school past two weeks

(4) % asthma patients with ED visit for asthma at local hospitals past 12 months

(5) % asthma patients with inpatient admissions to local hospitals past 12 months

(6) % patients who respond positively to the question “degree to which you have been helped to live with this condition

(7) add a safety measure, ie % of kids w/ asthma known to be using correct medication (in development)

David Link, MD

Laureen Gray

Center for Health and Health Care In Schools

(CHHCS)

Current, ongoing

AAAAI, NHLBI, AAP*

Chronic Asthma CQI for elementary school children:

Noted through annual risk assessment and biennial physical exam.

1) % of students with asthma plan

2) % of visits in "green zone" or (*) % of students who are stable (no symptoms of cough or wheeze, improved lung function, reduction in number of severe attacks, minimized sleep disturbance, and improved attendance in school, and reduction in number of hospitalizations)

No specific contacts given, as these initiatives occur nationwide at schools, however, Drs. Linda Juszczak, Doris Pastore, and Christopher Reif are responsible for design

AHRQ

9/30/02-12/31/03

Not specified beyond that it ties in with one of three AHRQ strategic goals

This study will test the feasibility and validity of a new measure of quality asthma care for poor inner-city children with asthma. The project will also test the Asthma Visit Questionnaire to assess the quality of asthma care in primary care settings.

None given

Yvonne Senturia

Jacobi Medical Center

Bronx , NY

AHRQ

9/30/00-9/29/03

Not specified beyond that it ties in with one of three AHRQ strategic goals, and that it was part of an initiative that focused on developing partnerships between researchers and health systems and organizations

Better Pediatric Outcomes Through Chronic Care: This quality improvement project will evaluate the impact of a computerized client server system that incorporates four modules for screening, outreach, and tracking pediatric asthma patients ages 5-18 in community health centers.

None given

Judith Fifield

University of Connecticut Health Center

Farmington , CT

AHRQ

9/26/00-8/31/03

Not specified beyond that it ties in with one of three AHRQ strategic goals, and that it was part of an initiative that focused on developing partnerships between researchers and health systems and organizations

Developing an Asthma Management Model for Head Start Children: This multi-part case-management intervention will engage Head Start personnel in efforts to improve the identification of asthma and identification of barriers to treatment, and to engage in problem solving with families of children ages 3 -5.

None given

Perla A. Vargas

Arkansas Children’s Hospital

Little Rock , AR

AHRQ

9/11/00-8/31/03

Not specified beyond that it ties in with one of three AHRQ strategic goals, and that it was part of an initiative that focused on developing partnerships between researchers and health systems and organizations

Managed Care Organization Use of a Pediatric Asthma Management Program: Study practices will be provided with five tools intended to simplify the asthma guidelines. One physician and one nurse from each practice will participate in a 5-hour training session on how to use the materials, followed by assistance with program implementation, trouble-shooting, and patient specific feedback.

None given

Michelle M. Cloutier

University of Connecticut Health Science Center

Hartford , CT

AHRQ

9/30/99-9/29/02

Not specified beyond that it ties in with one of three strategic goals

Evaluating Quality Improvement Strategies. This study will compare the effects of office-based quality improvement with regular practice on processes and outcomes of care for children with asthma ages 2 to 18. Effectiveness and cost-effectiveness will be evaluated in this managed care setting.

None given

Charles M. Homer

Children’s Hospital

Boston , MA

AHRQ

7/01/99-6/30/02

Not specified beyond that it ties in with one of three AHRQ strategic goals

Managed Care and Quality: This study will examine how the structural characteristics, incentives, and quality assurance efforts of managed care organizations affect quality of care among children with one of four conditions: asthma, diabetes mellitus, low birth weight and cerebral palsy

None given

Frederick A. Connell

University of Washington

Seattle , WA

AHRQ

7/01/98-6/30/01

Not specified

Quality of Care for Children with Special Needs in Managed Care: This research is assessing the effect of certain organizational features of nine different Managed Care Organizations (MCOs) on the processes and outcomes of care for children with special health care needs (CSHCN). MCO organizational features included in the research are: 1) characteristics of the provider network, 2) use of prior authorization procedures for specialty referrals, 3) presence and type of disease management programs, and 4) ownership status of the managed care organization. Quality of care will be assessed for children with asthma, diabetes, and CHSCN with varyingconditions aggregated by their functional status.

None given

Elizabeth Shenkman

University of Florida

Gainesville , FL

AHRQ

7/01/99-3/31/01

Not specified

Asthma Care Quality in Varying Medicaid Managed Care Plans: This study is identifying features of Managed Care Organizations (MCO) that are associated with the quality of care for children with asthma insured by Medicaid. The MCO features to be studied include payment mechanisms, provider profiles and incentives, and disease management programs, as well as features of care measured at the individual patient level such as accessibility, continuity, and self-care practices.

Not specified beyond that they will include change over time in asthma related quality of life, hospitalization and emergency department visits, and anti-inflammatory medication use.

Tracy Lieu

Kaiser Foundation Research Institute

Oakland , CA

AHRQ

9/30/98-9/29/01

Not specified

Impact of Managed Care Organization (MCO) Policy on Quality of Pediatric Asthma Care: This study is 1) determining the impact that transition from fee-for-service to managed care has on the quality of treatment, quality of life, and health outcomes for indigent children with asthma; and 2) determining the impact that exposure to specific managed care organization policies have on processes and outcome indicators of care for pediatric asthma patients. The findings are expected to shed new light on how restrictive MCO policies affect quality and outcomes for children with asthma.

None given

Bruce Stuart

University of Maryland at Baltimore

Baltimore , MD

AHRQ

6/01/96-5/31/98

Not specified

Measuring Quality of Life in Children with Asthma: This study will examine the relationship between a general multidimensional approach and a disease-specific approach to measuring quality of life in children with asthma. The two different methods will be assessed by administering the Pediatric Quality-of-Life Questionnaire to 600 asthmatic children and their parents participating in an asthma management program.

None given

Robert D. Annett

AHRQ

9/15/00-8/31/05

With the growth of publicly-funded health care programs for children and adolescents through Medicaid and the State Children's Health Insurance Program, there is increasing interest in using health services research to evaluate whether children and adolescents are receiving appropriate and high quality care through these programs

Access and Quality of Care for Vulnerable Black Populations: The School-based Asthma Study for Inner City Children will assess the effectiveness of an asthma screening/detection and morbidity reduction program for school-aged children.

None given

Robert Mayberry

Morehouse School of Medicine

Atlanta , GA

mayberry@msm.edu

AHRQ – EPC Evidence Report

Current as of September 2001

Part of AHRQ goal of facilitating the translation of evidence-based research findings into clinical practice. Further, all nominated topics must meet selection criteria, including high incidence or prevalence in the general population and in special populations, significance for the need of Medicare, Medicaid, and other Federal Health Programs, high costs associated with a condition, treatment, procedure, or technology, controversy or uncertainty regarding the effectiveness or relative effectiveness of available clinical strategies or technologies, impact potential for informing and improving patient or provider decision making, impact potential for reducing clinically significant variations in the prevention, diagnosis, treatment, or management of a disease or condition; in the use of a procedure or technology, or in the health outcomes achieved, availability of the scientific data to support the systematic review and analysis of the topic, submission of the nominating organization’s plan to incorporate the report into its managerial or policy decision making, submission of the nominating organization’s plan to disseminate derivative products to its members and plan to measure members use of these products, and the resultant impact of such use on clinical practice. Specifically, asthma is the most common chronic disease in childhood, affecting more than 4.8 million children. Death rates from asthma are the highest among blacks ages 15-24, a category that includes children (ages 15-17).

Management of Chronic Asthma: The report sought to answer 5 questions:

1)Does chronic use of inhaled corticosteroids (ICS) improve outcomes for children with mild to moderate asthma, and does chronic ICS use result in long-term adverse effects in children?

2)For patients with mild to moderate asthma, does early initiation of long term control medication (such as ICS) prevent asthma progression?

3)For patients with moderate asthma, does adding other long-term controller medications (such as leukotriene modifiers, long-acting beta 2 agonists, or theophylline) to low-moderate doses of ICS improve control of lower ICS dosage?

4)Does adding antibiotics to standard care improve outcomes for treatment of acute exacerbations of asthma?

5)Does addition of a written asthma action plan to medical management alone improve outcomes, and is a peak-flow monitor based plan superior to a symptom-based plan?

None specified, and details of the results are available on AHRQ’s website

None given, but the AAP, AAFP, and the National Heart, Lung and Blood Institute nominated this topic.

The Commonweatlh Fund

1/01/03-3/31/05

Not specified beyond the following: chronic health conditions afflict an estimated 100 million Americans and account for as much as one-quarter of U.S. national health care expenditures. Yet the management of chronic illnesses has lagged behind advances in technology and medicine. Quality and effectiveness are compromised by poor communication and a general lack of coordination among the clinicians caring for a patient and between the patient and primary care doctor. This project focuses on childhood asthma because it is a prototypic chronic disease

Managing Chronic Disease with and Internet-Supported Team: This project is a randomized clinical trial that will measure the impact on care of an interactive website that helps patients participate in the management of their disease by facilitating communication between the patient and the primary care practitioner and by educating patients about their disease. In addition, it will attempt to demonstrate that such internet-based technology could be used to create a “virtual” interdisciplinary team, foster teamwork, and even further improve clinical outcomes. If successful, this work could serve as a model for management of other chronic conditions.

None given

John Wiecha, MD, MPH

Dowling 5 South

Boston , MA 02118

American Academy of Family Physicians

(AAFP)

Current

The objectives of the Quality Initiative includes measuring and demonstrating the quality of care provided by family physicians, developing, testing and deploying intervention strategies to improve care, and educating and engaging family care physicians in health care quality improvement. Towards these ends, the AAFP bases performance measurements on the following: Importance (grounded in science, substantial potential for improvement, severity and prevalence, substantial impact, relevant, and improve value), Measurability (accurate and reliable, valid, precisely defined and specified, easily interpreted, risk adjusted), Achievability (improvement attainable, reasonable cost, feasible), and Adaptable. Additionally, the AAFP provides specific information on how each project in the Quality Initiative can satisfy the IOM’s six aims (Safe, Effective, Patient Centered, Timely, Efficient, Equitable). Finally and specifically, asthma is one of the most prevalent chronic conditions worldwide, especially in children.

A Learning and Improvement Collaborative on Healthcare for Children with Asthma:

The goal of this project is to improve the health status, outcomes, and satisfaction of patients while enhancing the family physician’s practice viability and vitality; and representations and partnerships with other organizations dedicated to quality care. 13 practices from around the nation focused on establishing best care patterns, communicated knowledge and tools, and are now in the process of disseminating their findings to other practices.

None given

Christine Pullman

AAFP

Pediatric Data Quality Systems (Pedi-QS) Initiative

Current

This collaborative currently includes the National Association of Children’s Hospitals and Related Institutions (NACHRI), Child Health Corporation of America (CHCA), Medical Management Planning (MMP), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Nemours Foundation and National Initiative for Children’s Healthcare Quality (NICHQ) The collaborative was formed in order to address the gap in representing children’s health care needs and quality measurement in national activities (NQF, JCAHO, etc.)

The goal of this collaborative is to populate a framework that includes IOM aims for improvement (Crossing the Quality Chasm, 2001), consumer quality needs and clinical systems of care. Measures are evaluated against criteria as adopted from the IOM Report, Envisioning the National Health Care Quality Report (2001): importance, scientific soundness, and feasibility. Asthma was identified as the first priority area for this collaborative. Priority areas are selected based on criteria adopted from IOM, Priority Areas for National Action (inclusiveness, improvability, impact)

An initial set of measures was submitted to the Joint Commission for consideration as core measures for children’s asthma care. Measures include: unplanned readmissions (7 and 30 days); Return to ED following discharge; Use of relievers, use of systemic corticosteroids, risk adjusted length of stay.

These measures are currently in public comment

Ellen Schwalenstocker

NACHRI

eschwalenstocker@nachri.org

Cheri Throop

CHCA

Cheri.throop@chca.com

Sharon Sprenger

JCAHO