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ECHO-Chicago: Complex Pediatric Asthma
Chicago, IL US
September 17, 2021 to December 10, 2021
PI CME/Quality Improvement Effort
Asthma affects approximately 8.6% of children in the United States, according to the Centers for Disease Control. During the years 2006–2010, 38.4% of children with the disease were poorly controlled; moreover, lack of asthma control has been associated with increased use of the health care system and decreased quality of life. Asthma control is the extent to which the manifestations of the condition are observed or have been improved by treatment. Good control reflects the minimization of the intensity and frequency of symptoms, as well as the overall reduction of functional limitations. Achieving control is a primary goal of asthma care, as it reflects the overall management of underlying airway inflammation, a key driver in the disease process. A principal and critical step in management, therefore, is the assessment of control.
The objective of this QI project is to improve the frequency and consistency of asthma control assessment during patient visits (regardless of visit reason) by increasing completion and documentation of any validated asthma control tests for the primary care providers. Specifically, we seek to increase asthma assessment during well child visits, asthma-related visits, sick visits, and follow-up visits for other reasons. Achieving control in asthma is a primary goal of pediatric care, and assessing the degree of control is a principal step in management.
There are several tools to evaluate asthma control in the clinical setting. The Asthma Control Test (ACT) and the Childhood Asthma Control Test (C-ACT) are validated tools to identify patients with poorly controlled asthma, and the ACT has been shown to reliably reflect asthma control over time. The ACT is designed for patients 12 years or older, whereas the C-ACT is appropriate for children aged 4–11 years. A score less than 20 on either tool indicates poorly controlled asthma with a sensitivity of 71% and specificity of 71% (ACT) or a sensitivity of 68% and specificity of 74% (C-ACT), as compared with forced expiratory volume in 1 second (FEV1) on spirometry, “the gold standard.” However, spirometry may not be available for every patient due to lack of accessibility in clinic and developmental requirements for patient participation in testing. Thus, other measures of asthma control are especially necessary as they are reliable, valid, easy to administer, and do not require FEV1 values. While the ACT/c-ACT are commonly used validated tools to measure asthma control, any other age-appropriate validated measure can be used.
The objective of this QI project is to improve the frequency and consistency of asthma control assessment during patient visits (regardless of visit reason) by increasing completion and documentation of any validated asthma control tests for the primary care providers. Specifically, we seek to increase asthma assessment during well child visits, asthma-related visits, sick visits, and follow-up visits for other reasons. Achieving control in asthma is a primary goal of pediatric care, and assessing the degree of control is a principal step in management.
There are several tools to evaluate asthma control in the clinical setting. The Asthma Control Test (ACT) and the Childhood Asthma Control Test (C-ACT) are validated tools to identify patients with poorly controlled asthma, and the ACT has been shown to reliably reflect asthma control over time. The ACT is designed for patients 12 years or older, whereas the C-ACT is appropriate for children aged 4–11 years. A score less than 20 on either tool indicates poorly controlled asthma with a sensitivity of 71% and specificity of 71% (ACT) or a sensitivity of 68% and specificity of 74% (C-ACT), as compared with forced expiratory volume in 1 second (FEV1) on spirometry, “the gold standard.” However, spirometry may not be available for every patient due to lack of accessibility in clinic and developmental requirements for patient participation in testing. Thus, other measures of asthma control are especially necessary as they are reliable, valid, easy to administer, and do not require FEV1 values. While the ACT/c-ACT are commonly used validated tools to measure asthma control, any other age-appropriate validated measure can be used.
Target Audience
This performance/quality improvement initiative is intended for physicians, residents, and fellows in the family medicine or pediatric specialties at the University of Chicago Medicine.
Learning Objectives
The aims for this project:
- Increase participating primary care physician's completion and documentation of the validated forms by 20% over baseline at any visit type for patients 4-18 years of age with asthma by completion of 3 months of ECHO-Chicago Complex Pediatric Asthma series participation.
University of Chicago Medicine
5841 S Maryland Ave
Chicago, IL
60637
United States
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ACCESSIBILITY The University of Chicago is committed to providing equal access appropriate to need and circumstances and complies fully with legal requirements of the Americans with Disabilities Act. If you are in need of special accommodation, please contact our office at via email at kmittal@peds.bsd.uchicago.edu.
QIPI Project Physician Lead
Daniel Johnson, MD
Professor of Pediatrics Chief, Section of Academic Pediatrics
Chief, Section of Pediatric Infectious Diseases
Vice Chair, Clinical Services
University of Chicago Medicine
Professor of Pediatrics Chief, Section of Academic Pediatrics
Chief, Section of Pediatric Infectious Diseases
Vice Chair, Clinical Services
University of Chicago Medicine
QI Project Owner
Kanika Mittal, MS
Director of Operations
ECHO-Chicago
Director of Operations
ECHO-Chicago
Disclosure Declarations
As a provider accredited by the ACCME, The University of Chicago Pritzker School of Medicine asks everyone in a position to control the content of an education activity to disclose all financial relationships with any ineligible companies. This includes any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Financial relationships are relevant if a financial relationship, in any amount, exists between the person in control of content and an ineligible company during the past 24 months, and the content of the education is related to the products of an ineligible company with whom the person has a financial relationship. Mechanisms are in place to identify and mitigate any relevant financial relationships prior to the start of the activity.
Additionally, The University of Chicago Pritzker School of Medicine requires Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration at first mention and where appropriate in the content.
Physician Credit
The University of Chicago Pritzker School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Chicago Pritzker School of Medicine designates this PI CME activity for a maximum of 20 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The University of Chicago Pritzker School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Chicago Pritzker School of Medicine designates this PI CME activity for a maximum of 20 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CME and MOC IV Credit
The national Multi-Specialty MOC Portfolio Approval Program has granted approval to the University of Chicago to award MOC Part IV credit to physicians participating in quality improvement (QI) projects. To qualify for both PI CME credit (AMA PRA Category 1 Credit™) and QI MOC through the ABMS Multi-specialty Portfolio Program, participants must be engaged in a systematic effort of reviewing and improving some aspect(s) of care or care delivery for their patients.
Sustained QI Cycles: Physicians are required to complete not less than 2 intervention cycles and not less than 3 data collection points:
1. Pre-intervention cycle 1
2. Post-intervention cycle 1
3. Post intervention cycle 2
The QI effort must be sustained, involving at least two or more linked cycles of performance review and improvement effort. The post-intervention data and review from one cycle become the baseline data and planning for the next cycle. Starting with a suspected or actual problem with care:
1st QI cycle
Baseline data collection, analysis/review, identify underlying cause(s)
Intervention(s) to address underlying cause(s)
Post-intervention data collection, analysis/review, identify remaining underlying cause(s)
1st QI cycle
Baseline data collection, analysis/review, identify underlying cause(s)
Intervention(s) to address underlying cause(s)
Post-intervention data collection, analysis/review, identify remaining underlying cause(s)
2nd QI cycle
Post-intervention data collection, analysis/review, identify underlying cause(s) (same as above)
Adjustment(s) / second intervention(s) to address underlying cause(s)
Post-adjustment data collection, analysis/review, identify remaining underlying cause(s)
Post-intervention data collection, analysis/review, identify underlying cause(s) (same as above)
Adjustment(s) / second intervention(s) to address underlying cause(s)
Post-adjustment data collection, analysis/review, identify remaining underlying cause(s)
Participants will be directed to attest and claim their 20 AMA PRA Category 1 CreditsTM through the CME website that is created for the project. Physician participation information will then be sent to the appropriate ABMS boards to report the successful completion of an MOC IV project. MOC IV credit will then appear in the diplomate’s specific board profile.
Attestation forms must be submitted by November 30th in order for us to report credit to your ABMS specialty board and have your credit count for that year.
Attestation forms must be submitted by November 30th in order for us to report credit to your ABMS specialty board and have your credit count for that year.
Registration: Closed to the public.
Claiming Credit: Enter the access code to unlock the credit claiming process.
Claiming Credit: Enter the access code to unlock the credit claiming process.
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