"I think the role of NACI is to decrease mortality and morbidity for patients with asthma… they can do [this] by implementation of the GIP messages”
Helen Ragazzi, M.D., Pediatric Medical Director, Medical Society of Virginia Foundation (Richmond, VA)
Helen Ragazzi, M.D., describes how the Medical Society of Virginia Foundation's quality improvement collaborative is helping pediatric practices deliver guidelines-based asthma care.
The Medical Society of Virginia Foundation (MSVF) tested the addition of a pediatric component to its Improving Asthma Care and Treatment (IMPACT™) program. It aimed to show how clinical training and practice redesign, with the incentive of credit for Maintenance of Certification, can best equip busy pediatricians and their staff with the tools and skills they need to deliver high quality patient-centered asthma care.
IMPACT™ Pediatrics led 32 pediatricians and nurse practitioners on five teams encompassing seven clinical practice sites in Virginia through a 12-month comprehensive asthma quality improvement collaborative. In addition to attending training sessions on guidelines-based care, participating practice teams learned how to apply quality improvement principles, track their own progress, share strategies with other practices, and receive support and guidance from knowledgeable faculty.
Pediatricians who successfully completed this quality improvement program were eligible to receive credit toward recertification. MSVF’s IMPACT™has received joint approval from the American Board of Family Medicine, the American Board of Internal Medicine, and the American Board of Pediatrics for Part IV Maintenance of Certification credit.
Track clinical indicators and process-of-care measures using chart reviews, and provide ongoing education, technical assistance, and support.
Promote delivery system redesign by helping practices select and integrate tools, such as templates for charting asthma office visits, patient education handouts, and written asthma action plans.
Physician and nursing staff participating in MSVF's IMPACT Pediatrics project.
Challenges & Solutions
Challenge: Nurse Engagement. To participate in this project, each practice was required to identify a nurse champion to attend structured, monthly conference calls and work with the lead physician to train other staff and coordinate asthma education for the practice. However, few nurses participated in the monthly calls. Possible reasons included busy or part-time work schedules, few or no nurses on staff, and lack of a strong incentive to join the calls. Unlike physician participants, nurses are not eligible to earn maintenance of certification credit for participating in this quality improvement activity.
Solution: In-person meetings. MSVF staff dispatched its lead nurse to meet with participating nurses at each practice, rather than by telephone. This direct, face-to-face approach enhanced communication with the nurses and increased opportunities to share guidance and tools.
Leyla McCurdy, M.Phil. (left), National Environmental Education Foundation, and Helen Ragazzi, M.D., Medical Society of Virginia Foundation, confer at a NACI meeting in Baltimore, MD.
MSVF staff coordinated the distribution of asthma action plans to 5,000 patients.
The IMPACT™ program exceeded the number of practices they sought to recruit through a partnership with the Virginia Chapter of the American Academy of Pediatrics.
MSVF shared and collaborated with additional NACI-funded projects to advance asthma care best practices. For example:
MSVF arranged for the another NACI Strategic Partner, the University of Washington, to present its Spirometry 360 program to the IMPACT™ Pediatrics teams. It spurred at least one practice to begin incorporating spirometry into its care.
MSVF used clinician training and focused on practice redesign to meet its project goals.
Other NACI-funded projects that used MSVF-type approaches are: