ICAP Project ICAP Project ICAP Project ICAP Project Orientation, Orientation, Orientation, Orientation, Metric Metric Metric Metric Evidence, & QIDA IntroductionEvidence, & QIDA IntroductionEvidence, & QIDA IntroductionEvidence, & QIDA IntroductionJULY 31, 2014JULY 31, 2014JULY 31, 2014JULY 31, 2014
SLIDE USED WITH PERMISSION FROM K PARIKH, E BIONDI, AND D WILLIAMS, “VIP NETWORK ICAP PROJECT ORIENTATION, METRIC EVIDENCE, AND QIDA
INTRODUCTION ” ORIGINALLY PRESENTED 7/31/14 TO THE VIP NETWORK ICAP QI PROJECT TEAMS
AgendaAgendaAgendaAgendaAgenda Item Speaker Time
Welcome and Introductions Faiza Khan 5 min
Project Overview/Teams Eric Biondi, MD
Kavita Parikh, MD
10 min
Inclusion/Exclusion Criteria Kavita Parikh, MD 5 min
Metric Evidence Derek Williams, MD 20 min
Overview of Chart Review Tool Kavita Parikh, MD 5 min
Brief Introduction to QIDA Lori Morawski 5 min
Questions and Answers All 10 min
ICAP WelcomeICAP WelcomeICAP WelcomeICAP Welcome
Improving care for pediatric patients with CAP across the county
Individual and community impact
4
53 Teams Accepted into ICAP in 26 53 Teams Accepted into ICAP in 26 53 Teams Accepted into ICAP in 26 53 Teams Accepted into ICAP in 26 States and PakistanStates and PakistanStates and PakistanStates and Pakistan
3 sites
1 site
1 site
1 site
1 site
5 sites
Indiana: 2 sites
2 sites
2 sites
2 sites
2 sites
1 site Massachusetts: 2 sites
Maryland: 2 sites
New Jersey: 1 site
4 sites
3 sites
West Virginia: 1 site
Virginia: 4 sites
Pennsylvania: 2 sites
South Carolina: 1 site
1 site
Tennessee: 1 site
Vermont: 1 site
Pakistan: 1 site
1 site
4 sites
How will we manage this large How will we manage this large How will we manage this large How will we manage this large collaborative?collaborative?collaborative?collaborative?
Listserv
Coaches
Email/Phone
Meet Deadlines
ICAP CoachesICAP CoachesICAP CoachesICAP CoachesJoanne Nazif – ICAP Project Lead Coach
Matthew D Garber, MD, FHM FAAPMatthew D Garber, MD, FHM FAAPMatthew D Garber, MD, FHM FAAPMatthew D Garber, MD, FHM FAAP
University of South Carolina
Michael P Koster, MD FAAPMichael P Koster, MD FAAPMichael P Koster, MD FAAPMichael P Koster, MD FAAP
Rhode Island Hospital
JoAnnaJoAnnaJoAnnaJoAnna K K K K LeyenaarLeyenaarLeyenaarLeyenaar, MD , MD , MD , MD
Tufts Medical Center
Michelle M Marks, DO FAAPMichelle M Marks, DO FAAPMichelle M Marks, DO FAAPMichelle M Marks, DO FAAP
Cleveland Clinic Foundation
Russell J Russell J Russell J Russell J McCullohMcCullohMcCullohMcCulloh, MD FAAP, MD FAAP, MD FAAP, MD FAAP
Children's Mercy Hospitals & Clinics
Vineeta Mittal, MDVineeta Mittal, MDVineeta Mittal, MDVineeta Mittal, MD
Children's Medical Center Dallas
Angela L Myers, MD, MPH FAAPAngela L Myers, MD, MPH FAAPAngela L Myers, MD, MPH FAAPAngela L Myers, MD, MPH FAAP
Children's Mercy Hospital/PedsID
Mary Ann Queen, MD FAAPMary Ann Queen, MD FAAPMary Ann Queen, MD FAAPMary Ann Queen, MD FAAP
University of Missouri at Kansas City School of Medicine
Shawn Shawn Shawn Shawn L Ralston, MD FAAPL Ralston, MD FAAPL Ralston, MD FAAPL Ralston, MD FAAP
Dartmouth-Hitchcock Medical Center
Emily A Emily A Emily A Emily A ThorellThorellThorellThorell, MD, MSCI FAAP, MD, MSCI FAAP, MD, MSCI FAAP, MD, MSCI FAAP
University of Utah Health Care
IlanaIlanaIlanaIlana WaynikWaynikWaynikWaynik, MD, FAAP , MD, FAAP , MD, FAAP , MD, FAAP
Connecticut Children’s Medical Ctr/Peds
Derek Derek Derek Derek J Williams, MD, MPH FAAPJ Williams, MD, MPH FAAPJ Williams, MD, MPH FAAPJ Williams, MD, MPH FAAP
Vanderbilt University School of Medicine
Jason G Newland, MD, MEd FAAPJason G Newland, MD, MEd FAAPJason G Newland, MD, MEd FAAPJason G Newland, MD, MEd FAAP
Children's Mercy Hospital
Natalia L Paciorkowski, MD, PhD FAAPNatalia L Paciorkowski, MD, PhD FAAPNatalia L Paciorkowski, MD, PhD FAAPNatalia L Paciorkowski, MD, PhD FAAP
Rochester General Hosp/Peds
Important Next Steps…Important Next Steps…Important Next Steps…Important Next Steps…Due dateDue dateDue dateDue date Next StepsNext StepsNext StepsNext Steps
ASAP Submit Pre-Project Survey via SurveyMonkey
Next 10 days Set up a time-table for meeting (integrated staff meet-ups, huddles, etc.) as
a core improvement team throughout this project
Next 10 days Review Orientation Packet PDF (sent out as a hyperlink this week)
Next 14 days Receive your Project Coach Assignment and touch base with your assigned
coach regarding your progress
August 28, 2014 Participate in Webinar 2: QI Orientation & Change Package Part 1, 10AM
PT/11AM MT/12Noon CT/1PM ET
August 29, 2014 Pending Final Approval: Submit ABP MOC Part 4 paperwork to Faiza Khan to
express interest in site participation in seeking ABP MOC Part 4 credit for
physicians at your site
August 31, 2014 Submit Baseline Data into QIDA (Cycle 1: Sept-Nov. 2013, Cycle 2: Dec 2013-
Feb 2014 & Cycle 3: March-May 2014)
How were Metrics Derived?How were Metrics Derived?How were Metrics Derived?How were Metrics Derived?
Expert Group Consensus:Expert Group Consensus:Expert Group Consensus:Expert Group Consensus:
• Kavita Parikh, MD
• Shawn Ralston, MD
• Eric Biondi, MD
• Joanne Nazif, MD
• Mary Ann Queen, MD
• Ricardo Quinonez, MD
• Derek Williams, MD
• Samir Shah, MD
Establishing MetricsEstablishing MetricsEstablishing MetricsEstablishing Metrics
1. Antibiotic Selection
2. Macrolide Utilization
3. CBC Utilization
4. Radiologic Imaging
5. Concurrent Asthma diagnosis with CAP
6. Blood Culture Utilization
Establishing MetricsEstablishing MetricsEstablishing MetricsEstablishing Metrics
Evidence-based best practices
Not exclusively based on IDSA guidelines
Targets established by group consensus
Inclusions and Inclusions and Inclusions and Inclusions and ExclusionsExclusionsExclusionsExclusions
Inclusions Exclusions
• Diagnosis (in any position) of
pneumonia (ICD9 codes: 481,
482.0, 482.2-.42, 482.89-.9, 485,
486)
• ICU care during admission
• Age 3 months to 18 years • Mechanical ventilation/Intubation
• Admitted to your hospital • Co-morbid conditions predisposing
to severe or recurrent respiratory
illness, including genetic,
congenital, chromosomal,
neuromuscular, or
neurodevelopmental abnormalities.
• Discharged from your hospital • Transfer to or from your hospital
• Received either a full inpatient
course of antibiotics or was
discharged to complete a full
course of antibiotics for CAP
• Any pleural drainage procedure
481 Pneumococcal pneumonia (s. pneumoniae) Pneumococcal Pneumonia
482.0 Pneumonia due to Klebsiella Pneumonia due to other bacteria
482.2 Pneumonia due to H.influnzae H. Flu Pneumonia
482.30 Pneumonia due to strep, unspecified Pneumonia due to Strep
482.31 Pneumonia due to strep, Group A Pneumonia due to Strep
482.32 Pneumonia due to strep, Group B Pneumonia due to Strep
482.39 Pneumonia due to other strep Pneumonia due to Strep
482.40 Pneumonia due to staph unspecified Pneumonia due to Staph
482.41 Methicillin susceptible pneumonia due to staph Pneumonia due to Staph
482.42 Methicillin resistant pnuemonia due to staph Pneumonia due to Staph
482.49 Other Staph pneumonia Pneumonia due to Staph
482.81 Pneumonia due to anaerobes Pneumonia due to other bacteria
482.82 Pneuomonia due to E.coli Pneumonia due to other bacteria
482.83 Pneumonia due to other gram negative bacteria Pneumonia due to other bacteria
482.89 Pneumonia due to other specified bacteria Pneumonia due to other bacteria
482.9 Bacterial pneumonia unspecified
Pneumonia due to unspecified
organism
485 Bronchopneumonia, organism unspecified
Pneumonia due to unspecified
organism
486 Pneumonia organism unspecified
Pneumonia due to unspecified
organism
Inclusion/Exclusion NotesInclusion/Exclusion NotesInclusion/Exclusion NotesInclusion/Exclusion Notes
Will use ICD9 codes to create chart poolWill use ICD9 codes to create chart poolWill use ICD9 codes to create chart poolWill use ICD9 codes to create chart pool
Will need chart review to verify inclusion and exclusions, Will need chart review to verify inclusion and exclusions, Will need chart review to verify inclusion and exclusions, Will need chart review to verify inclusion and exclusions, and include up to and include up to and include up to and include up to 20202020 charts per quarter in our samplecharts per quarter in our samplecharts per quarter in our samplecharts per quarter in our sample
Will not include viral and atypical PNA ICD9 codesWill not include viral and atypical PNA ICD9 codesWill not include viral and atypical PNA ICD9 codesWill not include viral and atypical PNA ICD9 codes
Will not include complicated PNA. Will not include Will not include complicated PNA. Will not include Will not include complicated PNA. Will not include Will not include complicated PNA. Will not include aspiration PNA.aspiration PNA.aspiration PNA.aspiration PNA.
Metric EvidenceMetric EvidenceMetric EvidenceMetric EvidenceDEREK WILLIAMS, MD, MPH
Metric #1: Narrow Spectrum AntibioticsMetric #1: Narrow Spectrum AntibioticsMetric #1: Narrow Spectrum AntibioticsMetric #1: Narrow Spectrum Antibiotics
Increase overall usage of narrow-spectrum antibiotics (e.g. ampicillin/penicillin G) for
inpatients with uncomplicatedCAP to 80% for eligible population
RationaleRationaleRationaleRationale
2011 PIDS/IDSA: Ampicillin or PCN G first-line for most children hospitalized with CAP (strong rec./mod. evidence)
S. pneumoniae remains most common bacterial cause of CAP(1)
Decrease in invasive pneumococcal infections and decrease in PCN-non-susceptible strains with PCV7/PCV13 (2,3)
Penicillin resistance not associated with treatment failure for non-CNS S. pneumoniae infections (4, 5)
Broader-spectrum antibiotics (e.g. ceftriaxone) used almost exclusively (>85% 2005-10) (6)
◦ Few head to head comparisons
171. Michelow I Peds 2004; 2. Pilishvili T JID 2010; 3. Kyaw MH NEJM 2006; 4: Dagan PIDJ 2001;
5. Weinstein MP CID 2009 6. Brogan PIDJ 2012
None of the outcomes studied favored OCG over ACG
Unmatched cohort: No differences in outcomes
Metric #2: Macrolide UseMetric #2: Macrolide UseMetric #2: Macrolide UseMetric #2: Macrolide Use
Decrease overall usage of macrolides for Decrease overall usage of macrolides for Decrease overall usage of macrolides for Decrease overall usage of macrolides for
inpatients with inpatients with inpatients with inpatients with uncomplicateduncomplicateduncomplicateduncomplicated CAP to:CAP to:CAP to:CAP to:
---- <5<5<5<5% for children under age % for children under age % for children under age % for children under age 5 years5 years5 years5 years
---- <25<25<25<25% for children age % for children age % for children age % for children age 5555----18 years18 years18 years18 years
RationaleRationaleRationaleRationale
2011 PIDS/IDSA: Combination therapy with macrolide for children in whom atypical pathogens are a “significant consideration” (weak rec./low evidence)
Distinguishing viral from atypical bacterial pathogen impossible based on clinical exam alone
◦ M. pneumoniae most common in school age children
◦ Endemic vs. epidemic
Macrolide use increasing among children (1,2)
◦ Increased use associated with antimicrobial resistance (3)
Questionable efficacy of macrolide therapy for atypical CAP
◦ Few prospective studies; many children recover without tx
211. Grijalva CG JAMA 2009; 2. Hersh A Peds 2011; 3. Hicks LA CID 2011
“We identified insufficient evidence to support or refute treatment of M. “We identified insufficient evidence to support or refute treatment of M. “We identified insufficient evidence to support or refute treatment of M. “We identified insufficient evidence to support or refute treatment of M.
pneumoniaepneumoniaepneumoniaepneumoniae in CAin CAin CAin CA----LRTI. These data highlight the need for wellLRTI. These data highlight the need for wellLRTI. These data highlight the need for wellLRTI. These data highlight the need for well----designed, designed, designed, designed,
prospective RCTs assessing the effect of treating M. prospective RCTs assessing the effect of treating M. prospective RCTs assessing the effect of treating M. prospective RCTs assessing the effect of treating M. pneumoniaepneumoniaepneumoniaepneumoniae in CAin CAin CAin CA----LRTI.”LRTI.”LRTI.”LRTI.”
MetaMetaMetaMeta----analysis of randomized trialsanalysis of randomized trialsanalysis of randomized trialsanalysis of randomized trials
Metric #3: CBC UseMetric #3: CBC UseMetric #3: CBC UseMetric #3: CBC Use
Decrease overall usage of complete Decrease overall usage of complete Decrease overall usage of complete Decrease overall usage of complete
blood counts for inpatients with blood counts for inpatients with blood counts for inpatients with blood counts for inpatients with
uncomplicated uncomplicated uncomplicated uncomplicated CAP CAP CAP CAP to less than 10%to less than 10%to less than 10%to less than 10%
RationaleRationaleRationaleRationale
2011 PIDS/IDSA: Complete blood counts should be obtained for those with severe pneumonia (weak rec./low evidence)
Complete blood counts obtained frequently among children hospitalized with acute infectious illness, >65%. (1) ◦ Rarely changes clinical management
◦ Potential source of waste/overuse
Association between high peripheral WBC count and bacterial pneumonia◦ Cut-offs are problematic
251. Brogan TV PIDJ 2012
“White “White “White “White blood blood blood blood cell indicators cell indicators cell indicators cell indicators are less valuable than inflammatory are less valuable than inflammatory are less valuable than inflammatory are less valuable than inflammatory markers for markers for markers for markers for ruling in ruling in ruling in ruling in
serious infection (positive likelihood serious infection (positive likelihood serious infection (positive likelihood serious infection (positive likelihood ratio 0.87ratio 0.87ratio 0.87ratio 0.87----2.432.432.432.43), and have no value for ruling out ), and have no value for ruling out ), and have no value for ruling out ), and have no value for ruling out
serious infection serious infection serious infection serious infection (negative likelihood ratio 0.61(negative likelihood ratio 0.61(negative likelihood ratio 0.61(negative likelihood ratio 0.61----1.141.141.141.14).”).”).”).”
On average, white cell counts higher in bacterial vs. viral infection; however, On average, white cell counts higher in bacterial vs. viral infection; however, On average, white cell counts higher in bacterial vs. viral infection; however, On average, white cell counts higher in bacterial vs. viral infection; however,
significant overlap exists which limits predictive powersignificant overlap exists which limits predictive powersignificant overlap exists which limits predictive powersignificant overlap exists which limits predictive power
Metric #Metric #Metric #Metric #4444: Radiologic Imaging: Radiologic Imaging: Radiologic Imaging: Radiologic Imaging
Uncomplicated CAP: Uncomplicated CAP: Uncomplicated CAP: Uncomplicated CAP:
----Decrease usage Decrease usage Decrease usage Decrease usage of of of of >1 CXR to <10%>1 CXR to <10%>1 CXR to <10%>1 CXR to <10%
Complicated CAP:Complicated CAP:Complicated CAP:Complicated CAP:
----Increase Increase Increase Increase usage of ultrasound to 10usage of ultrasound to 10usage of ultrasound to 10usage of ultrasound to 10%%%%
----Decrease Decrease Decrease Decrease usage of CT to 5%usage of CT to 5%usage of CT to 5%usage of CT to 5%
RationaleRationaleRationaleRationale
2011 PIDS/IDSA: CXR should be obtained in all hospitalized children with CAP…repeat CXRs are not routinely recommended among those improving clinically (strong rec./mod. evidence)
Chest radiographs offer valuable information ◦ Disease severity, complications, etc.(1)
Radiographic resolution often lags clinical improvement◦ Repeat radiographs rarely change management
◦ Significant clinical deterioration is the exception
Complicated CAP: Advanced imaging often useful◦ US similar/superior to CT; no ionizing radiation
291. McClain L JHM 2014
“CT detects “CT detects “CT detects “CT detects more more more more parenchymal abnormalities…the additional parenchymal abnormalities…the additional parenchymal abnormalities…the additional parenchymal abnormalities…the additional information does not alter information does not alter information does not alter information does not alter
management and management and management and management and is unable is unable is unable is unable to predict clinical to predict clinical to predict clinical to predict clinical outcome…omission outcome…omission outcome…omission outcome…omission of routine CT scanning in of routine CT scanning in of routine CT scanning in of routine CT scanning in
empyema will empyema will empyema will empyema will reduce the exposure of children to reduce the exposure of children to reduce the exposure of children to reduce the exposure of children to unnecessary radiation unnecessary radiation unnecessary radiation unnecessary radiation and reduce costsand reduce costsand reduce costsand reduce costs.”.”.”.”
31 children (8 mo-17 yr) with empyema who had CXR, CT, and US
10/25 with simple 10/25 with simple 10/25 with simple 10/25 with simple
consolidation on CXR had consolidation on CXR had consolidation on CXR had consolidation on CXR had
necrosis or cavitation on CT; necrosis or cavitation on CT; necrosis or cavitation on CT; necrosis or cavitation on CT;
findings findings findings findings ddddid not change id not change id not change id not change
management or predict management or predict management or predict management or predict
outcomeoutcomeoutcomeoutcome
19 children (8 mo-17 yr) with complicated pneumonia and parapneumonic effusion
ResultsResultsResultsResults
18/19 with effusion on CT and US18/19 with effusion on CT and US18/19 with effusion on CT and US18/19 with effusion on CT and US
LoculationLoculationLoculationLoculation: : : :
15/18 CT+, 13/18 US+15/18 CT+, 13/18 US+15/18 CT+, 13/18 US+15/18 CT+, 13/18 US+
Fibrin strands: Fibrin strands: Fibrin strands: Fibrin strands:
0/18 CT+, 17/18 US+0/18 CT+, 17/18 US+0/18 CT+, 17/18 US+0/18 CT+, 17/18 US+
“chest ultrasound and chest CT were similar in their ability to detect
loculated effusion and lung necrosis or abscess…CT did not provide any
additional clinically useful information…”
Metric #5: Concurrent Asthma TherapyMetric #5: Concurrent Asthma TherapyMetric #5: Concurrent Asthma TherapyMetric #5: Concurrent Asthma Therapy
Decrease concurrent treatment Decrease concurrent treatment Decrease concurrent treatment Decrease concurrent treatment for for for for asthma asthma asthma asthma
and pneumonia to and pneumonia to and pneumonia to and pneumonia to less than 10%less than 10%less than 10%less than 10%
RationaleRationaleRationaleRationaleOveruse of Overuse of Overuse of Overuse of chest radiographs among chest radiographs among chest radiographs among chest radiographs among children with asthma leads children with asthma leads children with asthma leads children with asthma leads to unnecessary antibiotic to unnecessary antibiotic to unnecessary antibiotic to unnecessary antibiotic use (atelectasis vs. infiltrate)use (atelectasis vs. infiltrate)use (atelectasis vs. infiltrate)use (atelectasis vs. infiltrate)
CXRs frequently obtained among children with acute asthma in ED (25-44%)(1, 2)◦ Narayanan: 180 children hospitalized with acute asthma: 18 (10%) had
‘abnormal’ CXR: atelectasis vs. infiltrate (n=9), consolidation/infiltrate (n=6), air leak (n=3); All with equivocal CXR findings received antibiotics (2)
Wheezing uncommon among children with typical bacterial pneumonia ◦ Michelow et al: wheezing documented in 13%, 41%, and 41% of children
with typical bacteria, atypical bacteria, and viruses, respectively(3)
◦ Corticosteroids may worsen pneumonia outcomes for those without acute wheezing
331Stanley RM Acad Em Med 2007; 2Narayanan S J Asthma 2014; 3Michelow I Peds 2004
Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with
longer hospital LOS. longer hospital LOS. longer hospital LOS. longer hospital LOS.
Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with Among children without acute wheezing, corticosteroids use was associated with
increased risk of readmission. increased risk of readmission. increased risk of readmission. increased risk of readmission.
Overview of Overview of Overview of Overview of Chart Review ToolChart Review ToolChart Review ToolChart Review Tool
ICAP Chart Review Tool
MONTH/YEAR______________________
CHART NUMBER _________ (number sequentially 1-5…)
PATIENT DATA: This section should be completed for each chart
INCLUSION CRITERIA EXCLUSION CRITERIA
• Diagnosis (in any position) of pneumonia (ICD9
codes: 481, 482.0, 482.2-.42, 482.89-.9, 485, 486)
• ICU care during admission
• Age 3 months to 18 years • Mechanical ventilation/Intubation
• Admitted to your hospital • Co-morbid conditions predisposing to severe or
recurrent respiratory illness, including genetic,
congenital, chromosomal, neuromuscular, or
neurodevelopmental abnormalities.
• Discharged from your hospital • Transfer to or from your hospital
• Received either a full inpatient course of
antibiotics or was discharged to complete a full
course of antibiotics for CAP
• Any pleural drainage procedure
1. I certify that I have reviewed the inclusion/exclusion criteria and this patient does meet the criteria.
� I certify that this patient does meet the criteria
2. Patient age ____
(In days if < 30 days, in months if < 24 months, in years if > 2 years)
3. Age is recorded in days months years
4. Select the appropriate age group for this patient:
Less than 5 years of age / 5 years of age and older
5. Gender MALE FEMALE
6. Length of stay in calendar days (LOS) _____ days
(Any part of 1 calendar day that is spent in the hospital is to be recorded as one full day e.g., a patient admitted at
8:30AM on Jan 1st who stays until 8:00AM on Jan 2nd will be recorded as “2”)
Metrics #1 and #2: Narrow Spectrum Antibiotic Use and Macrolide Use
- common macrolides include erythromycin, clarithromycin and azithromycin
1. What antibiotic, or combination of antibiotics, did the patient receive in your ED? (this excludes antibiotics given for
non-CAP reasons, i.e. otitis media)
a. Amoxicillin/ampicillin/penicillin only
b. Macrolide only
c. Amoxicillin/ampicillin/penicillin AND macrolide
d. Third generation cephalosporin only
e. Third generation cephalosporin AND macrolide
f. None
g. Not applicable (patient not admitted via my ED)
h. Other
2. What antibiotic, or combination of antibiotics, did the patient receive in the inpatient setting for management of CAP?
(This excludes ED management and antibiotics given for non-CAP reasons in the inpatient setting, i.e. otitis media)
a. Amoxicillin/ampicillin/penicillin only
b. Macrolide only
c. Amoxicillin/ampicillin/penicillin AND macrolide
d. Third generation cephalosporin only
e. Third generation cephalosporin AND macrolide
f. None
g. Other
3. What antibiotic, or combination of antibiotics, did the patient receive for CAP at discharge? (This excludes antibiotics
given for non-CAP reasons, i.e. otitis media)
a. Amoxicillin/ampicillin/penicillin only
b. Macrolide only
c. Amoxicillin/penicillin AND macrolide
d. Oral cephalosporin only
e. Oral cephalosporin AND macrolide
f. None
g. Other
Chart Review Tool (Chart Review Tool (Chart Review Tool (Chart Review Tool (contcontcontcont)…)…)…)…
Metric #3: Radiologic Imaging for CAP
Chest X-ray
1. Was a chest x-ray performed for this patient as an inpatient? YES NO
2. Was more than more than ONE chest X-ray performed for this patient as an inpatient? YES NO
Pulmonary Ultrasound
3. Was a pulmonary ultrasound performed in your ED or the inpatient setting? YES NO
Chest CT scan:
4. Was a chest CT scan performed in your ED or in the inpatient setting? YES NO
Metric #4: Complete Blood Count (CBC) utilization for CAP
5. Was a CBC performed for this patient as an inpatient? YES NO
6. Was more than one CBC performed for this patient as an inpatient? YES NO
Metric #5: Concurrent Asthma Diagnosis and Treatment
7. Did the patient receive MORE THAN ONE dose of a beta-agonist (e.g. Albuterol) as an inpatient?
YES NO
8. Did the patient receive MORE THAN ONE dose of systemic (oral/IV) corticosteroids as an inpatient? YES NO
Chart Review Tool (Chart Review Tool (Chart Review Tool (Chart Review Tool (contcontcontcont)…)…)…)…
Brief Introduction Brief Introduction Brief Introduction Brief Introduction to the to the to the to the Quality Improvement Data Quality Improvement Data Quality Improvement Data Quality Improvement Data
Aggregator (QIDA) Aggregator (QIDA) Aggregator (QIDA) Aggregator (QIDA)
ABOUT QIDAABOUT QIDAABOUT QIDAABOUT QIDA
� Web-based data aggregation system
� Secure login for all project participants
� Clinician enter chart data securely by patient or in aggregate
� Analyzes data via real time run charts
� Collaboration between project team members
� View project specific resources (workspace) and QIDA system
documents
ACCESSING QIDAACCESSING QIDAACCESSING QIDAACCESSING QIDA
• To access QIDA, go to the following link:
http://qidata.aap.org/quiincap
• For AAP members, you will use your AAP log-in
and password to access the site
• For non-AAP members, an AAP log-in has been
created for you and that information will be
e-mailed to you from [email protected] by August 6
QIDA SCREEN SHOTS FOR ICAP QIDA SCREEN SHOTS FOR ICAP QIDA SCREEN SHOTS FOR ICAP QIDA SCREEN SHOTS FOR ICAP ICAP Home Page
with Log-In
1 2 3
Once you log-in there are three
main areas: Project Home,
Workspace, and My Group
GROUP ADMINISTRATOR’S QIDA WEBINARGROUP ADMINISTRATOR’S QIDA WEBINARGROUP ADMINISTRATOR’S QIDA WEBINARGROUP ADMINISTRATOR’S QIDA WEBINAR
• QIDA Orientation WebinarQIDA Orientation WebinarQIDA Orientation WebinarQIDA Orientation Webinar (Open to all team
members, required for Group required for Group required for Group required for Group AdministratorsAdministratorsAdministratorsAdministrators)
• 20 minute pre20 minute pre20 minute pre20 minute pre----recorded webinar recorded webinar recorded webinar recorded webinar
• Available now at http://youtu.be/ZfgKONu5jRQhttp://youtu.be/ZfgKONu5jRQhttp://youtu.be/ZfgKONu5jRQhttp://youtu.be/ZfgKONu5jRQ\\\\
Important Next Steps…Important Next Steps…Important Next Steps…Important Next Steps…Due date Next Steps
ASAP Submit Pre-Project Survey via SurveyMonkey
Next 10 days Set up a time-table for meeting (integrated staff meet-ups, huddles, etc.) as
a core improvement team throughout this project
Next 10 days Review Orientation Packet PDF (sent out as a hyperlink this week)
Next 14 days Receive your Project Coach Assignment and touch base with your assigned
coach regarding your progress
August 28, 2014 Participate in Webinar 2: QI Orientation & Change Package Part 1, 10AM
PT/11AM MT/12Noon CT/1PM ET
August 29, 2014 Pending Final Approval: Submit ABP MOC Part 4 paperwork to Faiza Khan to
express interest in site participation in seeking ABP MOC Part 4 credit for
physicians at your site
August 31, 2014 Submit Baseline Data into QIDA (Cycle 1: Sept-Nov. 2013, Cycle 2: Dec 2013-
Feb 2014 & Cycle 3: March-May 2014)
Top Related