h3. H1N1 Influenza
The biggest story of 2009 has to be H1N1 Influenza. This new strain emerged in Spring of 2009. Initially there was rapidly changing information and recommendations on how to handle this. The potential to strain existing health systems was very real. The challenge of distributing vaccine was also very significant. The disease became widespread in Fall of 2009 and we scrambled to keep up with this at the same time as trying to get adequate vaccine distributed to our patients. We did our best to constantly reevaluate what we were doing and listening to suggestions from our patients. We learned a ton! We rate ourselves a B+ on how we handled it. Please use the comment section to give us your opinion.
h3. Quality Improvement Projects
One year ago in January 2009 our office formed a Quality Improvement group focussed on standardizing and improving our approach to patient care in our office. This group meets monthly to support ongoing efforts to improve medical care we deliver. The first big project we adopted was to standardize how our providers do checkups and evaluate all our interventions at each visit. The goal was to only do recommended interventions and assure that all providers used same tools. The changes that came from this group include:
* Addition of 9 month well child check for all infants with the addition of Ages and Stages screening tool at that visit
* Vitamin recommendation for all children
* Addition of 30 month well child check for children who have shown developmental delay or high risk for delay and also do Ages and Stages screening tool at that visit
* Addition of 3 year Ages and Stages screen for all children
* Reviewed educational material given out and expanded from simple 2 page handout to packet of useful health tips
* Addition of MCHAT autism screening tool for all 18 month and 2 year well child checks
Next steps for improving preventive care is to develop reminder system for children that are overdue for check-ups. We do review at time of visit and remind families at that time. This simple intervention has increased number of kids over age 5 who have had a well child check in the last 2 years from 56% to 68% and continue to show improvement each month.
h3. Asthma improvement project
Beginning in Fall of 2009 we began participation in a collaborative improvement project that involves about 11 practices in Oregon as well as 3 other states participating at the same time. This coordinated through American Academy of Pediatrics. The project uses a quick questionnaire that family fills out on checkin asking standardized questions to assess level of asthma control and other gaps in care. Our providers are measured on how well we meet the measure of optimum asthma care. Prior projects with similar goals have shown that once the percent of optimum care rose the number of emergency room visits and hospital admissions dropped. If you recently filled out one of these forms please let us know how that worked in our comment section.
h3. Future projects
We have a long list of potential future improvement projects affecting clinical care as well as office processes (scheduling, check-in, etc). I would be very interested in what is important to our patients. Please let me know in the comment section. I hope to have a section of our website dedicated to our quality projects and start publishing our data.