The CYPHP Asthma team care quality exceeds national standards.
A recent audit of patient notes in particular showed that records on Asthma Action Plans were especially good. The team were very pleased to learn from a recent audit of notes that 93% of patients in the CYPHP Asthma team received a written care plan, compared with national figures - 49% for under 6 year olds and 62% for 6 - 18 year olds. The team is very proud of these results, but continue to strive towards our service target to make sure that all of our patients have a current Asthma Action plan since this is an important evidence-based intervention to improve health for children with asthma.
The team also reviewed their results on health outcomes.
CYPHP uses the validated Asthma Control Test (ACT) to measure how well patients’ symptoms are responding to care. We were delighted that 90% of our patients had stable or improved scores for their ACTs. Note that stability in symptoms is an important outcome, and that all patients benefit from proactive early intervention, supported self-management, and health promotion.
Unfortunately there are no national data to compare our outcomes with, since routine quality of care measurement is not done. This is why one of CYPHP’s aims is to embed a Learning Health System, so that we can improve the systematic measurement of child healthcare quality and health outcomes.
The audit also raised some other learning points for the team.
We focus a lot of efforts on strengthening the system to improve care. Some of this work is evident, like the patient portal that improves access to care. Other system strengthening work is behind the scenes. For example, things like accurate consistent coding of health records, which is essential for reliable data for learning and improvement. In asthma, coding is especially difficult because there’s often diagnostic uncertainty. Our audit demonstrated coding problems among children with asthma, and other difficulties around documentation and the effective use of EMIS. For example, children with “asthma” may have their recorded problems as ‘Asthma’, ‘Suspected Asthma’, ‘Wheeze’ or ‘Viral Induced Wheeze’, or indeed not coded with a diagnosis at all. This finding gave us an appreciation and better understanding of the day-to-day issues faced by primary care and navigating documentation systems, and we’re working together to improve the systems so that we can improve care.
To round off the audit, the team asked their patients about their care experience.
We were all pleased to hear the following comments from some of the CYPHP clinicians’ patients and families:
“I have more control over my asthma and breathing.”
“I think that's the main thing that everybody needs, is advice and reassurance and maybe someone going through it and physically showing them, and then once you've done all that, then you're more confident in knowing, like maybe giving someone an action plan, "This is how it is", step by step, and they can stick it on a fridge or something.”
“I know my kids are happier, because I know that they're happy with the new inhalers that they're using, but had [asthma nurse] not come, or had you lot not given us the service, they still would have been on the old ones, we would still be like, "Oh my God, this is not working", there would be a lack of information coming our way, we'd be lacking support and we would still be at the same place we were a couple of years back.”
“Making sure they take it in the morning and taking it at night time, making sure that they're falling on the right steps, it helped to, what do you call it, get it under control again.”
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