Helping Improve Pediatric Practice Outcomes Study (HIPPO)

Protocol Overview

Phase One:

The project team will work directly with four practices in greater Boston and an additional four practices in the greater Chapel Hill, North Carolina area. The project team will a) assess the quality of care provided to patients through brief parent and patient surveys and chart reviews; b) charter a quality improvement team in the practice; and c) support the process through on-site visits and provision of materials. From the information gathered from these practices, the project team will develop a collaborative learning model which will be implemented in the practices recruited for phase two.

Phase Two (Rapid-cycle improvement facet):

2. Determine the Eligibility of All Patients PROS will recruit twenty practices to participate in a collaborative project. Two representatives from each practice will come to each of two training sessions held at a central location, and engage in rapid-cycle improvement projects at their practices with distant consultation from the project staff. Within each of these practices, patients who have visits for asthma will be periodically surveyed about the care they receive at that practice. Practices will specifically be instructed to survey “the next ten patients” who arrive for care after the initiation of the project, and then to repeat the measurement every two months.

Phase Three (Fostering the Appropriate Diagnosis Study (FAD) facet):
The FAD Study builds on questions arising out of the rapid-cycle improvement phase and a series of parent and practitioner focus groups. Thirty-five additional PROS practices will be recruited to examine how the diagnosis of asthma is established, and how it is best communicated to families. The particular focus of this component of the study will be for children who are less than five years old. Practitioners will administer a brief survey to parents of 40 consecutive children presenting to the office with acute respiratory symptoms before the visit and another after the visit. The PROS practitioner will also record his or her diagnosis and treatment plan in a log. Using these surveys and the clinician's assessment, the decision-making process will be evaluated.