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A Quality Improvement Bundle Including Pay for Performance for the Standardization of Order Set Use in Moderate Asthma

Conners, Gregory P. MD, MPH, MBA*†‡; Fowler, Milton A. Jr MD, MBA*†; Lee, Brian R. PhD, MPH*; Schroeder, Lisa L. MD; Feature Editor*†

Section Editor(s): Rutman, Lori E. MD, MPH

doi: 10.1097/PEC.0000000000001627
Original Research-QI

Objective In order to standardize use of our hospital's computerized asthma order set, which was developed based on an asthma clinical practice guideline, for moderately ill children presenting for care of asthma, we developed a quality improvement bundle, including a time-limited pay-for-performance component, for pediatric emergency department and pediatric urgent care faculty members.

Methods Following baseline measurement, we used a run-in period for education, feedback, and improvement of the asthma order set. Then, faculty members earned 0.1% of salary during each of 10 successive months (evaluation period) in which the asthma order set was used in managing 90% or more of eligible patients.

Results At baseline, the asthma order set was used in managing 60.5% of eligible patients. Order set use rose sharply during the run-in period. During the 10-month evaluation period, use of the asthma order set was significantly above baseline, with a mean of 91.6%; faculty earned pay-for-performance bonuses during 8 of 10 possible months. Following completion of the evaluation period, asthma order set use remained high.

Conclusions A quality improvement bundle, including a time-limited pay-for-performance component, was associated with a sustained increase in the use of a computerized asthma order set for managing moderately ill asthmatic children.

From the *Department of Pediatrics, Children's Mercy Kansas City; Departments of

Pediatrics and

Emergency Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, MO.

Disclosure: The authors declare no conflict of interest.

Presented in part at the 2017 Pediatric Academic Societies Annual Meeting and the 2017 Society for Academic Emergency Medicine Annual Meeting.

Reprints: Gregory P. Conners, MD, MPH, MBA, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108 (e-mail:

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