Enhancing Care for Children with Asthma

Felicia T. Fuller, Dr.PHJill Heins, MSNovember 18, 2014American Public Health AssociationNew Orleans, LA

Project Mission and Method

Mission: The systems-change project utilizes a collaborative approach to implement new systems that support and sustain the adherence to the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines in partnering clinics.

Method: Use a continuous quality improvement approach to develop clinic systems that facilitate and ensure high quality asthma care in clinics.

Importance of this Initiative

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1.Evidence-based framework

2.Sustained changes to the health care system

3. Impact on high-risk, diverse patients

4.Statistically significant outcomes

Enhancing Care for Children with Asthma Goals

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1.Teach primary care practices how to change (not a top down or cookie cutter model) by using Plan, Do, Study, Act Rapid Cycle Improvement

2.Sustain changes in primary care practice

3.Use “asthma” to learn change

4.Build awareness and capacity in the community

Implementation of Initiative

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1. State-level project managers

2. 12-month partnership with clinic

3. 5 joint in-person clinic meetings to cover specific quality improvement steps

4. Monthly technical assistance calls

5. Training available

6. Tools and resources provided

7. Chart audits at baseline, 12, and 18 months

12 Project Components

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1. Buy-in2. Rooming process3. Documentation process (opportunity to pilot electronic DDS)4. Self-assessment process5. Controller meds6. Albuterol refill protocol7. Asthma action plan8. Spirometry 9. Tobacco dependence10. Self-management/Patient education11. ED follow-up 12. Planned visit

Lesson learned: Organizational buy-in is most vital. EMR/documentation process is most difficult and takes the most time

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Clinic Trainings Provided

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1. Kickin’ Asthma and/or Open Airways

2. Implementation of Spirometry—one hour lecture about how to best conduct spirometry1. Onsite refresher course provided

3. Interpretation of Spirometry—two hour lecture about how to interpret spirometry1. Onsite refresher course provided

4. Asthma 101 for clinic staff

5. Asthma Educator Institute – a 16 hour training for non-providers

Outcome Measures

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1. Severity rating

2. Patient self-assessment (asthma control)

3. Controller medications

4. Written Asthma Action Plans

5. Spirometry

6. Patient education

7. Absenteeism

8. Health care utilization

Lesson learned: ALA has the ability to push best practices and quality forward in a friendly way.

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Regional Findings

Illinois

New Mexico

Texas

Oklahoma

Severity Rating ACT Controller Med AAP Spirometry Education0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Improvement in Quality IndicatorsBaseline - 12 Month - 18 Month Post-

interventionAggregate 23 Primary Care Clinics*

Baseline 12 Month 18 Month

Community Education and Outreach

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1. Erie Health System (Chicago) perfected asthma group visit

2. 2 Southside Chicago schools became Asthma Friendly Schools

3. NM legislation to stock emergency albuterol in schools

4. North Navajo Medical Center, EPA, and ALANM to air radio PSAs

5. Training 175 youth coaches in Tulsa

6. Taught 200 students in 7 schools in Tulsa Open Airways for Schools

7. Partnership with Texas Children’s Hospital

8. Trained 65 Asthma 101 community facilitators

9. Re-engaged Texas Gulf Coast Asthma Coalition

Can this Model be Replicated/Expanded

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Lessons learned: This is not a “program in a box”. Experience + Capacity = Success

1. Proven model with 10 years of experience

2. 160+ clinics in 9 different states

3. Have been supported by 8 different funding sources

4. Works with any variety of clinic models

5. Commitment of clinics for 1-year partnership

6. “Share generously. Steal shamelessly.”

7. Generalizable to other diseases states: COPD and tobacco cessation

Our Credo

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We will breathe easier when the air in everyAmerican community is clean and healthy.

 We will breathe easier when people are free from the addictivegrip of tobacco and the debilitating effects of lung disease. 

We will breathe easier when the air in our public spaces andworkplaces is clear of secondhand smoke.

We will breathe easier when children no longerbattle airborne poisons or fear an asthma attack. 

Until then, we are fighting for air.