The Morehouse Safety-Net Asthma Guidelines Implementation Project
| | |||
| Project ID: | |||
| Project Type: | Assessment | ||
| HP2010 Objectives: | 24-2. Reduce hospitalizations for asthma. 24-3. Reduce hospital emergency department visits for asthma. 24-6. Increase the proportion of persons with asthma who receive formal patient education, including information about community and self-help resources, as an essential part of the management of their condition. 24-7. Increase the proportion of persons with asthma who receive appropriate asthma care according to the NAEPP Guidelines. | ||
| Goals & Objectives: | | ||
| Rationale Abstract: | Asthma is growing public health problem. Over the last 15 years, the number of people affected by asthma has more than doubled to 17 million. It disproportionately affects children, particularly those under age 5 and racial and ethnic minorities, many of which reside in underserved communities, both rural and inner-city. Because of these disturbing reports, the NHLBI recently funded several community-based coalition projects to enhance the dissemination and utilization of science-based information on asthma. The Morehouse Safety-Net Practice based Research Network targets underserved populations in 16 of 142 Federally funded community and migrant health centers in Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. Two-thirds of the patients fall below poverty level. The project focuses training of primary care doctors to practice effective asthma management according to the NHLBI asthma guidelines and thereby reduce overall asthma morbidity in the southern region. | ||
| Rationale Detailed Narrative: | The asthma coalition project awardees began their work in March 2000. Morehouse was one of seven projects that were funded to increase the dissemination of asthma science-based information. The Asthma Coalition Awardees Project includes several approaches and strategies to increase implementation of the recommendations of the Expert Panel Report 2: Diagnosis and Management of Asthma. One example of an innovative strategy is being executed by Dr. Rust at the Morehouse Primary Care Institute in cooperation with 8 Federally-funded community health centers (CHCs) in selected Southeastern states. Each CHC has a disproportionately high prevalence of asthma. The overall objective of this project is to provide on-site training for primary care clinicians and other staff, provision of asthma kits (peak flow meters) and other resources, and technical assistance with re-designing medical records and other clinical systems to support population-based improvements in clinical outcomes. The NAEPP guidelines are used as the basis for implementing system changes to improve asthma care medical services. The Morehouse project strives to demonstrate that providing CHCs clinicians with resources, training, and re-designed processes can lead to improved asthma care management and improved clinical outcomes among high-risk patients in the CHC setting. The community centers in this region are called the Southeast Regional Clinicians Network (SERCN) and is the key location for these interventions. Two-thirds of the patients using these centers have family incomes below poverty level, 75% are either uninsured or on Medicaid. The patient population is ethnically diverse with 47% of the patients ethnically African Americans and 9% Hispanic. The SERCN is the clinical arm of the Southeast Consortium for Health Care, which is governed by a board representing local primary care clinicians providing care to the underserved. | ||
| Project Objective: | 1. Assess and monitor quality of asthma care and its outcomes 2. Improve quality of asthma care and its outcomes | ||
| Strategy Methodology Abstract: | 1. Gather data from patient questionnaires, chart audits, and hospital/ER visits 2. Work with partners to change primary care physicians’ practice | ||
| Strategy Methodology Detailed Narrative: | 1. Gather data from patient questionnaires, chart audits, and hospital/ER visits 2. Work with partners to change clinician behaviors and the system of care in safety-net CHC practices in order to reduce the gap between “usual care” and “optimal care” behaviors of for asthma. The strategies being implemented: -On-site training and system interventions at 16 sites (8- urban and 8-rural) -Improve performance on measures of adherence with national guidelines to >80% on each item at each clinic site -Increase resources for implementing guidelines, by making asthma kits with peak flow meters and MDI spacers available to all patients of participating CHCs regardless of patient’s ability to pay. -Introduce new forms and tools for documenting quality asthma care in medical records at all participating clinic sites -Implement standing orders and protocols for asthma management in all participating sites, including routine measurement of peak flow in all patients with asthma. -Implement standing orders and protocols for all patients who have an asthma-related ER visit or who miss a routine appointment (no-shows) for preventive or followup care. | ||
| Performance Measures: | 1. Clinician compliance with clinical practice guidelines and perceived barriers to implementation of guidelines 2. Patient adoption of self-management behaviors 3. Clinical outcomes of asthma (patient self-reports of functional limitation, e.g. symptom- free days, days of limited exertion, missed school days, frequency of use of rescue inhaler, etc.; pharmacy data (rescue-inhaler use, ratios of beta-agonist to long-term control medications); and ER visits, hospital admissions, and hospital-bed-days 4 Number of standard orders processed and protocols implemented in sites 5. Reduction in ER visits 6. Reduction in hospitalizations | ||
| Performance Partners: | The 16 Federally-funded Community Health Clinics The Southeast Regional Clinicians Network National Center for Primary Care --Morehouse School of Medicine Southeast Primary Health Consortium | ||
Archived page, reproduced from a 2001 copy. It is reference material, not current guidance.