AH! Asthma Health Community Collaborative

A Community-Based Learning Collaborative Improves Asthma Care

Julie Osgood, MSProgram Director, Clinical Integration

(207) 541-7515

osgooj1@mmc.org

What is MaineHealth?

Integrated healthcare delivery system serving central, southern, and western Maine (serves 10 counties)

Established the AH! Asthma Health Program in 1998

Ran a Clinical Practice Collaborative in 2002 Interest in improving asthma care and outcomes in

communities

Why Asthma? Affects over 24 million persons in U.S.1

Enormous health impact – annually…– >1.5 million ED visits– >500,000 hospitalizations– >1,000,000 lost work/school days

Est’d $11.3 billion direct + indirect costs Maine with one of highest prevalence in nation: 8.9%2, or

>100,000 persons Asthma rates in Cumberland County are higher than State

and National averages.

1 NIH NHLBI Data Fact Sheet, US DHHS, Jan ’992 CDC: MMWR Weekly Aug 2001, Self-reported prevalence asthma (BRFSS)

AH! Asthma Health Community-based asthma education program Based on national (NHLBI) Guidelines Founded on nationally recognized Chronic Care Model Hospital-based Community Asthma Education

Specialists – Maine Medical Center--Portland, – Southern Maine Medical Center--Biddeford, – St. Mary’s Regional Medical Center--Lewiston– MaineGeneral Medical Center—Augusta/Waterville– CHANS HomeHealth—Brunswick– St. Andrews Hospital—Boothbay Harbor

Informed,ActivatedPatient

ProductiveProductiveInteractionsInteractions

Prepared,ProactivePractice Team

Improved Outcomes

DeliveryDeliverySystemSystemDesignDesign

DecisionDecisionSupportSupport

ClinicalClinicalInformationInformation

SystemsSystems

Self-Self-Management Management

SupportSupport

Health SystemHealth SystemResources and Resources and PoliciesPolicies

Community Community

Health Care OrganizationHealth Care Organization

Care ModelCare Model

Patient/Family

Primary CareProvider

& Care Manager

Community AsthmaEducation Specialist

Ah! Program Model

School

Hospital

Public Health

Housing

Pharmacy

Specialists

Home Health

Business

Our Approach

In 2002, we ran a clinical Collaborative (using the IHI model), involving physician office and hospital-based teams.

Teams made measurable improvements in the care and outcomes of asthma patients.

The focus was on clinical measures (e.g. use of controller meds, classification, flu shots)

All Teams : April 2002 to March 2003

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Classification Controller Meds

Aggregate Improvement

Pre

Post

+22%*+52%*

* Indicates a P<0.05 for the before-after comparison

THEN…We got to thinking—

Why not apply this model in the community?!!

And subsequently rec’d a grant from the Maine Health Access Foundation to improve asthma care among disparate populations in

Greater Portland (metro population: 230,000)

What is a Collaborative? Teams meet 3 times for intense, one-day

“Learning Sessions”

Back at the office/hospital/organization, teams implement small PDSA cycles –testing various rapid cycle improvements

Send staff and their Senior Leaders reports on progress every month

Receive TA from MH staff (via conference calls, listserv, one-on-ones, lunch n’ learn, etc.)

Meet at the end of the Collaborative to celebrate (and demonstrate!) successes

Teams continue the work by “Spreading” to others in their organization even after the Collaborative has ended.

Collaborative Learning

Breakthrough Series Model

Select Topic

Planning Group

Develop Framework & Changes

Participants

Prework

LS 1

P

S

A D

P

S

A D

LS 3 LS 2

Supports for Teams

E-mail Visits

Phone conf calls Assessments

Senior Leader Reports

Report results

(“Reporting Congress”)

Why an Asthma Collaborative?

The collaborative model worked for others to promote improvement ...IHI Breakthrough Series

Resources were identified to provide support, tools for teams interested in making change

Foster spread of change across the system—and the community!

Asthma Health Community Collaborative

Collaborative Steering Committee

Planning Jun-Sept 04

Collaborative Learning & Action Oct ’04 through Dec ‘05

Evaluation/Reporting Jan -Apr ‘06

Mo 0 3 4 18 19 22

Steering Cmtemtg 8/3/04

LS 110/4/04

LS 22/11/05

LS 36/6/05

Final Summary

Meeting1/06

Media output

Asthma Collaborative Listserv & Asthma Quality Network

Action Period 1

Action Period 2Action Period 3

Data Collection

Evaluation10/05-12/05

Teams to Date

Physician Office Practices/Clinics: MMC Family Practice Center, Portland Mercy Primary Care, North Deering Intermed Pediatrics, Yarmouth Healthcare for the Homeless, Portland Portland School Based Health Center

Child Care Organizations: PROP Child and Family Services, Portland Noah’s Ark Child Care Center, Windham (faith-

based)

Teams to Date

Multicultural Programs Minority Health Program, City of Portland Somali Health Care Program, Portland Latino Health & Community Service The Root Cellar (multicultural and faith-based)Business Barber Foods (large multicultural population)

Examples of Improvements Noah’s Ark Childcare Center

– Completed indoor air quality assessment and removes carpeting, mold, other IAQ issues

Portland School Based Health Center– Increased # students w/asthma who had

severity classification documented:• 50% at baseline to 81% at completion (2/06)

– Increased # students w/asthma who had current asthma school plan

• 18% at baseline to 27% at completion

Healthcare for the Homeless– Increased severity classification from 0%

to 94%– Increased controller medication use

w/persistent asthma patients 0% to 96% MMC Family Practice Center

– Increased severity classification 24% to 99%

– Increased controller meds 7% to 100%

Examples of Improvements

Asthma Collaborative-Portland School Baswed Health Center % Patients Appropriately Classified

0

20

40

60

80

100

Baseline Dec-04 J an-05 Feb-05 Mar-05 Apr-05 May-05 J un-05 J ul-05 Sep-05 Oct-05 Nov-05 Dec-05 J an-06

per

cen

t o

f st

ud

ents

wit

h

asth

ma

n=106n=121

summer vacation

Healthcare for Homeless-% Appropriately Classified

0

20

40

60

80

100

Baseline Nov-04 Dec-04 J an-05 Feb-05 Mar-05 Apr-05 May-05 J un-05 J ul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 J an-06

perc

ent

Examples of Improvements Minority Health Program (City of Portland, Public Health

Division, Health and Human Services Department)– Conducted focus groups (Latino, Somali) to

understand cultural issues related to asthma.– Educated Latino/Somali populations regarding

asthma.– Hired and trained 2 Community Health Outreach

Workers (CHOW’s) to act as liaison between community members and healthcare providers.

– Established Asthma HelpLine to bridge minority communities and health system.

Community Health Outreach Workers—Awralla and Nelida

Asthma HelpLine

Held press briefing on March 2, 2006– Front page article Portland Press Herald– Article in 3 other publications– Shows aired on community TV and public radio

Posters, business cards distributed throughout the Latino/Somali communities.

Signs on city (Portland) buses Rec’d calls resulting in referrals to asthma education.

– Reached 12% target in Somali community; 10% target in Latino (based on pop./prevalence)

Testimonial: Somali CHOW

I have a Somali female patient and her three children all who have asthma. I

made a home visit one day and the home was in a very poor condition. It had

a lot of mold. Paint was chipping every where and the heater was spitting

water that made the mold even worse. I reported it to their primary care

doctor and she wrote a letter to the landlord. I copied the letter to the city's

Lead Program and Code Enforcement. They also wrote a letter to the landlord

to renovate the home and offered to help (the city has a program for landlords

to improve home condition). The landlord is renovating the home. We have

also tested all the children in the home for lead. The patient is also controlling

her family's asthma better because of education and intervention by the

Community Health Outreach Worker (CHOW).

Qualitative Evaluation

Created DVD with patient/community member stories.– “After going though the program (asthma

education) - all the pieces fell into place. I understood how to treat the asthma and what I could do to prevent attacks and if I do have an attack I know what to do and how to monitor myself - I had never used a peak flow meter before and I realize now what an important tool that is.”

Pre-post patient surveys were conducted with over 430 patients from the MMC Family Practice Center

Summary/Conclusions

AH! Asthma Health convened a Community Based asthma Collaborative to improve asthma care and outcomes in the Greater Portland area.

A “Summary & Celebration” was held on April 7, 2006 for all teams to showcase their work.

This experience provided an effective model for healthcare organizations/health systems to work with motivated community organizations to improve asthma care and outcomes.