Advanced Medical Home Model for Asthma

1. Advanced Medical Home Model for Asthma Kevin Taylor, M.D. HVPA Medical Director

2. Future of Family Medicine Project2001 • Every American should have a Personal Medical Home that serves as the focal point through which all individuals- regardless of age, sex, race, or socioeconomic status—receive their acute, chronic, and preventive medical care services. ANNALS OF FAMILY MEDICINE WWW.ANNFAMMED.ORG VOL. 2, SUPPLEMENT 1 MARCH/APRIL 2004 http://www.annfammed.org/cgi/reprint/2/suppl_1/s3

3. The Advanced Medical Home Model Continuous Healing Relationships Prepared Proactive Practice Team Informed, Activated Patient Productive Interactions

4. WHAT IS THE SYSTEM SUPPOSED TO DO? A: Move people from right to left—and keep them there Health care spending Healthy/ Low Risk At-Risk High Risk Active Disease Early Symptoms 20% of people generate 80% of costs A value-based health care system Source: HealthPartners

5. An entire system of providing care for all of our patients. Episodic Acute Care The basic premise of the medical home concept is care that is managed and coordinated by a personal physician with the right tools will lead to better outcomes. Continuous Comprehensive Model

6. http://www.aafp.orgFamily Practice Management Oct 2004

7. Creating anAsthma Medical Home • Identifying our asthma patients • Pulled all asthma claims for the previous two years by searching for code 493.xx • Preparing our staff • Conducted staff meetings to review the goals for and importance of high-quality asthma care • Defined each staff member’s role in the different types of patient encounters, such as acute-care visits, follow-up or asthma planned-care visits and patient phone calls

9. Asthma Planned Care Visit • A planned-care visit is a proactive clinical encounter that focuses on overall patient goals that are not usually delivered during an acute-care visit.

10. Scheduling Asthma Planned-care visits • The National Heart Lung and Blood Institute (NHLBI) recommends: • Yearly visits for mild intermittent asthma, • Six-month visits for mild persistent asthma, • Four-month visits for moderate persistent asthma • Three month visits for severe persistent asthma

11. Conducting Asthma Planned-care visits • Patient self-assessment • Review of symptoms and direct observation of the patient’s inhaler technique • Objective clinical reassessment by spirometry • Clinical exam and assessment, with revision of treatment plan

12. Conducting Asthma Planned-care visits • Discussion of goal setting and self-management plans according to their symptoms and/or pulmonary-function parameters • Scheduling a follow-up appointment at the time of check-out

13. Asthma Control Test™ 1. In the past four weeks, how much of the time did your asthma keep you from getting as much done at work or at home? • none of the time •  a little of the time • some of the time •  most of the time •  all of the time

14. Asthma Control Test™ 2. During the past four weeks, how often have you had shortness of breath? • not at all •  once or twice a week • 3 to 6 times a week •  once a day •  more than once a day

15. Asthma Control Test™ 3. During the past four weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night, or earlier than usual in the morning? • not at all •  once or twice • once a week •  2 to 3 nights a week  •  4 or more nights a week

16. Asthma Control Test™ 4. During the past four weeks, how often have used your rescue inhaler or nebulizer medication (such as albuterol)? • not at all •  once a week or less • a few times a week •  1 or 2 times per day  •  3 or more times per day

17. Asthma Control Test™ 5. How would you rate your asthma control during the past four weeks? • completely controlled •  well controlled • somewhat controlled •  poorly controlled •  not controlled at all

18. http://www.asthmaactionamerica.org/i_have_asthma/control_test_pr.htmlhttp://www.asthmaactionamerica.org/i_have_asthma/control_test_pr.html

21. The project’s outcomes • Ninety-two percent of patients felt the visits improved their asthma care • Classification rates increased from 20 percent to more than 90 percent • Use of inhaled corticosteroids increased from 50% to 87% • The Asthma Days program generated $5,600 over three months (Planned care that would not have been provided + Spirometry) • Ongoing follow-up is assured when return visits are made at the time of check-out • The Asthma Days principles may be applied to any chronic disease care plan Kurtis S. Elward, MD, MPH, FAAFP Family Practice Management Oct 2004