AH! Asthma Health Community Collaborative A Community-Based Learning Collaborative Improves Asthma Care

1. AH! Asthma Health Community CollaborativeA Community-Based Learning Collaborative Improves Asthma Care Julie Osgood, MSProgram Director, Clinical Integration (207) 541-7515 osgooj1@mmc.org

2. 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

3. 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 ’99 2 CDC: MMWR Weekly Aug 2001, Self-reported prevalence asthma (BRFSS)

4. 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

5. Care Model Community Health System Resources and Policies Health Care Organization ClinicalInformationSystems Self-Management Support DeliverySystem Design Decision Support Prepared, Proactive Practice Team Informed, Activated Patient Productive Interactions Improved Outcomes

6. Ah! Program Model School Patient/Family Hospital Specialists Primary Care Provider & Care Manager Home Health Community Asthma Education Specialist Pharmacy Public Health Business Housing

7. 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)

8. All Teams : April 2002 to March 2003 +22%* +52%* * Indicates a P<0.05 for the before-after comparison

9. 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)

10. 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

11. Collaborative Learning • 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.

12. Breakthrough Series Model Select Topic Participants Prework P P Develop Framework & Changes A D A D Report results (“Reporting Congress”) S S LS 1 LS 2 LS 3 Planning Group Supports for Teams E-mail Visits Phone conf calls Assessments Senior Leader Reports

13. 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!

14. Asthma Health Community Collaborative Collaborative Steering Committee Planning Jun-Sept 04 Collaborative Learning & Action Oct ’04 through Dec ‘05 Evaluation/ Reporting Jan -Apr ‘06 Mo0 3 4 18 19 22 Steering Cmte mtg 8/3/04 LS 1 10/4/04 LS 2 2/11/05 LS 3 6/6/05 Data Collection Evaluation 10/05-12/05 Final Summary Meeting 1/06 Media output Action Period 1 Action Period 2 Action Period 3 Asthma Collaborative Listserv & Asthma Quality Network

15. 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)

16. 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)

17. 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

18. Examples of Improvements • 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%

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20. 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.

21. Community Health Outreach Workers—Awralla and Nelida

22. 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)

25. 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).

26. 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

27. 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.