Update: AHEAD Asthma Protocol QI Project

1. Update: AHEAD Asthma Protocol QI Project Presented by: Katie Loveland, MPH, MSW

2. Background • MT Dept. of Public Health and Human Services • Funding through MT State Legislature and CDC • Facilitate asthma partnerships in MT • Program responsibilities: • Coordinate a statewide asthma control effort using State Asthma Plan • Develop an asthma surveillance system for the state • All MACP activities and partnerships are voluntary, not regulatory

3. The MACP AHEAD Protocol Asthma Hospital Patient Education, Action Plan, and Discharge Protocol Program: • New initiative funded by CDC grant and Flex Grant, partnerships with the PIN network • Designed to facilitate the implementation of EPR-3 recommendations for patient education upon discharge in Montana Emergency Departments • Simple, standardized educational tools and discharge instructions

4. AHEAD Program Goals • ED • Patients • Primary Care Providers • Increase awareness of asthma and training on how to educate patients about their disease • Increase referrals from ED for follow-up care following an asthma exacerbation • Provide useful tools to understand and self- manage asthma after an exacerbation • Improve ability to control their own disease and prevent future exacerbations • Improve existing system for providing asthma education to patients • Increase knowledge of which patients have uncontrolled asthma and facilitate better follow-up care in the appropriate clinical setting • Reduce need for urgent/emergent care for asthma and facilitate appropriate follow up with a PCP or specialist • Fewer readmissions for preventable asthma exacerbations

5. AHEAD Intervention Design • Data collection (Now for the past year) • Chart review I • Implementation (Next 12 months) • Staff training (2 presentations) • Implement AHEAD protocol • Data collection (Time 2-End of Year 1) • Chart review II • Continued implementation of protocol and ongoing program support

6. Implementing the AHEAD Protocol • Given written and verbal discharge education • Pt given education pamphlet and discharge instructions • Pt given brief self management education overview by ED staff • Inhaler technique assessed • Technique observed by ED staff with verbal instruction • Scheduled for follow up appt with PCP • Ideally, ED staff schedule appointment • Appt time and date noted on written discharge instructions • Prescribed ICS controller medication if appropriate • Pt given medication to improve control, not just manage exacerbation • All meds logged on discharge instructions PDF

7. AHEAD Protocol Materials • Educational pamphlet • 4 pages, pre-printed and provided free of charge by MACP • Covers asthma pathophysiology, triggers, follow-up care, asthma medications and inhaler technique

9. AHEAD Protocol Materials • Educational pamphlet • 4 pages, front and back, pre-printed and provided free of charge by MACP • Covers asthma pathophysiology, triggers, follow-up care, asthma medications and inhaler technique • Discharge instructions • Customizable PDF form • Specifies discharge medications and how to take them • Includes space to record time and date for follow-up appointment • Details instructions about how to monitor asthma over next time period and how to respond to symptoms

11. AHEAD Protocol Materials • Educational pamphlet • 2 pages, front and back, pre-printed and provided free of charge by MACP • Covers asthma pathophysiology, triggers, follow-up care, asthma medications and inhaler technique • Discharge instructions • Customizable PDF form • Specifies discharge medications and how to take them • Includes space to record time and date for follow-up appointment • Details how to monitor asthma over next time period and how to respond to symptoms • Asthma action plan • Customizable PDF form • Not necessarily filled out by the ED staff • To be taken to follow up appointment with PCP

13. Ensuring completion of the protocol Be sure to document discharge activities in patient’s chart!

14. AHEAD Roles and Responsibilities • MACP • 2 training presentations with CE and lunch provided • 2 chart reviews of asthma ED visits, pre=1 year before implementation of project, post reviews year during implementation • Chart review analysis with report sent back to the facility • Free educational resources, asthma demo kits ,etc. • Facility • Clinical champion • Commitment by ED staff to provide discharge teaching to asthma patients • Staff time to attend trainings • Provide access to charts and space to conduct chart review within HIPAA regulations

15. Chart Review Analysis

16. AHEAD Sites Sites with completed chart reviews/trainings • St. John’s Lutheran Hospital in Libby • Holy Rosary Healthcare in Miles City • Pondera Medical Center in Conrad Sites scheduled for implementation • Sidney Health Center in Sidney • Barrett Memorial Health Center in Dillon We are still recruiting for this project!

17. Interested in AHEAD? Contact Jeanne Cannon: Montana Asthma Control Program Quality Improvement Coordinator 444.4592 jcannon@mt.gov

18. References • 1. National Asthma Education and Prevention Program Expert Panel Report 3. Guidelines for the Diagnosis and Management of Asthma. National Heart Lung and Blood Institute, Summary Report, 2007. • 2. Montana Department of Public Health and Human Services. Montana State Asthma Plan, 2009. • 3. Montana Department of Public Health and Human Services. The Burden of Asthma in Montana, 2007. • 4.Centers for Disease Control and Prevention (CDC). www.cdc.gov/asthma/management.html • 5. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. www.ahrq.gov/qual/asthmacare/asthmod1.htm • 6. Joint Commission. www.jointcommission.org/NR/rdonlyres/7A1B10E8-7FBB-479D-B635-94AAF5CC5F29/0/Child_Asthma_Form.pdf • 7. McNairn JDK, Ramos C, Portnoy JM. Outcomes Measures for Disease Management. Medscape, www.medscape.com/viewarticle/559695_print, 2. • 8. National Heart Lung and Blood Institute. www.nhlbi.nih.gov/health/prof/lung/asthma/pace