BY PEGGY PECK
A year after implementing a chronic care model designed by the AAFP Asthma Collaborative, staff at La Familia Medical Center in Santa Fe, N. M., noticed an impressive result: The proportion of all children at the center who regularly took peak flow measurements as part of their asthma management plan increased from 36 percent to 76 percent, said nurse-educator Paula Devitt, R.N.
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Even more impressive: Peak flow measurements increased to 100 percent among patients referred to the chronic care education program, she said.
Devitt and representatives from two other family practices discussed implementation of the quality improvement initiative during an Oct. 3 Scientific Assembly session, "Improving Chronic Illness Care in Family Practice: Lessons from the AAFP Asthma Collaborative." Jonathan Sugarman, M.D., professor of family medicine at the University of Washington, Seattle, said the program was designed to improve management of childhood asthma, but "this chronic care model can be used for other chronic illnesses such as diabetes."
Other outcomes at the La Familia Medical Center included substantial increases in use of both as-needed and maintenance medications among all patients and patients in the education program. Use of NIH severity classification increased from 10 percent to 52 percent for all patients and increased to 93 percent among patients in the education program. "Moreover, 64 percent of all asthma patients are now receiving flu shots, and this rate is even higher -- 96 percent -- among patients in the education program," Devitt said.
Thirteen practice teams participated in the yearlong Asthma Collaborative, a program facilitated by the National Initiative for Children's Healthcare Quality. The panel at the Assembly session featured three practice models: public health clinic, residency practice clinic and private practice.
Devitt said her public health clinic concentrated on self-management "because we think this is the area that can make the biggest difference in practice." One feature of the La Familia program was the decision to use asthma patients as the "promotoras," or promoters of health, she said.
Gregory Lyon-Loftus, Ph.D., M.D., who practices in Mont Alto, Pa., represented private practice. He said one of the take-home messages from his participation in the collaborative is that "the best asthma care is delivered when the patient is well," which underscores the need for regular follow-up. "The other major message is that it is important to measure disease, not symptoms," which is why his practice is concentrating on the use of peak flow and spirometry, he said.
William Price, M.D., director of the Enid Family Medicine Clinic of the University of Oklahoma Department of Family Medicine, said he and his residents have worked to involve the community -- schools, coaches and the local health department -- in asthma care. After a year, he said, this effort has been so successful that "we are now getting calls from the schools asking, 'How bad should the peak flow be before we send the child home?'"
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