 Sept. 30 - Oct. 4, 2003 |
| ASSEMBLY EDITION • NEW ORLEANS |
A year after implementing a chronic care model designed by the AAFP Asthma Collaborative, La Familia Medical Center in Santa Fe, N. M., had an impressive result: The number of children who regularly took peak flow measurements to manage their asthma increased from 36 percent to 76 percent, said nurse-educator Paula Devitt, R.N.
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Devitt and representatives from two other family practices discussed implementation of the quality improvement initiative Friday during a practice management and enhancement course titled "Improving Chronic Illness Care in Family Practice: Lessons from the AAFP Asthma Collaborative." Jonathan Sugarman, M.D., professor of family medicine, 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."
Devitt said that as good as the increased peak flow measurements were for all asthma patients in the practice, "among patients referred to the chronic care education program, peak flow measurements increased to 100 percent." Other outcomes included an increase from 84 percent to 96 percent in use of PRN/maintenance medications among all patients and patients in the education program, and from 10 percent to 52 percent for use of NIH severity classification for all patients. Use of NIH severity classification 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," she 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 course 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.
Ed Schuurman, M.S., P.A.-C, who also works in the Mont Alto practice, said implementing the chronic care model is much easier when "you use an encounter form." The encounter form includes information such as medications, comorbidities, days with symptoms, personal best peak flow -- "in other words, everything you should be asking at every visit." Information from the encounter form can "be entered on a registry that will help in future management," he said.
Representing an academic model practice, 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?'"
The AAFP Asthma Collaborative was supported by an educational grant from Schering Corporation.
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Copyright © 2003
by American Academy of Family Physicians.