A Web-Based Asthma Management Program for Health Care Providers: An Interactive Demonstration

P.O. Box 12194 · 3040 Cornwallis Road · Research Triangle Park, NC 27709Phone: 919-541-6389 · Fax: 919-541-6854 · wliao@rti.org · www.rti.org

RTI International is a trade name of Research Triangle Institute.

Presented at The 131st Annual Meeting of the American Public Health Association San Francisco, CA, November 15–19, 2003

Presented by Winston Liao and David Evans

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Introduction and Background

Present framework for collaborative activities: community need research protocol translation web-based materials

Conduct interactive demonstration of test web site

Identify essential implementation and evaluation issues

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Introduction and Background

Availability of web-based health information and educational materials

Developed for patient and/or healthcare provider without specific reference to practice setting

The Creating a Medical Home for Asthma program for healthcare providers in public health settings

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History of CMHA

In 1990, the NYC DOHMH Child Health Clinics invited Columbia University to help them improve quality of care for asthma.

Their needs assessment showed: Only 2% of their patients were diagnosed

with asthma by the clinic Staff lacked confidence to treat asthma

We worked together to: Assess current care and need for change Develop interactive, team-based training Evaluate program with RCT in 22 clinics

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NYC Child Health Clinics

45 clinics in low income neighborhoods. Preventive care & treatment of minor illness. 90% of patients were 0-7 years of age. 50% of patients received care free of charge Each clinic team had 5 members:

Pediatrician Nurse Public health assistant Receptionist Laboratory technician, part-time

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Child Health Clinic Team

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The CMHA program included:

5 half day interactive workshops for all clinic staff to learn to: Understand preventive care for asthma Work as a team to create a medical

home for patients Screen patients to identify asthma Treat asthma using NHLBI guidelines

Active management by clinic supervisors to reach program objectives.

Follow up by the intervention team to assess progress.

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After a two year follow-up, when compared to controls, the program clinics increased:

Percentage of patients identified with asthma from 2.5% to 6.9% (p<.001).

Scheduled visits for asthma by 75% (p<.001).

Controller medications given to 25% of patients vs. 2% in controls (p<.001).

Asthma education from physicians (p<.01) and nurses (p<.05).

Urgent visits for asthma to clinic (p<.01), but decreased ED visits by patients (p<.05).

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A Research-Based Translation Framework

Modification Program evaluation Training Production Dissemination

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Translation: Modification

Assure science in program is current Replace research elements and language Create additional tools to help in using

program: Getting Started Program Handbook Evaluation Plan

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Translation: Evaluation

Develop an approach for local evaluation of implemented program

Include process, impact, and outcome evaluation

Provide an evaluation plan Design considerations Levels of measurement Plan implementation Sample evaluation instruments

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Translation: Training

Identify competencies required to implement intervention

Provide a training curriculum and/or implementation guide

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Translation: Production

Define a framework for the development of user-friendly materials appropriate for target audience

Use effective design and layout principles for different formats (i.e., hard copy, web-based)

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Translation: Dissemination

Identify a home Determine a distribution and marketing plan Determine oversight (i.e., maintenance)

responsibility

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Collaboration

Consultation with CMHA investigators at Columbia University

Working relationship between Columbia University and New York City Department of Health and Mental Hygiene (NYC DOHMH)

Consensus to make materials available through the Internet, via the DOHMH web site

Engaging and keeping Centers for Disease Control and Prevention informed

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Features of the CMHA Web Site

Accessibility – materials downloadable in two additional formats: pdf and MS Word

Resources – helpful links provided to obtain additional information related to asthma

Section 508 compliance – web site usable and available to people with disabilities

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Web Site Components and Navigation

Introduction Getting Started Implementation Guide Instructor’s Guide Program Handbook Evaluation Plan Links Contacts

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Benefits of CMHA for clinic staff

Working together to improve quality of care for asthma can: Improve patient satisfaction with care Improve patient health outcomes Improve clinic staff satisfaction with their

work Create a sense of teamwork among clinic

staff they can apply to other problems

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Challenges

Development of web site materials Systems compatibility Distributor requirements User access

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Evaluation Issues

User perception and applications Distributor support, maintenance, monitoring Cost

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Web Site Access

E-mail address: healthcmha@health.nyc.gov

Request to be notified when the program is posted to the web site

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Acknowledgments

Leslie Boss, Centers for Disease Control and Prevention

Michelle Hsiang, Thomas Morgan and AIRE Team, RTI International

Andrew Goodman, Lorna Davis, Carmen Ramos-Bonoan, New York City Department of Health and Mental Hygiene

Monique C.B. Winslow, Global Health Information Systems

Marcia Pinkett-Heller, New Jersey City University Robert Mellins, Columbia University College of

Physicians and Surgeons Sandra Wiesemann, Medical and Health Research

Association of New York City, Inc.

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Creating a Medical Home for Asthma

Supported with funding from the National Heart, Lung, and Blood Institute and Centers for Disease Control and Prevention