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

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A Web-Based Asthma Management Program for Health
Care Providers An Interactive Demonstration
Presented at The 131st Annual Meeting of the
American Public Health Association San
Francisco, CA, November 1519, 2003 Presented by
Winston Liao and David Evans
P.O. Box 12194 3040 Cornwallis Road
Research Triangle Park, NC 27709Phone
919-541-6389 Fax [phone]
wliao_at_rti.org www.rti.org RTI International
is a trade name of Research Triangle Institute.
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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 (plt.001).
• Scheduled visits for asthma by 75 (plt.001).
• Controller medications given to 25 of patients
  vs. 2 in controls (plt.001).
• Asthma education from physicians (plt.01) and
  nurses (plt.05).
• Urgent visits for asthma to clinic (plt.01), but
  decreased ED visits by patients (plt.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
• Instructors 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_at_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