Update: AHEAD Asthma
Protocol QI Project
Presented by:
Katie Loveland, MPH, MSW
Background
MT Dept. of Public Health
and Human Services
Program
responsibilities:
Coordinate a
statewide
asthma
control effort
using State
Asthma Plan
Funding through MT
State Legislature and CDC
Facilitate
asthma
partnerships
in MT
Develop an
asthma
surveillance
system for
the state
All MACP activities and partnerships are voluntary, not regulatory
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
AHEAD Program Goals
ED
Patients
Increase awareness of
asthma and training on
how to educate patients
about their disease
Provide useful tools to
understand and selfmanage asthma after an
exacerbation
Improve existing
system for providing
asthma education to
patients
Fewer readmissions
for preventable
asthma exacerbations
Improve ability to
control their own
disease and prevent
future exacerbations
Reduce need for
urgent/emergent care for
asthma and facilitate
appropriate follow up with
a PCP or specialist
Primary Care
Providers
Increase referrals
from ED for follow-up
care following an
asthma exacerbation
Increase knowledge
of which patients
have uncontrolled
asthma and facilitate
better follow-up care
in the appropriate
clinical setting
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
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
Scheduled
for follow
up appt
with PCP
Implementing
the AHEAD
Protocol
Prescribed
ICS controller
medication if
appropriate
• Technique observed by
ED staff with verbal
instruction
• Ideally, ED staff
schedule appointment
• Appt time and date
noted on written
discharge instructions
• Pt given medication to
improve control, not just
manage exacerbation
• All meds logged on
discharge instructions PDF
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
AHEAD Protocol Materials
Educational
pamphlet
Discharge
instructions
• 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
•
•
•
•
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
AHEAD Protocol Materials
Educational
pamphlet
Discharge
instructions
Asthma
action plan
• 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
•
•
•
•
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
• Customizable PDF form
• Not necessarily filled out by the ED staff
• To be taken to follow up appointment with PCP
Ensuring
completion
of the
protocol
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
Chart Review Analysis
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!
Interested in AHEAD?
Contact Jeanne Cannon:
Montana Asthma Control Program Quality
Improvement Coordinator
444.4592
jcannon@mt.gov
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/7A1B10E8-7FBB479D-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