Update: AHEAD Asthma Protocol QI Project

Presented by:Katie Loveland, MPH, MSW

Background

Funding through MT State Legislature and CDC

Program responsibilities:

Coordinate a statewide

asthma control effort

using State Asthma Plan

Develop an asthma

surveillance system for the state

Facilitate asthma

partnerships in MT

MT Dept. of Public Health and Human Services

All MACP activities and partnerships are voluntary, not regulatory

The MACP AHEAD ProtocolAsthma 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 GoalsED

Improve existing system for providing asthma education to

patients

Increase awareness of asthma and training on how to educate patients

about their disease

Fewer readmissions for preventable

asthma exacerbations

Patients

Provide useful tools to understand and self-

manage asthma after an exacerbation

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

Continued implementation of protocol and ongoing program support

Data collection (Time 2-End of Year 1)

Chart review II

Implementation (Next 12 months) Staff training (2 presentations) Implement AHEAD protocol

Data collection (Now for the past year)Chart review I

Implementing the AHEAD Protocol

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

• Technique observed by ED staff with verbal instruction

Scheduled for follow up appt

with PCP

• Ideally, ED staff schedule appointment

• Appt time and date noted on written discharge instructions

Prescribed ICS controller medication if appropriate

• Pt given medication to improve control, not just manage exacerbation

• All meds logged on discharge instructions PDF

AHEAD Protocol Materials• 4 pages, pre-printed and provided free of charge by MACP• Covers asthma pathophysiology, triggers, follow-up care, asthma

medications and inhaler technique

Educational pamphlet

AHEAD Protocol Materials• 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

Educational pamphlet

• 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

Discharge instructions

AHEAD Protocol Materials• 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

Educational pamphlet

• 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

Discharge instructions

• Customizable PDF form• Not necessarily filled out by the ED staff• To be taken to follow up appointment with PCP

Asthma action plan

Ensuring completion of the

protocol

Be sure to document discharge activities in patient’s chart!

AHEAD Roles and Responsibilities

• 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.

MACP

• 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

Facility

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 Coordinator444.4592jcannon@mt.gov

• 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/7A1B10E8-7FBB-479D-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

References