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

1. 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 15–19, 2003 Presented by Winston Liao and David Evans 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.

2. 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

3. 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

4. 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

5. 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

6. Child Health Clinic Team

7. 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.

8. 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).

9. A Research-Based Translation Framework • Modification • Program evaluation • Training • Production • Dissemination

10. 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

11. 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

12. Translation: Training • Identify competencies required to implement intervention • Provide a training curriculum and/or implementation guide

13. 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)

14. Translation: Dissemination • Identify a home • Determine a distribution and marketing plan • Determine oversight (i.e., maintenance) responsibility

15. 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

16. 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

17. Web Site Components and Navigation • Introduction • Getting Started • Implementation Guide • Instructor’s Guide • Program Handbook • Evaluation Plan • Links • Contacts

18. 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

19. Challenges • Development of web site materials • Systems compatibility • Distributor requirements • User access

20. Evaluation Issues • User perception and applications • Distributor support, maintenance, monitoring • Cost

21. Web Site Access • E-mail address: healthcmha@health.nyc.gov • Request to be notified when the program is posted to the web site

22. 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.

23. Creating a Medical Home for Asthma Supported with funding from the National Heart, Lung, and Blood Institute and Centers for Disease Control and Prevention