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133rd Annual Meeting & Exposition
December 10-14, 2005
Jennifer H. Boer, MS, Patricia G. Porter, RN, MPH, CHES, Sibylle Lob, MD, MPH, David Rocha, BA, Joel W. Adelson, MD, PhD, MPH, and Patrick J. Fox, PhD, MSW. Integrating Medicine and Public Health (IMAP) Program, Institute for Health and Aging, University of California, San Francisco, 1616 Capitol Avenue, Suite 74.317, PO Box 997413, MS 7210, Sacramento, CA 95899-7413, 916-552-9929, Jholloma@dhs.ca.gov
Asthma is widespread in childhood and adult populations. Poor asthma management results in excess morbidity and reduced quality-of-life. We designed and tested an evidence-based intervention based on NIH recommendations using a Continuous Quality Improvement (CQI) model that integrated clinic- and community-based health care information from high-risk economically-disadvantaged children and families served by community health clinics in 7 geographically and ethnically diverse regions of California. Each clinic utilized an interdisciplinary CQI team that included a “physician champion” responsible for project leadership, a trained community health worker (CHW) to interface with patients, families, schools and community agencies, and other clinic personnel to institute systematic, data-driven improvements in asthma management. Evaluation consisted of a quasi-experimental design with baseline and 12 and 24-month follow-up. Patient/caregiver interviews and chart reviews were used to establish demographics, disease symptoms and severity, and quality-of-life indicators. Children (n=405) aged 5-18 years (mean=10.1 yrs), were mainly Latino (82%) and African-American (14%); 75% were covered by Medicaid. Comparisons of baseline and follow-up measures showed significant improvements in the number of children with a severity classification and a reviewed asthma action plan, and in patient and family confidence in managing asthma (p<0.0001 for all). Highly significant reductions were also found in the number of acute care and emergency department visits, overnight hospitalizations, daytime/nighttime symptoms, and number of school days missed (p<0.0001 for all). The project illustrates that an effective community health clinic-based CQI intervention, coupled with CHWs, can significantly improve outcomes in an economically-disadvantaged, geographically-disparate population of school-aged children with asthma.
Learning Objectives: At the conclusion of the session, the participant (learner) will be able to
Keywords: Quality Improvement, Health Disparities
Related Web page: arcc.ucsf.edu/caasa
Presenting author's disclosure statement:
I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.
The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA