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APHA Scientific Session and Event Listing

Helen Ragazzi, MD¹, Hedley Gunther, RN, FNP¹, Anne-Marie Irani, MD², Ryan Ehrensberger, MPH³, and Adrienne E. Keller, PhD⁴. (1) CARMA, 2025 East Main St., Suite 207, Richmond, VA 23223, 804-644-2149, hragazzi@vcu.edu, (2) Pediatrics, Virginia Commonwealth University, Box 980225, Richmond, VA 23298, (3) CARMA, Bon Secours Richmond Health System, 2025 East Main St., Suite 207, Richmond, VA 23223, (4) Prevention Research, University of Virginia, P.O. Box 800623, Charlottesville, VA 22908

The Central Virginia Asthma Coalition (CVAC) was created by local community members (professional and lay) to address the high asthma morbidity in the Richmond area. In 2001, CVAC received a multi-year grant from the CDC as part of the Controlling Asthma in American Cities Project. Controlling Asthma in the Richmond Metropolitan Area (CARMA) is managed by one of CVAC's participating organizations, Bon Secours Richmond Health System. The majority of pediatric asthma is treated by pediatricians and family practitioners. Published evidence, and local experience, indicates that many PCPs do not follow best practice guidelines. Single-point-in-time educational interventions have limited potential to change practice behavior. In 2004, CARMA initiated a multilevel Provider Quality Improvement (PQI) intervention. PQI is offered to pediatric practices that meet one or more of the following criteria: serve patients in high hospitalization rate zip codes; are identified by a pharmaceutical company as high prescribers; request information about CARMA; have a practitioner who signed up for a CARMA CME workshop. Led by a primary care physician and pediatric nurse practitioner, PQI is modeled on “academic detailing,” an intervention derived from drug company marketing strategies, with demonstrated success in changing practice patterns. The highest PQI level (Level 3) is an individualized practice-focused continuous quality improvement initiative. Ten Key Clinical Activities recommended by the National Asthma Education and Prevention Program are the basis for physician and nursing asthma management objectives, with the goal of establishing an “Asthma Friendly Practice” providing care according to the NHLBI (National Heart, Lung and Blood Institute) Guidelines. At least one provider and one nurse is identified in each practice as a “Champion,” and is responsible for facilitating the dissemination of asthma information throughout the practice. Practices participating in Level 3 PQI agree to periodic chart review for evaluation of practice change. The key indicators are severity classification, patient education, spirometry and action plans. To date, six practices have completed Level 3 PQI, with pre- and post-intervention chart review. The mean months of participation is 4.5 (range=3-6), with weekly contact with the CARMA PQI team. The mean number of charts reviewed per practice pre-intervention=15.8 (range=6-30), post-intervention=19.8 (range=14-26). The mean percent improvement for each indicator (with range of values) is: classification=.44 (.13-.64), education=.42 (.16-.76), spirometry=.29 (-.11-.90), action plans=.39 (.18-.73). Overall, these six practices had a 37% improvement in performance on the four indicators, with a range from 16% to 63%.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Articulate the evidence that many PCPs do not follow best practice guidelines in the management of pediatric asthma
• Describe the process of “academic detailing”
• Identify appropriate indicators of improvement in the management of pediatric asthma within a primary care practice setting

Keywords: Asthma, Primary Care

Presenting author's disclosure statement:

Not Answered