AsthmaCommunityNetwork.org

First Things First: Building The System

Strategy 1 - Ensure Mission-Program Alignment
Develop a program strategy that aligns your organization’s mission and priorities with your community’s asthma care needs, Respect the boundaries that your mission entails
Strategies in Action:
  • BPHC’s leaders asked, “What is our core function and where do we fit in the fight against asthma?” BPHC had capacity in environmental health, home-based services, and health education and saw an unmet need their program could address: in-home environmental interventions.
  • IMPACT DC’s mission is to serve underserved children with the most poorly controlled asthma. The program’s directors know that “our strength is our presence in the community and their trust in us. We can’t afford to promise anything we aren’t sure we can deliver and sustain.”
Strategy 2 - Build Evaluation in From the Start
Determine your program’s data needs and incorporate a process for collecting the data into the program’s design, Do what it takes to get the data you need—train staff to collect it, partner with local hospitals or public health departments, or provide incentives, if necessary
Strategies in Action:
  • CHA’s program seeks to reduce the number of ER visits and hospitalizations for children with asthma. One of CHA’s first steps when establishing its program was to create an information technology (IT) system to support an asthma registry and electronic medical records for patients. This infrastructure provides the mechanism CHA needs to collect the data to validate the program.
  • CAPP trains their home visitors to collect reliable environmental and health outcomes data using a standard assessment form. “Each home visitor needs to respond the same way to the question, ‘is the home carpeted’ when they see a throw rug.” CAPP reviewed the forms item-by-item with their home visitors to ensure consistent answers and CAPP now uses the data to assess the home visit program's impact.
  • CMFHP found it difficult to get quality of life (QOL) data from patients, so they began offering $10 gift certificates to patients who returned surveys.
Strategy 3 - Let the Data Guide the Program
Use surveillance, utilization, health outcomes, or other data that describes the burden of asthma in your community to guide strategic planning, program design, and implementation, Continuously monitor the data to optimize program delivery
Strategies in Action:
  • CMFHP used surveillance and health care data to identify their pediatric asthma population and assess the systems in place to meet its needs. They saw a large primary care provider (PCP) network, so they designed a program to turn available PCPs into high-quality asthma care providers by educating, supporting, and paying them to deliver improved care.
  • CHA uses its asthma registry and electronic medical records to monitor outcomes—“The IT infrastructure and constant review of evaluation data has been critical…When there’s slippage, we take immediate corrective action.” For more than three years in a row, CHA has held hospitalizations to 2% per year and ER visits to 6%.
Strategy 4 - Conduct Needs-Based Planning
Ask patients, providers, partners, and other stakeholders what they need and act on what you hear, Seek ongoing feedback from your target community to refine your program delivery
Strategies in Action:
  • CMFHP convened provider focus groups to discuss what it would take to improve pediatric asthma care. The answers were training, time, support for patient education, and regular feedback on the impact of their efforts. CMFHP hired asthma educators to provide intensive training for PCPs and developed codes that providers who completed the training could use to bill for patient education.
  • Based on feedback from families in the low-income communities they served, the BPHC began providing resources and materials as well as in-home environmental education to make it easier for families to act on the environmental management guidance they received.
Strategy 5 - Start Small to Get Big
Create a process for testing out new approaches and recognize that you cannot do everything at once. Building a high-quality asthma care system is a marathon, not a sprint
Strategies in Action:
  • UHP’s program leaders wanted to ensure that upgrades to care led to sustained improvements. One way they do this is to pilot-test potential improvements at single sites, refining interventions hundreds of times while carefully studying the data for evidence of improved outcomes. “When we see the slope in the line that we’re looking for, we launch our spread strategy…we have an approach that works and data to prove it.”
  • Optima staff noticed that, despite pharmacological advances in asthma therapy, hospital admissions for asthma were increasing. They designed a yearlong pilot study with 50 high-risk children, during which clinicians made home visits to develop self-management practices. When they compared post-study to pre-study utilization, they saw a dramatic improvement. Based on these results, Optima expanded the program to all members with asthma.
Strategy 6 - Align Incentives With Goals
Use institutional levers, such as pay for performance, awards for high-performers, and provider compensation for standards-based care, to drive progress toward program goals
Strategies in Action:
  • Monroe’s goal is to shift asthma care from ERs and hospitals to clinical settings by improving patient-provider interactions. Monroe incentivizes patients and providers to interact regularly by providing transportation subsidies for patients and CPT codes to reimburse providers for time spent on patient education.
  • Priority established the Physician Incentive Program (PIP) to offer incentives to providers to ensure that members use asthma medications appropriately and to implement the Planned Care Model. The goal is to encourage evidence-based practice so the program offers a financial incentive (per member per month) to physicians whose asthma patients meet a specified ratio of long-term controller to short-acting medication.
Strategy 7 - Focus on the Resource Strategy at Every Step
Build a strategy for resourcing and sustaining the program into your program design
Strategies in Action:
  • When CAPP expanded to North Philadelphia, they first convened a group of local partners to discuss the program, and hear about local needs. They also established a long-term resource plan: in year 1, CAPP would deliver the program; in year 2, CAPP would manage a train-the-trainer program to prepare community members to take over; in year 3, CAPP would be available as a resource, if needed. “Our home visit and community education [has been] incorporated into existing programs and sustained by local providers.”
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