Use Data to Demonstrate Your Program's Impact
The Center's asthma program is sustained through funding from the CDC, the McKesson Foundation and California tobacco-tax revenue. The demonstrated success of several of the Center's key programs, including CB's successes in surveillance, schools-based interventions and addressing asthma disparities and CAPHI's successes in addressing the burden of asthma in California, has led to repeat funding from CDC, McKesson and annual state tobacco tax funding.
Promote Institutional Change for Sustainability
The Center's focus on building community capacity and partnerships to address asthma throughout the state has led to sustainable asthma improvements. Funding and technical assistance have increased the ability of local organizations and clinical providers to implement the SPAC and have seeded ongoing commitment to addressing California's asthma burden. For example, the San Diego Black Health Associates (SDBHA) received funding from the Center in 2006 and 2007 to address asthma disparities among African Americans in faith-based settings. While the group had substantial experience working with the target population, asthma had never before been a focus. Now, SDBHA targets asthma as a key issue in their ongoing work to reduce chronic disease health disparities.
Similarly, capacity building efforts targeting improved clinical care have resulted in sustainable improvements that directly affect asthma morbidity. For example, CAPHI's IAC collaborative has resulted in improved clinical care that will continue even after funding for the IAC ends. Also, educational outreach by the Center's WRA program to health care providers and workers affected by WRA has built enduring clinical and public capacity to help patients reduce exposures and manage asthma in the workplace.
The CDPH Center for Chronic Disease Prevention and Health Promotion (the Center) has a unique and critical leadership role in combating asthma in California. It facilitates a diverse statewide network to ensure asthma efforts are coordinated and strategic. The Center also oversees and supports partnerships focused on asthma care improvement, helps to evaluate the effectiveness of different approaches and spreads knowledge and capacity to deliver interventions that work. The Center's efforts increase the capacity of health care and asthma service providers, public health practitioners, community education and health promotion organizations and many others working to reduce the burden of asthma in high need communities statewide.
The Center's various asthma programs focus on surveillance and data-driven, community-focused public health interventions; monitoring of pollutant exposures that may be related to work-related asthma (WRA); promoting education and effective treatment for WRA; and facilitating community-wide, school-based and clinical asthma education, management and prevention.
CAPHI promotes best clinical practices in pediatric asthma care in partnership with CHCs. The partnerships target high-need, underserved communities. CHC leaders work with local health departments, providers and plans to promote clinical care grounded in EPR-3. One way the partnership improves care is through the EPR-3 summary tool, a consensus-based tool developed by the CHC-CAPHI partnership to manage patient encounters according to national standards. In the first six months after the tool's adoption, the CHCs saw a 15% improvement in the number of pediatric patients documented for asthma control, a 7% increase in the number of patients using appropriate controller medications and a 28% increase in appropriate chart documentation of key indicators of asthma control.
Conduct Needs-Based Planning: Seek Input from the Community
The Center's many asthma initiatives fit into and help drive delivery of a comprehensive strategy for reducing the burden of asthma statewide. This strategy is the result of a multi-year, stakeholder-led planning process that created the Strategic Plan for Asthma in California (SPAC). The Center developed SPAC through a facilitated and highly collaborative process that brought together academic and clinical scholars, government representatives, public health practitioners, health organization leaders, legislative staff and many other asthma leaders from across the state. The SPAC--first released in 2002 and updated in 2007--ensures that state-level efforts are responsive to the needs of California's diverse asthma care leaders and that the Center's activities are integrated with community-level action.
Let the Data Guide Program Planning, Design and Implementation
All of the Center's asthma programs are aligned with the SPAC. The Center uses its unique position and capacities in surveillance, technical assistance and the ability to coordinate activities at the state and community levels to help ensure that local asthma efforts are data-driven, evidence-based and strategic. For example, the Center's California Breathing (CB) Program helps to increase understanding of asthma surveillance data and its use in program planning, links agencies and organizations addressing asthma to maximize efficiency and program efficacy and supports implementation of targeted interventions. CB uses surveillance data to focus its grant-making to community-based, faith-based and county organizations in the most disproportionately affected communities.
Build Evaluation in from the Start
The Center's California Asthma Public Health Initiative (CAPHI) leads a program with a network of community health centers (CHCs) to Improve Asthma Control (IAC). An IAC collaborative with 10 CHCs seeks to integrate the National Guidelines for the Diagnosis and Management of Asthma (EPR-3) into standard clinical practice in communities that serve a diverse population of children with asthma, the majority of whom are covered by Medicaid. The IAC focuses on tool development to support clinical improvements; training for CHC staff on topics such as culturally competent communications and supporting tenants' rights; and placement of asthma care coordinators at CHCs to provide individualized patient education and home visits. From the beginning, the IAC program defined process and outcomes measures to track the implementation and success of the interventions. The impact of each CHC program has been carefully evaluated using a quasi-experimental evaluation design. The design combines longitudinal patient interviews with cross sectional chart review to determine improvements in clinical care, changes in the frequency of asthma symptoms and changes in asthma health care utilization.
HIGH PERFORMING COLLABORATIONS--BUILD ON WHAT WORKS
The Center's focus on leading and facilitating partnerships resulted in a statewide agenda and a shared framework for planning and implementing asthma activities across California. This focus resulted in collaborations with who are recognized leaders in their communities and helped to garner important social capital and the community infrastructure necessary for implementing the Strategic Plan for Asthma.
COMMITTED LEADERS AND CHAMPIONS: INSTITUTIONALIZE THE FOCUS ON OUTCOMES CB provides easy access to surveillance data via its website. By helping community and clinic-based leaders to use data that describes asthma prevalence, severity and outcomes at the community and state level, the Center helps to ensure asthma efforts are responsive to the risks and needs of each community. Helping stakeholders to use surveillance data to target their work furthers two key goals of the SPAC--data-driven programming and coordination of state and community work.
The Center's asthma programs evaluates all clinical and environmental efforts, the effectiveness of its partnerships, the utility of its surveillance system and the cumulative impact of statewide efforts on asthma morbidity and mortality. All asthma programs in the Center are predicated on logic models with specific process and outcome measures. The CB program uses the Centers for Disease Control and Prevention's (CDC) Framework for Public Health Evaluation as a guide. Partners, including impacted stakeholders, play a critical role in the evaluation process. Their participation ensures that our evaluation efforts inform our programming as well as the programming of key partner organizations.
Use Evaluation Data to Demonstrate the Business Case
The Center conducts extensive longitudinal evaluations of the clinical quality improvement (CQI) initiatives CAPHI supports, such as the IAC described above. All clinical initiatives have demonstrated similar significant improvements in care, reductions in asthma-related symptoms and reduction in costly health care utilization. Though specific returns on the Center's investments through CAPHI's CQI initiatives are hard to capture, the sizeable reductions in utilization achieved by CAPHI-funded programs saved costs through a 64-78% decrease in asthma-related ED visits and 67-85% drop in hospitalizations. These reductions directly impact the state's Medicaid spending, which accounts for 61% of state asthma hospitalization charges. CAPHI-funded clinical programs also have demonstrated dramatic improvements in patient quality of life and significant reductions in missed school and work days.