Make It Easy to Support Your Program
The AH! Program is sustained by funding from a variety of sources. The funding model that AH! Program leaders originally established for local hospitals is a key factor in sustaining the program. One-third of the funding for community asthma education specialists comes from the community hospitals that host local AH! Programs; one third is funded by MaineHealth; and one third is funded by the income generated by community asthma education specialists for direct patient care.
Use Data to Demonstrate Your Program's Value--Demonstrate Your Impact
Recognition for excellent outcomes has caught the attention of supporters. The AH! Program has received awards from the national Environmental Protection Association and has been profiled on the Agency for Healthcare Research and Quality innovations Exchange website. Locally, the AH! Program has been recognized by the Maine Public Health Association and the American Lung Association of Maine, in recognition of the impact the program has achieved. AH! Program leaders' ongoing involvement with public policy issues, such as advocating to allow children with asthma to carry inhalers, keeps their work in the spotlight and helps to increase the program's visibility.
MaineHealth launched the AH! Asthma Health Program in 1998 to address high asthma prevalence rates in Maine. Environmental factors--such as the wide use of woodstoves and wood boilers, high ozone rates and mold problems in many old school buildings--have contributed to indoor and outdoor air quality problems in many areas of the state. In response, MaineHealth developed a comprehensive asthma management program that combines standards-based clinical care with robust environmental asthma management.
The AH! Program works closely with community organizations to increase awareness and education of environmental management of asthma. For example, Community Asthma Education Specialists found that child care centers were eager to convert to "green" cleaning practices and supplies after receiving practical information about the effectiveness of the products and where to find them.
Focus on the Resource Strategy at Every Step
The AH! Program has formed lasting relationships with a diverse group of health care partners, including school-based health centers, childcare centers, public health departments, worksites and other groups, to deliver asthma care and education.
Conduct Needs-Based Planning--Seek Input from the Community
In order to effectively reach Maine's disadvantaged populations, AH! Program researchers conducted needs assessments and developed culturally appropriate interventions targeted to diverse groups. A series of focus groups with Somali and Latino populations--two of Maine's growing foreign-language populations--revealed that many individuals in these groups are fearful of the U.S. health care system; didn't understand the impact of the environment on asthma; and live in substandard housing. In order to reach out to these groups and meet their needs, the program supported specially trained, indigenous community outreach workers to deliver educational interventions in their communities.
Translating standardized, evidence-based program materials into six languages and creating low literacy tools and materials using pictograms has also helped the AH! Program meet the needs of the community. Key community partners, such as the Maine Medicaid Program, the American Lung Association of Maine and the Minority Health Program of Portland's Public Health Division, help deliver services to disadvantaged populations.
The AH! Program supports member hospitals to develop and sustain certified asthma education specialists who work with patients in the hospital service area on an inpatient and outpatient basis.
A comprehensive evaluation mechanism is the centerpiece of the AH! Program. Built-in measurement tools, such as a web-based Clinical Improvement Registry (CIR), help measure results including behavioral, clinical, health status and cost outcomes. AH! Program leaders monitor and evaluate the effect of interventions on different populations including patients and physicians. Research for the past 10 years shows that typical reported outcomes (e.g., reduced ED and hospitalization health care utilizations) are largely sustained. Outcomes are comparable to other national reported studies and benchmarks. For example, the length of stay for hospitalized pediatric patients with a primary diagnosis of asthma was 1.98 days compared with the 2008 national benchmark of 2.23 days.
Evaluate Program Implementation
In order to quickly and easily measure the effects of the program's efforts on clinical and behavioral outcomes, the AH! Program integrated key measures into the CIR. To encourage physicians to use the CIR to track data points and increase the quality of asthma care, the Program works with the Physician Hospital Organization to provide financial incentives to physician practices for achieving excellent outcomes. The CIR has resulted in improved care of pediatric asthma patients by measurably increasing severity classification, controller medication use with persistent disease, written asthma actions plans, use of Quality of Life (QoL) Asthma Control Test (ACT) questionnaires, referral to asthma educators and other key measures.