To improve long-term outcomes for asthma patients and their families and to improve key process outcomes such as decreasing length of stay below the national average, and then maintain those outcomes over five years.

Process Measures:

• Asthma admissions to the Inpatient Unit (IPU) of The Barbara Bush Children’s Hospital at Maine Medical Center
• Length of stay on the IPU

Patient Outcomes:

• Emergency department visits / Hospitalizations over a 12-month period
• Missed work / school days over a 12-month period
• Percent of patients with persistent asthma on Controller Medications

The AH! (Asthma Health) Program is a multidisciplinary approach designed to improve asthma care.  This program was developed by MaineHealth, Maine Medical Center’s parent organization.  Through hard work, collaboration and cooperation this program has spread throughout Southern and Central Maine. The Barbara Bush Children’s Hospital (BBCH) at Maine Medical Center initially was one of three pilot sites to implement AH!. Over the years the BBCH has taken the lead in developing tools and tracking outcomes.  The AH! program consists of three components;

1. Formation of partnerships with patients, primary care providers, sub-specialists, asthma educators, and community agencies
2. Standardization of patient and provider education, provider encounter forms and self-management approaches
3. Monitoring of outcomes by interviews with patients and families at baseline, 6 and 12 months and by the annual collection of information on emergency visits and hospitalizations

Accomplishments:

• Developed innovative flip chart with updated National Heart, Lung, Blood Institute (NHLBI) Guidelines
• Developed and implemented standard health care provider encounter forms in paper and electronic format
• Developed and implemented statewide school management plan
• Developed and implement statewide Action Management Plan
• Adopted the Chronic Care Model to asthma care in over 15 clinical sites, including 3 hospitals
• Coordinated with school nurses to increase use of Maine School Asthma Plan
• Worked with local public health officials to pass legislation for children to carry and use inhalers at school
• Developed teaching curriculum for statewide Asthma Educator Institute
• Developed teaching curriculum for child care providers
• Effectively partnered with local (Mothers of Asthmatics) and state (Maine American Lung Associations) to form a valuable coalition

There has been a significant improvement in patient outcomes as measured by a reduction in the number of missed work and/or school days secondary to asthma in the previous 6 months, as well as a reduction in emergency department visits and hospitalizations. There also has been a steady and now stable decline in inpatient asthma admissions to the BBCH-IPU over the last 5 years.  The length of stay (LOS) for asthma patients has also declined and has remained below the national benchmark for asthma LOS.

Lessons Learned

• Create partnerships within your institution. Participation from Family Practice, Medicine, Nursing, Respiratory Therapy, and Emergency Medicine has been vital for the continued success of AH! Program.
• Foster partnerships within your community. Visiting nurses, school nurses, local and state policy makers, child care providers, patients and families are the backbone for our continued improvement in key areas of patient self-management and satisfaction.
• Standardize materials.  Developing easy to use and accessible educational materials for patients and health care providers has allowed us to focus on guidelines and keep the message clear and concise.
• Embed clinical decision support. By embedding decision support into health care provider encounter forms you allow for better teaching of medical students and residents and better compliance with national guidelines.
• Develop regional disease management forms. This enhances communication and goes hand-in-hand with standardization of patient care from one area of the region or state to the other. Statewide action management forms for home and school have allowed patients, health care providers, and community partners to better communicate about the patient’s asthma care.
• Track outcomes which are important to your institution.  This will allow for continued senior leadership support.
• Bring the patient and family into the heart of your program. Partnering with patient/family organizations is an important link to the real world of our patients.

Victoria W. Rogers, AH! Asthma Health,
Program Director KIDS CO-OP (Clinical Outcomes and Outreach Program)
The Barbara Bush Children’s Hospital at Maine Medical Center
rogerv@mmc.org

[Storyboard presentation at IHI's National Forum, December 2004]