1. Dr. Peter Berman Medical Director Katie Allen Asthma/COPD Health Educator

2. Financial Disclosure Statement Dr. Peter Berman and Katie Allen have no financial relationships with commercial interests relevant to this CME activity.

3. July August September October November December January February March April May Partnership ARC &PHHC Asthma/COPD & smoking cessation education 20122013 Participated in the Spirometry 360 program Asthma/COPD registry development Spirometry in- service for PHHC providers Providers begin making spirometry referrals SFGH spirometry program agrees to over-read PHHC spirometry tests

4. Potrero Hill Health Center distribution of patients

5. Lung Health Appointment Referral from provider (practitioner, RN, MEA), asthma/COPD registry, or drop-in Appointment is scheduled and reminder calls made At the apt: Asthma COPD education Spirometry Smoking cessation Report is entered into LCR and chart Follow up as needed

6. Lung disease Symptom evaluation Inhaler teaching with spacer Peak flow Office spirometry Controlling triggers Home visit referral Smoking cessation Oxygen therapy Pulmonary rehabilitation Asthma action plan

7. PHHC Lung Health Clinic 2012-2013

8. PHHC Lung Health Clinic (cont.) 2012-2013 Number of patients

9. Quality Improvement Early identification of obstruction for smoking population Improved medical management of asthma and COPD patients Sustainability Practical application of spriometry in-service for medical providers by Pulmonologist (Dr. George Su) In-service for all nursing and support staff for on how to use spirometry software and coach a patient

10. Case study Primary Care Apt Aug 1 Pt expressed interest in quitting Request for office PFT Lung Health apt Aug 6 Office Spirometry Asthma Education Smoking Cessation PFT SFGH Nov 21 Based on PFT Qvar dose was increased 44 Year old African American Male History of asthma Current smoker both tobacco and marijuana Previous occupation: Worked in the shipyard as a painter

11. Provider’s prospective Public Health Nurse to implement a new and important resource – In house PFTS – Timely – Asthma/COPD/Smoking Education One Stop Shopping Registry development all asthma/COPD & smokers – Focus: Education Referral generated from entire clinic staff, not just PCP Using current systems in place for providers to make referral – Pink slip – Warm handoff Communication—via Notes in LCR Challenges…. Allocating space – Must be flexible – Know who’s in what room Getting spirometry on PCP radar – In terms of any new service – Staff remembering to order – Need ongoing education/in- services – Improved Registry Sustainability – MEAs trained on spirometry