1. Update: AHEAD Asthma Protocol QI Project Presented by: Katie Loveland, MPH, MSW

2. Background Funding through MT State Legislature and CDC Program responsibilities: Coordinate a statewide asthma control effort using State Asthma Plan Develop an asthma surveillance system for the state Facilitate asthma partnerships in MT MT Dept. of Public Health and Human Services All MACP activities and partnerships are voluntary, not regulatory

3. The MACP AHEAD Protocol Asthma Hospital Patient Education, Action Plan, and Discharge Protocol Program: New initiative funded by CDC grant and Flex Grant, partnerships with the PIN network Designed to facilitate the implementation of EPR-3 recommendations for patient education upon discharge in Montana Emergency Departments Simple, standardized educational tools and discharge instructions

4. AHEAD Program Goals ED Improve existing system for providing asthma education to patients Increase awareness of asthma and training on how to educate patients about their disease Fewer readmissions for preventable asthma exacerbations Patients Provide useful tools to understand and self- manage asthma after an exacerbation Improve ability to control their own disease and prevent future exacerbations Reduce need for urgent/emergent care for asthma and facilitate appropriate follow up with a PCP or specialist Primary Care Providers Increase referrals from ED for follow-up care following an asthma exacerbation Increase knowledge of which patients have uncontrolled asthma and facilitate better follow-up care in the appropriate clinical setting

5. AHEAD Intervention Design Continued implementation of protocol and ongoing program support Data collection (Time 2-End of Year 1) Chart review II Implementation (Next 12 months) Staff training (2 presentations)Implement AHEAD protocol Data collection (Now for the past year) Chart review I

6. Implementing the AHEAD Protocol Given written and verbal discharge education Pt given education pamphlet and discharge instructions Pt given brief self management education overview by ED staff Inhaler technique assessed Technique observed by ED staff with verbal instruction Scheduled for follow up appt with PCP Ideally, ED staff schedule appointment Appt time and date noted on written discharge instructions Prescribed ICS controller medication if appropriate Pt given medication to improve control, not just manage exacerbation All meds logged on discharge instructions PDF

7. AHEAD Protocol Materials 4 pages, pre-printed and provided free of charge by MACP Covers asthma pathophysiology, triggers, follow-up care, asthma medications and inhaler technique Educational pamphlet

9. AHEAD Protocol Materials 4 pages, front and back, pre-printed and provided free of charge by MACP Covers asthma pathophysiology, triggers, follow-up care, asthma medications and inhaler technique Educational pamphlet Customizable PDF form Specifies discharge medications and how to take them Includes space to record time and date for follow-up appointment Details instructions about how to monitor asthma over next time period and how to respond to symptoms Discharge instructions

11. AHEAD Protocol Materials 2 pages, front and back, pre-printed and provided free of charge by MACP Covers asthma pathophysiology, triggers, follow-up care, asthma medications and inhaler technique Educational pamphlet Customizable PDF form Specifies discharge medications and how to take them Includes space to record time and date for follow-up appointment Details how to monitor asthma over next time period and how to respond to symptoms Discharge instructions Customizable PDF form Not necessarily filled out by the ED staff To be taken to follow up appointment with PCP Asthma action plan

13. Ensuring completion of the protocol Be sure to document discharge activities in patient’s chart!

14. AHEAD Roles and Responsibilities 2 training presentations with CE and lunch provided 2 chart reviews of asthma ED visits, pre=1 year before implementation of project, post reviews year during implementation Chart review analysis with report sent back to the facility Free educational resources, asthma demo kits,etc. MACP Clinical champion Commitment by ED staff to provide discharge teaching to asthma patients Staff time to attend trainings Provide access to charts and space to conduct chart review within HIPAA regulations Facility

15. Chart Review Analysis

16. AHEAD Sites Sites with completed chart reviews/trainings St. John’s Lutheran Hospital in Libby Holy Rosary Healthcare in Miles City Pondera Medical Center in Conrad Sites scheduled for implementation Sidney Health Center in Sidney Barrett Memorial Health Center in Dillon We are still recruiting for this project!

17. Interested in AHEAD? Contact Jeanne Cannon: Montana Asthma Control Program Quality Improvement Coordinator 444.4592 jcannon@mt.gov

18. 1. National Asthma Education and Prevention Program Expert Panel Report 3. Guidelines for the Diagnosis and Management of Asthma. National Heart Lung and Blood Institute, Summary Report, 2007. 2. Montana Department of Public Health and Human Services. Montana State Asthma Plan, 2009. 3. Montana Department of Public Health and Human Services. The Burden of Asthma in Montana, 2007. 4.Centers for Disease Control and Prevention (CDC). www.cdc.gov/asthma/management.html 5. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. www.ahrq.gov/qual/asthmacare/asthmod1.htm 6. Joint Commission. www.jointcommission.org/NR/rdonlyres/7A1B10E8-7FBB- 479D-B635-94AAF5CC5F29/0/Child_Asthma_Form.pdf 7. McNairn JDK, Ramos C, Portnoy JM. Outcomes Measures for Disease Management. Medscape, www.medscape.com/viewarticle/559695_print, 2. 8. National Heart Lung and Blood Institute. www.nhlbi.nih.gov/health/prof/lung/asthma/pace References