Targeting Improvements in Asthma Morbidity in Chicago: Quality Improvement

Supported by funding from The Otho S.A. Sprague Memorial Institute, a series of Chicago-area collaboratives were formed to assess current asthma care patterns and to use social networking theory to improve quality and reduce unwanted variation in care of asthma in Chicago. Three collaboratives were conducted: (1) the Chicago Emergency Department Asthma Collaborative (CEDAC), a 1-year collaborative with 21 participating EDs; (2) the Chicago-Area Hospital Asthma Collaborative, a 6-month collaborative with 17 participating hospitals; and (3) the Chicago Primary Care Asthma Collaborative (CPAC), a 6-month collaborative with 15 participating practices.

The collaboratives used techniques pioneered by the Institute for Healthcare Improvement. They provided participants with tools to measure simple process-of-care elements; shared knowledge, skill, and techniques of improved asthma care using social learning networks; assisted participants in setting and attaining specific asthma quality-improvement goals; and convened regular meetings in which teams reported quality improvement cycles and shared asthma-care process-attainment rates. The collabo-ratives generated tremendous enthusiasm among the participants because they were a venue for discussing asthma quality improvement efforts, and they modeled cross-disciplinary quality improvement teams. The collaboratives were not designed to show improvement in patient outcomes. However, many teams showed improvements in asthma care practices. For example, the CEDAC effort showed a significant increase in the percent of asthma patients that received systemic steroids while in the ED.

Asthma care

The Community-Provider-Patient Partnership to Improve Asthma Care was a project of the Chicago/ Cook County Community Health Council that aimed to create organizational change in primary healthcare sites to improve asthma care. Funded by the Robert Wood Johnson Foundation and The Otho S. A. Sprague Memorial Institute, the partnership included an intensive 5-month intervention. Clinical coordinators at 30 primary care sites impacted 211 providers in five underserved regions in Chicago/ Cook County. The goal was to increase prescriptions of antiinflammatory medications, increase use of asthma action plans, improve asthma self-management support, and improve the quality of asthma trigger assessment and avoidance. The project directly supported 627 patients to more fully participate in their care, and developed five coalitions that increased awareness of the seriousness and controllability of asthma in the targeted regions.

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The Asthma Champion Initiative, a project of the Cook County Bureau of Health Services, continued to expand the pool of primary care providers with asthma expertise in Chicago neighborhoods. This project was jointly funded by the Centers for Medicaid and Medicare Services and the Illinois Department of Public Aid. A total of 34 primary care providers and 16 nurses/health educators from 27 primary care sites participated in a 16-week clinical rotation in an asthma specialty clinic that modeled optimal asthma assessment and chronic illness comanagement. Similar to the CPAC, the Asthma Champion Initiative used quarterly group meetings to facilitate asthma quality improvement efforts at each site, and to share strategies around achieving these goals.