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A Web-Based Asthma Management
Program for Health Care Providers:
An Interactive Demonstration
Presented at
The 131st Annual Meeting of the
American Public Health Association
San Francisco, CA, November 15–19, 2003
Presented by
Winston Liao and David Evans
P.O. Box 12194 · 3040 Cornwallis Road · Research Triangle Park, NC 27709
Phone: 919-541-6389 · Fax: 919-541-6854 · [email protected] · www.rti.org
RTI International is a trade name of Research Triangle Institute.
Introduction and Background

Present framework for collaborative
activities: community need  research
protocol  translation  web-based
materials

Conduct interactive demonstration of test
web site

Identify essential implementation and
evaluation issues
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Introduction and Background

Availability of web-based health information
and educational materials

Developed for patient and/or healthcare
provider without specific reference to
practice setting

The Creating a Medical Home for Asthma
program for healthcare providers in public
health settings
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History of CMHA

In 1990, the NYC DOHMH Child Health
Clinics invited Columbia University to help
them improve quality of care for asthma.

Their needs assessment showed:
 Only 2% of their patients were diagnosed
with asthma by the clinic
 Staff lacked confidence to treat asthma

We worked together to:
 Assess current care and need for change
 Develop interactive, team-based training
 Evaluate program with RCT in 22 clinics
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NYC Child Health Clinics

45 clinics in low income neighborhoods.

Preventive care & treatment of minor illness.

90% of patients were 0-7 years of age.

50% of patients received care free of charge

Each clinic team had 5 members:
 Pediatrician
 Nurse
 Public health assistant
 Receptionist
 Laboratory technician, part-time
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Child Health Clinic Team
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The CMHA program included:

5 half day interactive workshops for all clinic
staff to learn to:
 Understand preventive care for asthma
 Work as a team to create a medical
home for patients
 Screen patients to identify asthma
 Treat asthma using NHLBI guidelines

Active management by clinic supervisors to
reach program objectives.

Follow up by the intervention team to
assess progress.
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After a two year follow-up, when
compared to controls, the
program clinics increased:

Percentage of patients identified with
asthma from 2.5% to 6.9% (p<.001).

Scheduled visits for asthma by 75%
(p<.001).

Controller medications given to 25% of
patients vs. 2% in controls (p<.001).

Asthma education from physicians (p<.01)
and nurses (p<.05).

Urgent visits for asthma to clinic (p<.01), but
decreased ED visits by patients (p<.05).
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A Research-Based Translation
Framework

Modification

Program evaluation

Training

Production

Dissemination
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Translation: Modification

Assure science in program is current

Replace research elements and language

Create additional tools to help in using
program:



Getting Started
Program Handbook
Evaluation Plan
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Translation: Evaluation

Develop an approach for local evaluation of
implemented program

Include process, impact, and outcome
evaluation

Provide an evaluation plan
 Design considerations
 Levels of measurement
 Plan implementation
 Sample evaluation instruments
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Translation: Training

Identify competencies required to implement
intervention

Provide a training curriculum and/or
implementation guide
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Translation: Production

Define a framework for the development of
user-friendly materials appropriate for target
audience

Use effective design and layout principles
for different formats (i.e., hard copy, webbased)
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Translation: Dissemination

Identify a home

Determine a distribution and marketing plan

Determine oversight (i.e., maintenance)
responsibility
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Collaboration

Consultation with CMHA investigators at
Columbia University

Working relationship between Columbia
University and New York City Department of
Health and Mental Hygiene (NYC DOHMH)

Consensus to make materials available
through the Internet, via the DOHMH web
site

Engaging and keeping Centers for Disease
Control and Prevention informed
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Features of the CMHA Web
Site

Accessibility – materials downloadable in
two additional formats: pdf and MS Word

Resources – helpful links provided to obtain
additional information related to asthma

Section 508 compliance – web site usable
and available to people with disabilities
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Web Site Components and
Navigation

Introduction

Getting Started

Implementation Guide

Instructor’s Guide

Program Handbook

Evaluation Plan

Links

Contacts
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Benefits of CMHA for clinic
staff

Working together to improve quality of care
for asthma can:
 Improve patient satisfaction with care
 Improve patient health outcomes


Improve clinic staff satisfaction with their
work
Create a sense of teamwork among clinic
staff they can apply to other problems
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Challenges

Development of web site materials
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Systems compatibility
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Distributor requirements
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User access
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Evaluation Issues

User perception and applications

Distributor support, maintenance,
monitoring

Cost
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Web Site Access

E-mail address:
[email protected]

Request to be notified when the program is
posted to the web site
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Acknowledgments

Leslie Boss, Centers for Disease Control and
Prevention

Michelle Hsiang, Thomas Morgan and AIRE Team,
RTI International

Andrew Goodman, Lorna Davis, Carmen RamosBonoan, New York City Department of Health and
Mental Hygiene

Monique C.B. Winslow, Global Health Information
Systems

Marcia Pinkett-Heller, New Jersey City University

Robert Mellins, Columbia University College of
Physicians and Surgeons

Sandra Wiesemann, Medical and Health Research
Association of New York City, Inc.
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Creating a Medical Home for Asthma
Supported with funding from the National Heart, Lung, and Blood
Institute and Centers for Disease Control and Prevention
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