University of California, San Francisco

"The APPUC study aims to provide asthma physicians and educators with learning modules to enhance asthma care practices and techniques based on the NAEPP Guidelines Implementation Panel (GIP) messages."

Michael Cabana, M.D., Principal Investigator, University of California, San Francisco (San Francisco, CA)

Project Snapshot

The University of California, San Francisco's (UCSF) Bay Area Asthma Champions Program recruited nearly two dozen local health care professionals from primary care practices serving racially and ethnically diverse minority and underserved families to bring home the recommendations of the National Asthma Education and Prevention Program's Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma (EPR-3) and the six priority messages of its companion Guidelines Implementation Panel (GIP) Report. The program combined elements of the well-established Physician Asthma Care Education (PACE) program and the Applying PACE to Underserved Communities (APPUC) cultural competency module developed through UCSF's NACI Demonstration Project.

UCSF provided its asthma champions a train-the-trainer session, expert technical assistance, and educational tools and methods to promote practice change. The UCSF team also developed one-hour presentations on the key GIP messages to help its asthma champions reach and engage larger numbers of providers, both within their own practices and within other busy primary care practice settings.

Project Goals

1. Identify asthma champions at primary care practices in the Bay Area.
2. Build upon collaborations in the Bay Area.
3. Improve care by GIP messages and assist primary care providers that serve minority and underserved families.
4. Use educational outreach visits to deliver key GIP messages.
   

Challenges & Solutions

Challenge: Overcome barriers to implementing all six priority GIP messages. UCSF staff and asthma champions noted that some primary care providers could only incorporate one or two of the six priority GIP messages into their asthma care. Providers reported that scheduling follow-up visits for asthma was particularly difficult, as patients and their families were not always adherent to recommendations or did not see the value of a follow-up visit when no asthma symptoms were apparent. They also indicated that "lack of time" to complete all the key messages was a barrier.

Solution: Start slow. Instead of attempting to incorporate all six GIP messages in their educational sessions, USCF and its asthma champions introduced the messages one at a time to practices that were not ready to implement all of the recommendations at once. They also provided additional implementation tools. For example, UCSF collaborated with the South Bronx Asthma Partnership (SOBRAP)/Bronx-Lebanon Hospital's NACI Demonstration Project to incorporate SOBRAP's "Asthma Passport" education tool into the onsite training sessions. The tool, which offers families a road map of topics to be covered during follow-up visits, was well received by a number of the practices. To address the lack of time, one site's asthma champion added a presentation on how "smart set" orders already within the electronic medical record could be used to save time by providing quick access to an asthma action plan, questions to help assess asthma control, and instructions for ordering inhaled corticosteroids, and by making it easier to document the care provided.

Highlights

UCSF collaborated with Regional Asthma Management and Prevention (RAMP) and other partners to recruit asthma champions from 23 primary care practices in the San Francisco Bay Area. RAMP also provided additional access to resources and tools for spreading the GIP messages.

UCSF distributed a recorded webinar training module, other educational tools, and asthma action plans to the asthma champions to use and share with their practices.

USCF's asthma champions adopted UCSF's webinar, slides, and accompanying implementation tools for presentations they conducted within their own practices. The asthma champions further expanded their outreach by conducting grand rounds presentations with other health care providers in the community.

Synergies

UCSF shared and collaborated with other NACI-funded projects to improve asthma care and control. For example:

UCSF collaborated with the South Bronx Asthma Partnership (SOBRAP)/Bronx-Lebanon Hospital, a NACI Demonstration Project, to use and adapt SOBRAP's "Asthma Passport" education tool.

UCSF worked with the Medical Society of Virginia Foundation (MSVF), a NACI Demonstration Project and Clinical Champion, to adapt several of MSVF's GIP-message slides.

To meet its project goals, UCSF applied a train-the-trainer approach to facilitate clinical practice change in an area affected by asthma disparities.

Other NACI-funded projects that used UCSF-type approaches are:

• Boston Public Health Commission
• HHC Woodhull Medical and Mental Health Center
• University of Michigan

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