ECHO-Chicago asthma education project pre-intervention provider self-efficacy

Document Type

Other

Publication Date

2017

Abstract

Rationale: An estimated 150,000 children in Chicago suffer from asthma, with the greatest disease burden among Black children. Black children have 2-3-fold higher rates of hospitalization and emergency department (ED) visits and 4.9-fold higher mortality compared to white children. In the predominantly Black communities on Chicago’s South Side, among the 17.3% of children with asthma, 58.7% visit urgent care or EDs, 57.7% miss school, and 49% require parents to miss work annually due to asthma, with rates of asthma-related hospitalization as high as 77.5 per 10k population. Asthma also contributes to disrupted sleep thereby impacting daily functioning, with significant implications for children’s school performance and well-being, especially for vulnerable populations. Methods: Research shows that adherence to National Heart, Lung, and Blood Institute (NHLBI) guidelines leads to decreased healthcare utilization and morbidity. However, prevalence in Chicago’s Black communities suggests critical gaps in the translation and implementation of these guidelines. [AVB1] In September 2016, we recruited 12 primary care providers (PCPs) from 8 Chicago community health centers to participate in a pilot to support increased PCP use of NHLBI asthma guidelines in underserved Chicago communities using the Extension for Community Outcomes at the University of Chicago (ECHO-Chicago), an evidence-based telementoring model to expand capacity of community-based PCPs in the management of common, chronic diseases. Results from a pre-intervention PCP survey indicated lower self-efficacy in ability to 1) diagnose asthma, 2) choose appropriate inhalation device, and 3) assess adherence and proper technique using an inhaler. Results: A pilot curriculum based on results of the pre-intervention survey was developed by a University of Chicago asthma care team comprised of a primary care provider in Internal Medicine/ Pediatrics, a specialist in Pediatric Pulmonary Medicine, and a Pediatric Pulmonary Clinical Nurse Specialist. A series of 12 60-minute telementoring sessions will be held from 9/2016 through 2/2017. Each session includes a 20-minute didactic and patient case presentations by participating PCPs. Conclusions: The ECHO-Chicago asthma intervention is designed to increase PCP use of NHLBI asthma guidelines. Evaluation of the intervention will be based on changes in provider self-efficacy, provider behaviors and patient health outcomes using data from surveys and patient case presentations. Based on previous studies by ECHO-Chicago and Project ECHO at the University of New Mexico, we expect increased capacity to manage complex asthma in the primary care setting, indicated by improved self-efficacy, practices changes, and health outcomes for patient cases presented at ECHO-Chicago sessions.

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