Practices in Transformation

A is for asthma

by Lisa S. on 1/23/2012 2:11:03 AM

Pediatric safety-net clinic improves asthma care with clinical registry

Community Health Services (CHS), a busy safety-net clinic for low-income children in Adams County, is a convert to the power of technology. “We can’t see a future without technology. We want to know: ‘How can we use it more?,’” says Rebecca Lusk, PNP, one of the providers. The organization adopted a clinical registry in late 2010 and “It’s been a wonderful first step for us, to use data to support the job we do. We have tightened the use of clinical guidelines, and we have seen improvement in asthma care by using flow sheets for daily [patient] management. The registry helps us know what things will be like when we get an electronic medical record (EMR).”

CHS joined HealthTeamWorks’ Patient-Centered Medical Home Foundations program in October 2010 after taking the SBIRT* training for substance abuse screening that HealthTeamWorks provides, and from technology guidance as part of HealthTeamWorks’ partnership with the Colorado Regional Health Information Organization. HealthTeamWorks Quality Improvement Coach Shelli James helped CHS establish the ReachMyDoctor patient registry, which allows a practice to monitor its care for specific patient populations — such as children with asthma.

Restructuring processes, culture to improve patient care

“The asthma flow sheet [generated by ReachMyDoctor] helps us do a thorough job,” Lusk says. “It increases the number of action plans we give out to families, reduces the number of prescription refill requests and improves our follow-up care for kids with persistent asthma.” In addition, she says, “ReachMyDoctor allows us to cross-check whether our patients have received flu shots.”

James says that the five CHS clinics in the PCMH Foundations program have made significant changes in the way they provide care for patients and their families, and for asthma patients in particular. “They hit the ground running, writing new protocols and revising tools, using their registry for planned care and completing action plans. The clinics made their medical assistants (MAs) an integral part of the team — responsible for data collection, outreach to patients, and with greater involvement in patient care. The clinics are continually examining their processes to learn how they can improve. CHS clinics are an invaluable asset to Adams County.”

Only source of primary care for many children

Nonprofit CHS was established more than 30 years ago in medically underserved areas of Adams County to provide primary and preventive healthcare services for children from birth to age 21. Nurse practitioners provide most of the care, with oversight from a part-time pediatrician. Commerce City, where five CHS clinics are located, has no private medical practices; CHS is the only medical organization that specializes in pediatrics. It also operates clinics inside two middle schools and two high schools. A sixth CHS community clinic is in Westminster, where private practices are unwilling to serve the indigent. 

“Our patient population is low-income — over 60 percent are Spanish-speaking only,” Lusk says. “Many are covered by Medicaid and CHP+; others are uninsurable and uninsured.  We offer these families assistance in applying for Medicaid/CHP+ or the CHS sliding fee. It’s also a transient population. We are the only source of primary care for some kids.”

“Accountable to the data”

In addition to the registry, HealthTeamWorks has helped CHS improve its work flow and encouraged the organization to give more responsibility to MAs, freeing time for other healthcare professionals. Lusk says that the MAs “have enjoyed the additional responsibility and greater involvement in patient care.” Because of HealthTeamWorks’ process redesign, CHS now devotes time during provider meetings for data review: “We are now accountable to the data and use it to guide us.”

Elated over their clinical progress with the registry, CHS employees “want to do more,” Lusk says. “Technology doesn’t take that much time and the benefit is apparent to providers. We hope to get an EMR so we can manage childhood obesity [ReachMyDoctor does not do this]. We want to incorporate what we’ve learned with asthma for other conditions.”

*Screening, Brief Intervention, Referral to Treatment