Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
Domestic Programs: Connecticut (cont'd)
Connecticut Children's Medical Center
Michelle M. Cloutier, MD
Easy Breathing, a copyrighted asthma management program for primary care clinicians who care for children, was developed in 1998 in Hartford, CT. The goals of Easy Breathing are to improve the diagnosis, determination of disease severity, and treatment of asthma for disadvantaged, urban, primarily minority children.
The program consists of a validated survey that parents of children (6 months to 18 years) who present for care, for any reason, at any of the six primary care clinics in Hartford. The survey addresses asthma symptoms, triggers, previous diagnosis of and treatment for asthma, family history, demographics, and environmental exposure. Once a physician diagnoses a child with asthma (using information from the survey, medical record, and additional testing) the physician determines the severity of asthma with the aid of a separate written instrument. A comprehensive management plan is then developed using a severity-specific treatment selection guide and color-coded (by severity) tabs. This plan helps parents know what medications to use, when to use the sick plan, and who and when to call.
A pre/post intervention study was done to determine whether Easy Breathing improves adherence to national asthma guidelines in the six urban primary care clinics in Hartford. Thirty-four primary care physicians, 37 midlevel practitioners, 32 nurses, and 69 pediatric and family practice residents and medical students participated. Before implementation of Easy Breathing clinicians at each site participated in four hours of training. Knowledge was assessed before (pretest) and after (posttest) the training program and 12 to 18 months after (follow-up) implementing Easy Breathing. Questions were divided into factual, guideline recommendation, and guideline application.
After implementing Easy Breathing adherence to prescribing guidelines was 93% to 99% and was associated with a 3-fold increase in inhaled corticosteroid prescriptions. Physicians reported that they had integrated Easy Breathing into practice but did not think this represented a substantial change. Easy Breathing has also been associated with improved healthcare utilization outcomes for children with asthma.
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