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Asthma Health Outcomes Project

Overviews of Surveyed Asthma ProgramsSeptember 2005

Domestic Programs: IllinoisBack to Index

System Redesign at a Community Health Center

Rural Health Inc.

Anna, IL

Molly Johnson, APN, NP

(618) 833-4471         


System Redesign at a Community Center asthma program was implemented in August of 2001 by Rural Health Inc. in Anna, IL. The goals of the program are: 1) to provide better care, with improved health outcomes for its patients with asthma; 2) to learn how to implement the Chronic Care Model, using asthma as the disease focus; 3) to expand the asthma Chronic Care Model beyond the initial population of focus to all asthma patients at Rural Health; 4) to experience change through the work of an interdisciplinary team within the health center and to use that team model and experience to affect change in other areas of the health center; and 5) to use the asthma chronic care process as a model to provide better care for its patients with other chronic medical conditions.

The system of care at Rural Health Inc. was changed by establishing a registry, encouraging routine visits, developing effective patient education and goal development, expanding the nurses' roles, and following the National Institutes of Health (NIH) Guidelines very closely. All providers from Rural Health, Inc. are required to participate in the program. There was initially one intensive half-day education session for the providers and nurses. Sessions included education on proper assessment of asthma patients, treatment according to NIH Guidelines, encouraging regular follow-up, and how to educate patients about asthma and help them develop their own self-management plan. Each new provider is also educated on the asthma program, the NIH guidelines, and the Chronic Care Model as part of their orientation. On-going asthma education and updates are provided at medical staff meetings. Each participating provider is also given quarterly feedback about their performance. There are periodic creative and playful training sessions for the nursing and medical staff. Lastly, an asthma team reviews and evaluates aspects of the program monthly.

Program evaluation to date demonstrated a positive impact on lost days (school and work), symptom-free days and anti-inflammatory medication use for patients with chronic asthma.

The program is ongoing.

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