South Bronx Asthma Partnership/Bronx-Lebanon Hospital
"The project facilitates the implementation of evidence-based, patient-centered interventions that can improve overall care for all patients with asthma."
Mamta Reddy, MD, Director, South Bronx Asthma Partnership (Bronx, NY)
Mamta Reddy, M.D., (right) discusses SOBRAP's Asthma Passport with Michael Cabana, M.D., at a NACI meeting in Baltimore, MD
Expanding upon its NACI Demonstration Project, the South Bronx Asthma Partnership (SOBRAP) at Bronx-Lebanon Hospital cultivated 32 physicians from across the country as asthma champions to nurture systems change in their respective practices and communities. The Clinical Asthma Champions Leadership Training Program aimed to build the leadership abilities of early-career physicians that serve vulnerable patient populations by enhancing their asthma knowledge and communication skills and by engaging them in a practice redesign project to improve asthma care in their current practice settings.
To prepare its asthma champions for these challenges, SOBRAP brought participants together in small groups for an interactive, specialist-delivered workshop with a focus on the National Asthma Education and Prevention Program's (NAEPP) Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma (EPR-3) and the six priority messages from the NAEPP's Guidelines Implementation Panel (GIP) Report. Each participant received a toolkit of clinical practice tools, practice redesign resources, and patient education materials. After the workshop, the asthma champions received technical assistance from SOBRAP to design and lead a "change project" at their institution, giving them the opportunity to apply in practice the teachings and skills they acquired from the workshop.
- Increase the number of asthma champions that can nurture systems change in their respective practices.
- Conduct workshops based on EPR-3 and GIP messaging to cultivate asthma champions through interactive, specialist-driven instruction.
- Redesign practice delivery systems through toolkit-based coaching of asthma champions.
Challenges & Solutions
Challenge: Foster community and collaboration among asthma champions after the in-person training ended. SOBRAP wanted to ensure that the asthma champions continued to grow and learn from one another after the in-person training was over, even though they could no longer meet face to face.
Solution: Provide technical assistance and group calls for asthma champions. SOBRAP held a series of group calls for its asthma champions that focused on such topics as challenges and advantages in team building, factors to consider in selecting process and outcomes measures, and the Plan-Do-Study-Act process. The calls provided time for interactive discussion among asthma champions about their challenges, solutions, and progress implementing practice change.
"Several of the Champions have
gone beyond the call of duty and have actually teamed up with other members of their institution to devise an additional change project related to asthma in another setting, namely the emergency room and inpatient settings, to bridge the gap between emergency and primary care."
-- Mamta Reddy, M.D., South Bronx Asthma Partnership
SOBRAP provided a 1.5-day workshop (offered five times) for the 32 asthma champions, using a systems-based approach and interactive, case-based discussion to help them to understand key clinical concepts from the EPR-3 and how to apply these concepts in clinical practice. An assessment conducted before and immediately following the workshop showed gains in participants' knowledge as a result of the workshop; further evaluation showed good retention of this knowledge six months later as well as greater confidence to carry out the strategies they had learned.
The asthma champions also reported improvements in how often they performed the clinical management strategies taught at the workshops, with the greatest reported improvement in how often they assessed risk and classified severity based on EPR-3 criteria and how often they applied the EPR-3's stepwise approach for medication management. They also reported improvements in how often they conveyed key educational messages with patients and their families, particularly in offering patients and families specific methods to minimize exposure to environmental asthma triggers, helping them understand the difference between inflammation and bronchoconstriction, and writing and explaining an asthma action plan.
SOBRAP's asthma champions, in turn, disseminated information to other providers through a variety of venues and forums. For example, 20 champions conducted grand rounds presentations at their institutions or at other local institutions and 10 champions discussed with residency training program directors in their area the importance of teaching guidelines-based asthma care early in training and asked them to help them arrange a presentation for residents-in-training. They also offered training sessions to medical students, clinicians in emergency departments and urgent care centers, school nurses, and sports leaders and coaches.
SOBRAP shared and collaborated with other NACI-funded projects to improve asthma care and outcomes. For example:
SOBRAP accepted six physicians from the Michigan Department of Community Health, another NACI Clinical Champion, and one physician from the Children's Research Institute at Children's Medical Center, a NACI Demonstration Project, as asthma champions in its Clinical Asthma Champions Leadership Training Program.
Mamta Reddy, M.D., SOBRAP's Director, collaborated with other NACI Clinical Champions on a presentation about their projects at a meeting of the NAEPP Coordinating Committee. Her remarks are included in the Special Edition issue of the NACI In the Know eNewsletter.
To meet its project goals, SOBRAP used asthma education and empowerment and systems integration in its work with patients and their families, health care providers, and community programs.
Other NACI-funded projects that used SOBRAP-type approaches are:
South Bronx Asthma Partnership
1650 Selwyn Ave, #2C
Bronx, NY 10457
Last Updated January 2013