“So the NACI in essence is a catalyst giving us the vision of the goal and giving us the supporting tools that enable to carry out this mission on the front lines”
Michael Akerman, M.D., Asthma Program Director, HHC Woodhull Medical and Mental Health Center (Brooklyn, NY)
Michael Akerman, M.D., describes how HHC Woodhull Medical and Mental Health Center's PACER program helps providers achieve a guidelines-based standard of asthma care.
Desire LaTempa, Woodhull's Asthma Program Coordinator, conducts one-on-one coaching sessions with physicians and nurses.
To achieve its goal of a single standard of care, HHC Woodhull Medical and Mental Health Center (“Woodhull”) shaped its Physician Asthma Care Education Reinforcement (PACER) Program to serve as a model for overcoming barriers to guidelines-based medical care. Through PACER, Woodhull expanded its training programs, providing a coach for practical onsite guidance and support, and embedding guidelines elements in its electronic medical record.
PACER tracked the care provided by clinicians who complete its Physician Asthma Care Education (PACE) and Nurse Asthma Care Education (NACE) trainings. For clinicians having difficulty implementing these lessons, the program’s coach engaged the clinician in one-on-one problem solving, and placed emphasis on adhering to the six priority Guideline Implementation Panel (GIP) messages that reinforce guidelines use.
Woodhull further reinforced this standard of care by educating and empowering its patients through the distribution of updated PREP (People Reaching Empowerment Program) for Asthma cards. The PREP cards feature the GIP messages in a patient-friendly format.
Increase the application of a single standard of care for patients who live in the North Brooklyn area of New York City.
Educate and empower patients to expect a single standard of care through the distribution of updated PREP (People Reaching Empowerment Program) for Asthma cards.
Dr. Ackerman, and colleague Ms. LaTempa at a NACI meeting in Baltimore, MD
Challenges & Solutions
Challenge: Falling short of the mark. Despite the best efforts of its existing asthma program staff, Woodhull’s quality management measures indicated that physicians who had received its PACE training were still not providing the single standard of care consistent with all six GIP priority messages.
Solution: Asthma Coach: Woodhull hired an asthma coach to overcome remaining barriers to implementing the standard of care taught in the trainings. Upon seeing the initial successes of PACER at Woodhull, the offsite North Brooklyn Health Network clinics are sustaining this momentum and growth by designating their own local asthma champions and replicating key aspects of the coach model.
PACER staff trained over 200 physicians and nurses, 43 of whom were trained one-on-one with HHC Woodhull's asthma coach.
Because of the success of the PACER program, HHC Woodhull increased institutional support for guidelines-based asthma care and added two GIP messages to its quality indicators for ambulance care.
Woodhull shared and collaborated with additional NACI-funded projects to advance asthma care best practices. For example:
Dr. Ackerman with Leyla McCurdy, NEEF, reviewing publications developed by NACI-funded projects
In collaboration with the National Environmental Education Foundation (NEEF), a NACI Demonstration Project, Woodhull conducted onsite training on the “Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers” presented by Joel Forman, M.D., a NEEF Pediatric Asthma Faculty Champion. NEEF’s training also reinforces GIP messages.
To meet its project goals, Woodhull used training, practice improvement, and systems change.
Other NACI-funded projects that used Woodhull-type approaches are: