Special Edition, 2011
NACI Partner Profile
NACI's Three Prongs Spearhead Change in the Asthma Arena
If you received funding to improve asthma care and control using six priority messages designed to put science-based asthma guidelines into action, how would you describe what your program did and what your program accomplished?
About 40 project representatives from the three core, funded programs of the National Asthma Education and Prevention Program’s (NAEPP) National Asthma Control Initiative (NACI)—Demonstration Projects, Strategic Partners, and Clinical Champions—came to the 2011 NAEPP Coordinating Committee meeting in Baltimore, MD, to answer those two questions. They discussed not only how their projects put the priority messages from the NAEPP’s Guidelines Implementation Panel (GIP) Report into practice, but also how their findings might guide the future direction of the NACI and the NAEPP.
Dr. Mamta Reddy presenting on measures to improve asthma care and control
The combined efforts of the various NACI program partners “are like a pebble dropped in the water,” stated Mamta Reddy, M.D., of the South Bronx Asthma Partnership at Bronx-Lebanon Hospital, referring to the ripple effect where the impact from one action extends outward to produce additional effects.
But that’s not all Dr. Reddy said.
“Our projects are working to bring about positive changes in practice behaviors, consistent with the GIP messages,” she continued, “to create meaningful and lasting improvements in asthma care and to create new leaders for asthma control.”
During the conference, Dr. Reddy along with Ms. Leyla McCurdy and Dr. Michael Cabana, two other NACI project representatives, provided an overview of the three core NACI programs, and the lessons learned to date by the projects within those programs.
Dr. Michael Cabana in discussion at the 2011 NAEPP Coordinating Committee Meeting
As it turns out, 13 was a lucky number for the NACI: It is the number of Demonstration Projects that, for the past two years, have been examining ways to use the priority GIP messages to reach diverse audiences and communities at greatest risk, and to bridge gaps in asthma care and control.
Michael Cabana, M.D., M.P.H., of the University of California, San Francisco is the lead investigator on one of the 13 projects, and works in a city where one of every three residents was born in another country. Cabana’s project, which like the other 12 projects is officially at the end of its term, used all six priority messages in materials specifically geared toward minority and underserved children.
As Dr. Cabana pointed out in his presentation, patients are just one of the many audiences that the Demonstration Projects were trying to reach with the priority messages. These audiences—and the interventions used to engage them—included:
- Providers (focus: practice redesign, spirometry, communication skills)
- Patients and their families (focus: self-management education, home environmental assessment)
- Health systems (focus: electronic information sharing, care coordination, decision support)
- Communities (focus: school and childcare staff development, community health worker interventions)
These projects found practical ways to improve asthma care and control, and now it’s up to the NAEPP and the NACI to discover ways to share these tips with other clinicians. “How do you reach every practice?” asked Dr. Cabana. “You look for the trendsetters.”
He stressed the importance of identifying key champions and opinion leaders who can help share these findings and the priority messages in order to reach a diverse array of health care providers and other asthma stakeholders in every setting, coast-to-coast, in a lasting way.
Leyla McCurdy, M.Phil., with the National Environmental Education Foundation (NEEF), highlighted the accomplishments of the 10 funded and 2 non-funded Strategic Partners during her presentation. She underscored the depth and breadth of interventions underway, including the following activities:
- train-the-trainer programs
- patient outreach and education
- spirometry training for safety-net practices
- online continuing education
- asthma self-assessment for maintenance of certification
- development of decision-support tools
She noted that each Strategic Partner contributes in-kind support to its project. In addition, the Strategic Partners are reaching out through their national networks and communication channels to spread and advance the six GIP priority messages to diverse audiences.
Leyla McCurdy, NEEF, speaks about the NACI Strategic Partnership Program
“With the NACI’s help, a great momentum has been created,” observed Ms. McCurdy. “However, with the current Strategic Partnership subcontracts ending in early 2012, continuation and enhancement of the NACI is critically important. Lessons learned and findings from these models, tools, and resources can be refined and/or expanded to additional geographic areas, institutions, and audiences—or replicated by others as a model.”
Ms. McCurdy also spoke about the benefits of having the NACI provide a forum through which like-minded asthma organizations could work together to improve asthma care and control. She used NEEF’s collaboration with the New York City Health and Hospitals Corporation’s Woodhull Medical and Mental Health Center (Brooklyn, NY), a NACI Demonstration Project, as an example of successful collaboration. The center hosted one of NEEF’s asthma faculty members, who conducted a training session for Woodhull’s pediatricians, residents, and medical students.
It is the focus on creating lasting improvements to asthma care and control that led to the NACI Clinical Champions program.
Dr. Mamta Reddy, Director of the South Bronx Asthma Partnership (SOBRAP), spoke about this newest prong of the NACI and recognized the need for the five Clinical Champions—chosen competitively from the pool of existing program participants—to “take their Demonstration Projects and Strategic Partnerships to the next level.”
“They will build on, and expand the reach of, the quality improvement strategies and tools they tested through the NACI,” said Dr. Reddy.
To increase awareness and use of the priority messages, the Clinical Champions aim to expand a practice-based quality improvement initiative, increase adoption of decision-support tools, train early-career physicians to promote systems change, use a train-the-trainer approach to develop new spirometry instruction sites around the country, and enlist champions to conduct presentations on culturally competent patient education within their minority-serving primary care practices.
NACI Breakout Sessions
For the small-group discussions that followed, NAEPP Coordinating Committee members joined the NACI project representatives to share insights, lessons learned, areas for collaboration, and ways to better communicate and advance the goals of the NACI. The most frequent comments reflected some of the insights noted above, including the opportunities that the NACI provides for focused intervention and resource sharing as well as the need for continued support to promote sustainable practice and systems change. Participants also agreed on the importance of sharing success stories, tools, and materials through a variety of vehicles, including the NACI Web site, NACI In the Know eNewsletter, and NACI webinars.
Check out the NACI Web site to learn more about the Demonstration Projects, Strategic Partners, and Clinical Champions.
Last Updated October, 2011