Dorchester House Multi-Service Center
“Low-income communities such as Dorchester are often the last to benefit from medical technology. We are changing that scenario by integrating spirometry into our primary care office visits for children who have asthma”
Jean Kelley, M.D., Pediatrician, Dorchester House Multi-Service Center (Dorchester, MA)
Spirometry testing during asthma visit at Dorchester House Multi-Service Center.
Jean Kelly, M..D, (second from right) of Dorchester House and colleagues discuss their projects at a NACI meeting in Baltimore, MD.
Through its Spirometry Integration Project (SIP), Dorchester House Multi-Service Center (“Dorchester House”) trained and equiped primary care providers with spirometry tools and information to improve their ability to accurately diagnose, assess, monitor and treat asthma, and keep children who have asthma out of the emergency department. By increasing access to this lung function testing technology in the primary care setting, as recommended by the Expert Panel Report 3–Guidelines for the Diagnosis and Management of Asthma (EPR-3), Dorchester House worked to improve asthma control, particularly among low-income and minority children who are at increased risk for poor asthma outcomes.
Over the course of this project, Dorchester House’s entire pediatrics department engaged in a spirometry training and quality improvement process, gradually bringing spirometry testing in-house and then making it an integral part of the regular asthma visit. Previously, Dorchester House had made referrals for spirometry to outside specialty clinics, where often patients faced lengthy waiting times, transportation issues, and language barriers. An effort to conduct spirometry in-house as a separate, stand-alone visit with an asthma nurse also proved inconvenient. Now that its pediatric department has made spirometry a routine part of the office-based asthma visit, Dorchester House is working to incorporate spirometry into its family medicine practice.
- Incorporate spirometry testing in the evaluation of all pediatric patients with chronic cough and asthma seen at the Dorchester House pediatric primary care clinic.
- Educate Dorchester House pediatric primary care providers and support staff about the EPR-3 recommendations regarding spirometry testing in asthma diagnosis and assessment of disease severity and control.
- Improve asthma outcomes for Dorchester House pediatric patients by integrating office-based spirometry testing in the evaluation of children with chronic cough and asthma.
Barbara Rogers, P.N.P., Dorchester House, takes notes during a NACI meeting in Baltimore, MD.
Challenges & Solutions
Challenge: Spirometer integration into Electronic Medical Records (EMR). Dorchester House lacked a direct interface between its spirometer and its off-site EMR, making it more difficult to standardize the entry of spirometry results Into the EMR.
Solution: Purchase separate spirometry software. While Dorchester House worked with the EMR provider to resolve this issue, it purchased and installed the spirometry software for its in-house use and implemented new forms and standard processes to input the spirometer results manually into the off-site EMR.
Because of SIP, the DHMSC Pediatric Department now performs 15-25 spirometry tests per month.
DHMSC successfully incorporated Asthma Action Plans into its Family Medicine Department. Previously, Asthma Action Plans were used in the Pediatric Department only.
Dorchester House shared and collaborated with additional NACI-funded projects to advance asthma care best practices. For example:
Dorchester House’s entire medical pediatric staff completed the Spirometry 360 training program conducted by the University of Washington, a NACI Strategic Partner. Throughout the program, they received customized spirometry quality feedback reports from the University of Washington’s clinical experts.
Dorchester House focused on asthma disparities and provider education to meet its project goals.
Other NACI-funded projects that used Dorchester House-type approaches are:
Dorchester House Multi-Service Center
1353 Dorchester Avenue,
Dorchester, MA 02122