- Volume 10 | Fall 2012
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NACI Partner Profile
Dorchester House Brings Spirometry In–House for Its Patients with Asthma
- Long wait times
- Transportation limitations
- Language barriers
These are the types of challenges that some children and families face when referred outside their primary care medical home for spirometry, an objective measure of lung function. For patients with asthma ages 5 and up, the National Asthma Education and Prevention Program’s (NAEPP) clinical practice guidelines recommend spirometry to assess asthma severity and monitor asthma control, two of six key actions that the NAEPP has identified as critical to the improvement of asthma control and care.
That’s why Boston’s Dorchester House Multi–Service Center (“Dorchester House”)—a community–based organization providing an array of health and social services for a racially and ethnically diverse patient population—took a bold step with funding and technical assistance through the National Asthma Education and Prevention Program’s (NAEPP) National Asthma Control Initiative (NACI).
Dorchester House brought spirometry testing in–house.
Through its NACI–funded Spirometry Integration Project, Dorchester House sought to increase its patients’ access to spirometry testing within the primary care setting, with the aim of improving the overall quality of asthma care they received. As a result, the project has made spirometry part of its pediatric asthma visits, an important step forward for the 1,200 primarily low–income, minority children with asthma that Dorchester House serves.
“It can be hard to get kids to asthma specialists in the Boston area. So we decided to conduct spirometry testing at Dorchester House so that we could assess and monitor their disease on the spot,” said Jean Kelley, M.D., a pediatrician at Dorchester House. “Our efforts led to spirometry becoming a routine part of the office–based asthma visit, and we now perform an average of 15–25 spirometry tests per month.”
How did they do it?
In collaboration with the University of Washington (UW), a NACI Strategic Partner and Clinical Champion, Dorchester House’s entire pediatric staff received training through UW’s Spirometry 360 program. Clinical experts from UW also provided Dorchester House’s pediatricians with customized feedback reports on the quality of their spirometry tests.
By training its staff on how to properly test a patient’s lung function, and making it easier for patients to get this test done during a regular visit, Dorchester House enabled physicians to better match each child’s level of asthma severity or control with the appropriate treatment recommendations from the NAEPP's clinical practice guidelines.
By the end of the two–year project, Dorchester House’s Pediatric Department had made spirometry a routine part of the office–based asthma visit. Its nurses performed all the tests, sparing children with asthma and their families the inconvenience of going outside of Dorchester House for spirometry testing.
“The NACI gave us the opportunity to integrate spirometry into the flow of our clinic,” said Dr. Kelley. “We found that spirometry did not interfere with our clinical flow as some had feared. In fact, we found it easy to do spirometry right then and there during the asthma appointment.”
Dorchester House reports that this integration has resulted in more “patient–centered” care and is a very efficient approach. It allows patients to receive asthma testing and treatment under one roof.
In this case, “in–house spirometry testing” equals a win for all, empowering this community–based organization to address a critical component of effective asthma management within its own walls. Now, Dorchester House is in a position to share its lessons learned with other community–based health centers interested in implementing clinic–based spirometry with their patients who have asthma.