EPIC – Asthma Chronic Care Management

Eleven pediatric and family practices in Trenton participated in the PCORE EPIC program have completed three components of continuing education on Asthma Care Management. The program was designed to improve the quality of chronic care for patients with asthma within the context of a medical home. The EPIC – Asthma module shared strategies to improve identification and treatment of childhood asthma. Health teams (physicians, nurses, and others) from each practice participated in the continuing education which focused on the four major components of Asthma Management: Objective Assessment, Partnership in Care (Roles of Health Care Provider, Parent, Patient and Community), Environmental Control and Pharmacologic Therapy. The program highlighted the use and understanding of two important tools: the Asthma Control Test and the Asthma Action (Treatment) Plan. A demonstration of “gizmos and gadgets” provided practice staff with hands on training, so that they can teach children and families how to effectively use various pharamcologic devices. Each practice received bilingual parent education materials to distribute to the families they serve and a toolkit with curriculum and additional resource information. Pre and post evaluations were used to evaluate the effectiveness, usefulness and quality of the program.

The participating practices participated in continuing education on several other preventive care topics: Immunization Education, Childhood Lead Poisoning Prevention, Suspected Child Abuse and Neglect, Developmental Anticipatory Guidance and Postpartum Depression. Improving Chronic Care Management for Children, support for their families, and education /technical support for the healthcare team is at the core of building and sustaining community based medical homes. Improving care for children with special health care needs within a practice tends to improve healthcare for all children within the practice. Asthma is one of several chronic care continuing education modules that will be developed for the participating pediatric providers in the Trenton metropolitan area.
Educational Outcomes

Health Care teams who have completed the program, strongly agree as a result of participating they now…
• Understand the difference between asthma severity classes 42.7% Increase (84.4%)
• Know that most pediatric asthmatics have persistent asthma 52.7% increase (65.8%)
• Believe the benefits of ICS therapy outweigh potential risks 42.5% increase (71.1 %)
• Will use the Asthma Control Test 36.7% increase (72.4%)
• Know how to properly step up treatment for uncontrolled asthma and step down treatment for controlled asthma 32.4% increase (55.6%)
• Will complete the Asthma Action (Treatment) Plan 41.4% increase (69%)

(Note: Part 1: Pre N=84,Post N=76; Part 2: Pre N=82, Post N=81)

What did the Healthcare Teams Say About the EPIC Asthma Training?

A few examples of the positive feedback noted on evaluation forms: “This is a very important program to attend; it’s a wonderful feeling knowing that we have the knowledge that we do about such a deadly disease. I have learned a lot of things at this program that I had no prior knowledge about and I am happy that such a program exists to enlighten us on this subject. Keep up the good work guys.”; – “well done, like “real world” examples”; and “as per usual, excellent”.
Sustained Quality Improvements

Two practices have instituted small process improvements that have significant impact related to caring for children with Asthma and providing support for their families. One practice is now scheduling/grouping visits for patients with asthma to allow more time for patient management and education. Additionally, in another practice, patients and their family now routinely receive education materials that are organized in “Ziploc” bags and provided in English and Spanish language materials. Simple changes that enhance care in community based medical homes.