The Managed Care College and Pediatric Asthma Management

The Managed Care College

The Managed Care College is a comprehensive professional development program that is intended to go beyond the transfer of information. It attempts to persuade clinicians that change is necessary and desirable, to provide leadership and guidance in seeking change, to create opportunities to collaborate with colleagues in planning and implementing change, and to provide ongoing provider performance feedback to monitor change. The College is an on-site, continuous program. The notion behind the College was that continuing medical education should not be removed from everyday clinical practice, but instead should be a part of it. The College offers a variety of courses, ranging from clinical epidemiology to customer oriented service provision. There is also a series of courses directed at specific conditions.

Pediatric Asthma Management Course

One of the courses within the Managed Care College focused on the ambulatory management of pediatric patients with bronchial asthma.  Within the context of this asthma course, and with guidance from course faculty, the participants did the following:

  • Completed directed reading and received a lecture to review the epidemiology and pathophysiology of asthma,
  • Agreed on a definition of pediatric asthma, based on billing codes.  To inform this process, participants conducted a chart review from an initial computer-generated list of their own asthma patients to identify coding issues.  Based on agreed-upon definitions, a registry of asthma patients was established for each participant.
  • Studied and discussed the implications of a computer-generated list of their own patients in the asthma registry, flagging patients with a recent emergency room visits and admissions and those who had submitted no claims for inhaled steroids, a preventive treatment for asthma. The list also identified the 20% of patients who had been seen by an allergy specialist, or who had poor continuity of care by primary care clinicians.
  • Reviewed externally developed guidelines for patients with bronchial asthma. These guidelines were then discussed within the context of specific patient scenarios to evaluate the appropriateness and feasibility of adapting them within the HFHS.
  • Developed a clinical-process flowchart to identify barriers to implementation of asthma guidelines, with special focus on barriers to patient education.

With this as background information about their own clinical practices, and after having reviewed a number of externally developed guidelines, the class adapted the National Heart, Lung, and Blood Institutes guidelines for the diagnosis and management of pediatric asthma. Ultimately, after several reviews and approvals, those guidelines became the guidelines adapted by the entire HFHS. As part of these guidelines, some specific tools were developed. For example, a standardized “zone sheet” was developed, including an action plan for the patient to follow depending upon their self-measurement of peak expiratory flow rate. A peak-flow diary was also created to record results of self-monitoring.

Evaluation

As part of a formal program evaluation of the Managed Care College, pre- and post-surveys were administered to all course enrollees.

  • At the end of the course, enrollees were more likely to agree that they understood the “zone sheets.”
  • Enrollees were also more likely to indicate that home monitoring of peak expiratory flow rates was important, consistent with the practice guideline.
  • Sixty four percent of enrollees indicated that their participation in the course changed their approach to the management and treatment of patients with asthma.
  • Almost three-quarters agreed with the statement that participation in the course increased the percentage of patients for whom they recommend home monitoring of peak flows.
  • About 63% said the course increased the percentage of patients for whom they prescribed preventive or maintenance medications.
  • Just over 50% indicated that participation increased the frequency with which their patients with asthma received education.

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