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Asthma Management: A Local Health Department’s Perspective

Date: 11/16/2011 12:03 PM

Related Categories: Performance Management and Quality Improvement (PMQI), Quality Improvement Demonstrations

Topic: Performance Management and Quality Improvement

Tag: Asthma, Improving Asthma Outcomes, Quality Improvement Application

A conversation with Kathleen C. Brown, PhD, MPH, Director of Community Assessment and Health Promotion at the Knox County Health Department (KCHD) in Knoxville, Tennessee
What challenges does Knoxville have related to asthma?
One of the greatest challenges with asthma management is that even the best controlled can get into trouble. In Knox County, we face many challenges related to asthma management that puts us in the top ten most challenging cities to live with asthma (Asthma and Allergy Foundation of America).  High absenteeism and emergency room visits resulting from adults and children with asthma emergencies can be highly disruptive and can lead to a less productive workforce and impair continuity in school education.  It would benefit the community to minimize the impacts of poor asthma management. 
What challenges does the Knox County Health Department (KCHD) face around asthma management?
Convening a group around asthma is difficult since our health department doesn’t have an asthma prevention program.  Our TENNder Care Program does work around asthma with Medicaid patients, but their program scope is limited.  Asthma prevention staff are needed just as much as tobacco prevention staff, who can also play a role in improving asthma management in the community.
How could a KCHD asthma management program be effective?
Essential elements for any successful program are for it to be part of an organization’s primary mission, for there to be committed leadership, involved staff, broad representation from the team members, consistency of team member participation, and for there to be opportunities for team members to continuously generate conversation around program evaluation and improvement.  A designated leader who can push a project to the next level, or as I call “herding the kittens along,” is key.
What results and plans for the future emerged from the Improving Asthma in America QI demonstration project?
As a result of this project, we are better connected to the medical community and have met with the Summit Medical Group project team to share plans for project evaluation. Next steps include finalizing the Asthma Management Kit – Teacher Module and evaluating it in spring 2012.  We also plan to connect with staff at the East Tennessee Children's Hospital about opportunities to work together around asthma management. We greatly appreciated the training and technical assistance provided by Jack Moran and PHF and look forward to applying the tools and methods to project work ahead. Of course, since the project ended, there have been challenges to push forward due to competing priorities. For example, the school nurses are very busy right now with flu season preparation.
From 2010-2011, the Public Health Foundation (PHF) worked with four teams in the Knoxville, Tennessee area to achieve improvements in the management and control of asthma through use of quality improvement (QI) tools and methods in process improvement. A full report, one-page summaries and related resources are available on the Asthma QI Demonstration Project page.
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Ron Bialek


Healthcare organizations have been employing QI methods far longer than public health agencies. As public health increases its use of QI, do you think that this may help to create some bridges between public health and healthcare? Do you see opportunities down the road for your health department and healthcare providers in your community to jointly employ QI methods and tools to address important health issues for your community?

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