(Chest. 1999;116:129S-130S.)
© 1999
American College of Chest Physicians
Preface*
Civic Support and Leadership as a Catalyst for Addressing the Problem of Urban Asthma: The Otho S. A. Sprague Memorial Institute's Asthma Initiative
James N. Alexander, JD
*
From Alexander Associates (Mr. Alexander), Evanston, IL, consultant to the Otho S.A. Sprague Memorial Institute, Chicago, IL.
Correspondence to: James N. Alexander, Alexander Associates, 2129 Central Park Ave, Evanston, IL 60201-1801; e-mail: alexassocs{at}aol.com
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Introduction
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In
1911, the Otho S.A. Sprague Memorial Institute was created by one of
Chicago's civic leaders. In his will, Otho Sylvester Arnold Sprague
set forth a clear and simple mission, "the investigation of the
causes of disease and the prevention and relief of human suffering in
the City of Chicago." In the days before the National Institutes of
Health, the board of the Sprague Institute sought to achieve this
mission through the support of a group of scientific researchers whose
accomplishments were noteworthy. The difficulties resulting from a
volunteer board managing such an ambitious approach ultimately resulted
in a shift to the support of biomedical researchers working within
various academic medical centers in Chicago. Beginning in 1989, the
board diversified its grant-making strategies in pursuit of outcomes
that were within the fiscal reach of a mid-sized independent
foundation. As is increasingly the case with grant makers, they sought
focus and measurable outcomes for their philanthropy. In 1994, the
disproportionately high rates of asthma mortality and morbidity in
Chicago caught the attention of several board members.
During the summer of 1995, the board convened several
meetings to evaluate the possibility of an initiative focused on
asthma. A diverse group of representatives of nonprofit agencies,
physicians, researchers, health-care providers, and other grant makers
attended these meetings. These focus groups outlined the magnitude of
the problem in Chicago. They counseled that although asthma is not a
curable disease, with proper diagnosis and treatment, the risk of
mortality for persons with asthma should be similar to that of the
general population. They observed that many individuals with asthma are
not receiving correct diagnoses and may not be following a prescribed
program of care. They also questioned whether health-care providers in
the Chicago area were providing care in accordance with the asthma
guidelines of the National Heart, Lung, and Blood Institute of the
National Institutes of Health.
At its fall 1995 meeting, the Program and Grant Committee
of the Sprague Institute issued requests for proposals to qualified
nonprofit organizations. In December 1995, the board formally launched
its Asthma Initiative for a period of 3 to 5 years. The board approved
asthma-oriented grants to 11 nonprofit recipients. Several were
multiyear awards that were contingent on receipt of satisfactory
progress reports. The grants ranged from support of a peer education
initiative encouraging asthma awareness among low-income minority
populations to support of basic science attempts to identify the asthma
gene. In the next two grant cycles, the Sprague Institute increased the
number of asthma-oriented grants, building on the visibility of the
initiative within the nonprofit community.
Three of the Sprague Institute's grants launched very
ambitious programs. One grant established the Chicago Asthma Consortium
(CAC), and a second grant established the Chicago Asthma Surveillance
Initiative (CASI). The most recent grant supported the Chicago/Cook
County Community Health Council's Asthma Initiative in five
underserved community areas.
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The Chicago Asthma Consortium
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The centerpiece of the Sprague Institute's Asthma
Initiative was a grant to the American Lung Association of Metropolitan
Chicago to serve as fiscal agent and primary coordinator of a newly
established community organization, the CAC. The American College of
Chest Physicians, national headquarters of which are located in the
Chicago area, was supported as co-conveyer of the project. The CAC was
modeled after the National Asthma Education and Prevention Program of
the National Institutes of Health. Since its first meeting in February
1996, the membership of the CAC has grown to hundreds, representing
many organizations and individuals in the Chicago area. It is governed
by a diverse, self-selected executive committee and has hired an
executive director and an administrative assistant to supplement the
staff borrowed from the American Lung Association of Metropolitan
Chicago and other supporting organizations. Although not without
administrative difficulties, the CAC has become a premier networking
vehicle for community and health-care professionals and a potential
model for other US cities. In just over 3 years, the CAC, through its
various committees, has accomplished several important tasks, including
the following:
• The Marketing Committee of the CAC
publishes a CAC newsletter, Web site, and the city's first
resource directory for asthma-related programs and services.
• The School Committee of the CAC has changed the
medication policy within the Chicago Public Schools to permit students
with asthma to keep their inhalers with them, rather than surrendering
them to school office or nursing personnel, who may not be available in
times of need. Through joint efforts with the CAC, the Chicago Public
Schools now train school personnel on this policy and have co-funded
(along with the Sprague Institute) a project to improve asthma care in
the schools. As a result, > 300 school nurses and many school
principals have been trained to better understand asthma and care for
students with asthma.
• Through the Access to Care Committee, the CAC has
enlisted nearly two dozen Chicago-area emergency departments to work
together in a 1-year collaborative effort to improve emergency
department asthma care across the community.
• The Data Committee of the CAC has alerted
the media to the magnitude of the public health problem defined by
asthma.
• The CASI project has provided the CAC with
valuable baseline data characterizing asthma and asthma care in the
Chicago area. It has also shown the aspects of care in need of
improvement.
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The CASI Project
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The Sprague Institute's board recognized that
much of the effort of the CAC would be aimed at increasing awareness
and improving care throughout the Chicago area. Without a formal
evaluation component, however, there would be little or no data (except
asthma mortality and perhaps hospitalization rates) by which to judge
the success of these efforts. Therefore, the Sprague Institute funded
the creation of the CASI to provide data that will increase the
awareness of asthma-related issues as well as to evaluate changes in
asthma and asthma care over time. To date, the CASI has surveyed
Chicago-area hospitals, emergency departments, primary care physicians,
asthma specialists, pharmacists, managed care organizations, and the
general public as well as persons with asthma and their families to
learn about asthma care and its outcomes.
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The Chicago/Cook County Community Health Council
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This grantee coordinates the community-based
health initiatives identified by the leadership in five distinct
community areas. Together, they determined that asthma affected them
all. With support from the Sprague Institute, they studied the problem,
identified community and provider education as a potential solution,
and devised a multiphase strategy to effect change. In July 1999, they
were awarded a $470,000 matching grant by the Local Initiatives Funding
Program of the Robert Wood Johnson Foundation.
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Networking
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The Sprague Institute's involvement in their Asthma
Initiative goes beyond funding. In addition to the social network
resulting from the CAC, the Sprague Institute has encouraged
collaboration and sharing. It periodically convenes its grantees to
meet and discuss their work with each other and with the members of the
board. Examples include the following:
• Patient-tracking computer software
developed by Children's Memorial is now used by Bethany, Lawndale, and
LaRabida Hospitals.
• A screening instrument developed by researchers at
Rush-Presbyterian-St. Luke's Medical Center has been validated and
used by grantees at LaRabida Hospital and the University of Illinois at
Chicago to predict the likelihood of asthma.
• AmeriCorps members of the Chicago Health Corps are
collaborating with the staff of the American Lung Association of
Metropolitan Chicago to make the curriculum of the Open Airways Program
more culturally appropriate for the diverse school population of
Chicago.
• The American Red Cross of Greater Chicago
used the expertise of many of the Sprague Institute's grantees in
creating and field-testing their first asthma education program.
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Funding
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The board defines a research grant to be a project
that is likely to be submitted for publication in a professional or
scientific journal. Much of their funding is based on a 50:50 formula.
Approximately 50% of its grants are invested in research, and 50% are
invested in nonresearch activities that meet the Sprague Institute's
mission. Since its inception, the Asthma Initiative has awarded
> $3.1 million in total grants.
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The Downsides
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Although the Asthma Initiative has done well in
many areas, there have also been some impediments to success. At
least one of the community-based initiatives did not fare well. In
addition, many of the grantees have focused their efforts on low-income
populations, in which it is not uncommon to experience difficulties in
maintaining contact for purposes of long-term follow-up. Also, whereas
the work with the Chicago Public Schools is going well, the velocity of
this work is less than is needed based on the urgency and magnitude of
the problem. Finally, although the CAC has become a strong,
self-determined community organization, it has only recently felt
capable of incorporating itself as an independent 501(c)(3) tax-exempt
nonprofit organization.
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The Future
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It is too soon to expect conclusive outcomes from the
Asthma Initiative, at least in terms of its impact on asthma morbidity
and mortality. When dealing with a problem of this magnitude,
improvement cannot be instantaneous. At the end of 1998, the board
evaluated the Asthma Initiative's first 3 years. The board concluded
that it had been successful at focusing its grant-making energies, had
induced other funding organizations to recognize the need to support
asthma projects within Chicago, and had commissioned the publication of
this supplement to CHEST to document the best practices and
outcomes for others in the philanthropic and health communities. In the
short term, the Sprague Institute will continue its support of select
asthma-oriented projects even as it convenes a new series of focus
groups to help the board identify their next priority. It is clear,
however, that the Sprague Institute's investment has jump-started the
issue of asthma for the Chicago community. It has brought together and
energized a variety of well-qualified academic and nonprofit
organizations, along with a diverse group of health-care professionals,
to work with community leaders in addressing this problem. In just 3
years, it has demonstrated what a local philanthropy can do when it
focuses its resources in a timely fashion on an important public health
concern.
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Footnotes
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Abbreviations: CAC = Chicago Asthma Consortium;
CASI = Chicago Asthma Surveillance Initiative
TOP
Introduction
The Chicago Asthma Consortium
