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The Chicago Asthma Consortium^*

A Community Coalition Targeting Reductions in Asthma Morbidity

Edward T. Naureckas, MD; Raoul L. Wolf, MD, FCCP; Mitchell J. Trubitt, MD, FCCP; Kevin B. Weiss, MD; Eva Hernandez-Thomas, MSN; Sandra Thomas, MD, MS; James Fink, RRT; Howard J. Zeitz, MD; Lenore Coover, RN, MSN; Jura S. Scharf and for the Chicago Asthma Consortium Executive Committee

^* From the Department of Medicine (Dr. Naureckas), Department of Pediatrics (Dr. Wolf), University of Chicago, Chicago, IL; United Healthcare (Dr. Trubitt), Chicago, IL; Center for Health Services Research (Dr. Weiss), Rush Presbyterian St, Luke's Medical Center, Chicago, IL; Ms. Hernadez-Thomas, Chicago, IL; Chicago Department of Public Health (Ms. Thomas), Chicago, IL; Department of Medicine (Dr. Fink), Loyola University Medical Center, Maywood, IL; University of Illinois College of Medicine (Dr. Zeitz), University Asthma and Allergy Service, Rockford, IL; Lenore Coover, RN, MSN, University of Illinois at Chicago (Ms. Coover), School of Public Health, Chicago, IL; and Chicago Asthma Consortium (Ms. Scharf), Chicago, IL. Deceased. A complete list of participants is located in the ^Appendix.

Correspondence to: Edward T. Naureckas, MD, University of Chicago, 5841 S Maryland Ave, MC-6026, Chicago, IL 60637

	Abstract

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
T he problem of asthma in Chicago remains a complex one, and it is too early to know whether any programs and efforts have had a discernible effect, but the Chicago Asthma Consortium continues to expand its membership and to define its mission. The successes have come from harnessing the passion of the individual members to move the projects forward. As the focus of the consortium moves to addressing system-wide problems in asthma care and the delivery of that care, the consortium is undertaking the construction of a guide for future efforts. In this way, the consortium will fulfill its vision of creating a comprehensive, community-wide plan for the management of asthma, impacting on the unacceptable current levels of morbidity and mortality of the disease.

	Introduction

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
The Chicago Asthma Consortium (CAC) was organized in January 1996 in response to the epidemic of asthma in the city of Chicago. The CAC was formed jointly by the American Lung Association of Metropolitan Chicago and the American College of Chest Physicians, with enabling support by the Otho S.A. Sprague Memorial Institute. Its charge was to coordinate the efforts of individuals and institutions involved in asthma care. By 1998, the organization included > 350 members with varied backgrounds, including practitioners, asthma educators, asthma patients, local hospitals, clinics, managed care organizations, and industry representatives. The CAC is dedicated to the mission of coordinating the activities of individuals and organizations working in asthma care and advocacy to improve asthma care in the city of Chicago, and thereby, reduce asthma morbidity and mortality. Although numerous efforts to combat asthma have been made in the Chicago area, what makes the consortium unique is the ability to provide synergy among these efforts. The success of this organization provides a model that can be generalized to help combat other chronic diseases.

This integrated approach adopted by the CAC, which involves individuals from a broad range of backgrounds and interests, reflects the belief that asthma presents a complex problem that cannot be solved by isolated focus in a narrow area. The long-range goals of the consortium to meet its mission are the following:

1. Raise awareness of the public, patients, and practitioners that asthma is a serious disease. 2. Ensure the proper diagnosis and treatment of asthma by professionals and foster adherence to the consensus guidelines. 3. Facilitate access to care for asthma patients regardless of income or other factors. 4. Foster partnerships among patients, caregivers, health-care providers, and community organizations to improve care of asthma in Chicago.
   

Ample evidence of the state of asthma in the Chicago area has demonstrated the need for this organization. The Sprague Institute-funded Chicago Asthma Surveillance Initiative (CASI) demonstrated the wide gaps in the treatment of asthma that exist between the consensus guidelines developed by the National Institutes of Health and actual practice in the community. This disparity is present both in primary care offices¹ and in emergency departments.² A survey released by the American Lung Association indicated that patients and caregivers of children with asthma lack knowledge about the disease, its seriousness, and its treatment. The objective consequences of the above were highlighted in two recent data workshops held by the Data Committee of the CAC, which reported that asthma mortality has continued to increase in Chicago despite advances in treatment of the disease. When compared with data from a recent U.S. Centers for Disease Control and Prevention report on asthma, the mortality figures in Chicago are among the highest in the nation.³ Especially shocking is that the mortality rate for African Americans, in the same report, was higher in Illinois than any other state. Data from the Illinois Health Care Cost Containment Council, presented at the CAC data workshop, indicated that Chicago accounted for a disproportionate number of asthma hospitalizations and that patients in Chicago were found to have increased lengths of stay compared with US statistics.

The structure of the CAC is designed to address multiple aspects of the problem of asthma. Seven standing subcommittees were created and are the actual working units of the CAC. The seven committees are Access to Care, Community, Data, Marketing, Public/Patient Education, Professional Education, and School. Membership on a given committee is open to all consortium members. In keeping with the integrative function of the CAC, many members participate in more than one committee. All committees report to an executive committee each month, as well as at the general membership meeting of the CAC held quarterly. As the organization matures, an increased emphasis has been placed on having the subcommittees work with each other on projects that involve intersecting spheres of influence. An overview of the activities of each of the committees is described below, followed by a series of three brief reports detailing specific successes of some of the committees to date.

	Access to Care Committee

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
The Access to Care Committee, as the name implies, was created to focus on issues related to the delivery of asthma care both at a public policy level and at the individual site level. The work of the Access to Care Committee is closely linked to that of CASI, which has supplied a focus on those areas (both geographically and in practice) in which gaps in care are occurring. In addition, CASI will provide an outcome marker for the CAC to assess the success of its efforts.

Committee accomplishments to date include the creation of the Chicago Emergency Department Asthma Collaborative. Although it is well recognized that the emergency department is far from the ideal site for asthma care delivery, it is, in reality, the only site in which many asthma patients in Chicago receive care. More than 20 hospital emergency department medical directors are collaborating to develop and implement a comprehensive set of protocols for emergency care of patients with asthma. A key component of these protocols, and an initiative for the upcoming year, is a program to ensure linkage with a primary care provider for the patient after being seen in an emergency department.

To extend the same concept to inpatient care, a project is underway to bring together leaders from Chicago hospitals to explore the concept of "Centers of Excellence" for asthma care. Of particular note is the interest shown by a number of managed care organizations to the activities of this committee.

Numerous challenges remain in improving access to quality asthma care in the Chicago community. Various barriers to care including cost, availability of local quality care, transportation, and childcare during visits remain to be explored and may be opportunities for advocacy by the consortium in the future. The role of the consortium in advising public policy remains in evolution.

	Community Committee

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
Asthma as a disease does not exist in isolation, and issues related to asthma have different causes and different impacts in the numerous communities throughout the city of Chicago. The Community Committee was formed with the understanding that the CAC will not be able to accomplish its mission without the involvement of the numerous community organizations now in existence, many of which already have some form of asthma program in place but may not have the resources to achieve their mission. The diversity of communities within Chicago also emphasizes the fact that there is not a "one size fits all" solution for asthma in Chicago. Community-based asthma interventions have been presented to the consortium at quarterly meetings. These programs have been valuable in demonstrating the power of this approach.

Presently, the Community Committee is working in partnership with the Patient/Public Education Committee in the "Asthma Adventure." This hands-on patient participation educational session takes asthma patients through a number of stations staffed by volunteers highlighting principles of asthma management. Seven of these sessions are scheduled for the coming year.

	Data Committee

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
The Data Committee was created to report information and seek out sources of information specific to asthma in Chicago. An additional mission of this committee has been to identify gaps in our current understanding of the disease and to foster interactions between CAC members to fill in those gaps. These goals have been furthered by a number of accomplishments during the past 2 years. A data workshop has been held yearly to bring together researchers and public agencies investigating asthma in a forum of free interchange. This workshop resulted in the production of a monograph on the workshop, which is available through the consortium. Many of the investigators present at the October 1998 workshop have also submitted reports for this monograph. The Data Committee was also responsible for the development of an Internet Web site (www.chicagoasthma.org) for the consortium to aid in the dissemination of data on asthma and the consortium. The Web site also provides links to the American College of Chest Physicians, the American Lung Association, and numerous other asthma-related Web sites.

More recently, the data committee has collaborated with the Environmental Protection Agency to look for links between airborne pollutants monitored by this organization and asthma incidence, morbidity, and mortality throughout the city.

Major challenges remain for the data committee in the future. Many untapped sources of data remain to be investigated. In addition, the role of indoor environment and allergens as a cause of the observed increases in asthma continues to be an area of vital interest.

	Marketing Committee

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
The Marketing Committee has the dual role of increasing public awareness of the severity of asthma in Chicago and of publicizing the CAC and its work to increase its reach throughout the city. The chair of the committee is responsible for organizing press conferences and other media events around the CAC.

Accomplishments of the Marketing Committee include a survey of CAC members to ascertain what information should be presented at the quarterly membership meetings. Through this survey, the membership indicated that there was a great demand for information on local asthma education programs and local health plan initiatives. Refocusing the agenda of the quarterly meetings toward subjects desired by the memberships has increased participation in these meetings and served to energize the membership.

The Marketing Committee was also responsible for the Chicago Asthma Resource Directory, which includes information on a variety of programs providing asthma care, education, support groups, professional education programs, and demonstration research programs. More than 7,500 copies of this directory have been distributed to area hospitals, clinics, libraries, patients, and providers. This directory is also available on the CAC Web site in an electronic version.

Also available on the Web site and in printed form is the brochure "Getting Your Asthma Under Control: A Self-Evaluation," which was created by the Marketing Committee. This brochure is available in English, Spanish, and Polish and represents a component of a broader public awareness program. As part of this drive, CAC members have appeared on a number of television and radio forums discussing asthma, including Chicago Tonight on WTTW and the 848 program on WBEZ (public television and radio stations serving Chicago).

As part of its mission to extend the reach of the CAC, the Marketing Committee held an industry roundtable in early October 1998. The purpose of this meeting was to facilitate partnerships with industries having a natural interest in improved asthma care and to foster their support of the consortium.

Future goals for the Marketing Committee include a public relations campaign to increase asthma awareness in the city of Chicago.

	Public/Patient Education Committee

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
The mission of this committee is to facilitate improvements in the education of patients and the public as a whole. This committee includes pharmacists, respiratory therapists, physicians, nurses, and community health workers. Major accomplishments of the Public/Patient Education Committee include the development of an evaluation tool to assess the conformity of educational materials with the information contained in the National Heart, Lung, and Blood Institute consensus guidelines. The committee also used this tool to evaluate > 130 individual materials submitted to the consortium. The 20 brochures that best met these criteria were published in the CAC resource directory along with the evaluation tool. The results of this evaluation project were presented at the annual meeting of the American Public Health Association.

Other accomplishments include a survey, conducted among CAC members through the CAC newsletter, that assessed the need for Spanish-language asthma materials. A major challenge for this committee in the coming year is to determine, among the various programs available, such as peer education, what methods are most likely to improve indices of asthma care such as adherence to inhaled steroids or environmental amelioration in the home. In addition, the Public/Patient Education Committee was responsible for the distribution of > 1,000 spacer and peak flow devices to clinics throughout Chicago.

	Professional Education Committee

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
This committee was formed to undertake one of the most difficult tasks of the consortium: changing physician practices through education to improve asthma care. If the National Heart, Lung, and Blood Institute guidelines are accepted as "best practice," it is clear from the CASI data available to date that current treatment falls well below this mark. The Professional Education Committee has focused on partnering with professional organizations and evaluating available professional educational programs. The target audience for this process includes physicians, respiratory therapists, nurses, and pharmacists.

This committee has accomplished much to date. The committee organized a CAC presentation at the 1998 Chicago Medical Society Midwest Clinical Conference and hosted two educational sessions as well as a booth during the conference. Because of the initial success of this participation, the CAC will be responsible for five programs at the 1999 conference. In a similar fashion, the CAC participated in the American Lung Association of Metropolitan Chicago Nursing Assembly Conference.

To explore and further a "best practices" approach to professional education itself, the committee has developed a CAC asthma speaker's kit for use by CAC members for educational programs. An evaluation procedure was also developed to assess the quality and content of professional education programs. Also, at the fall 1998 quarterly meeting, a presentation of problem-based learning was undertaken to expose the membership to this powerful education tool.

Many challenges remain, one of which is to decide on a professional education strategy that is appropriate for the myriad professionals in the Chicago area. As altering physician behavior has repeatedly been demonstrated to be difficult, the Professional Education Committee continues to seek out additional techniques to accomplish this goal.

	Schools Committee

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 
Other fine examples of what can be accomplished by a cooperative effort such as the CAC can be found within the work of the Schools Committee. This committee was formed to address issues related to asthma in the schools and has been able to form close working relationships with administrators and school nurses in both the public and parochial school settings. A major accomplishment of the Schools Committee has been to effect a change in the Chicago Public School (CPS) medication policies, which previously prevented school children from carrying and using their metered-dose inhalers in class. This major change had been attempted for years without success before the formation of the CAC. Increasing awareness of the policy changes throughout the CPS is an ongoing goal of the Schools Committee. As part of this effort, committee members are creating a pamphlet for parents and teachers describing these changes.

Because children spend a large portion of their day in school, maintaining an environment that promotes asthma control has also been part of the agenda of the School Committee. One success so far has been the support of legislation introduced to the Illinois State House requiring 48-h parental notification before spraying pesticides in schools or day-care centers. A number of School Committee members have been involved in a task force organized by Illinois state representatives to review this important legislation. A related effort that remains an ongoing project for the committee is to promote safer pest control within schools, using comprehensive methods that reduce the need for frequent use of insecticides, organized by the Safer Pest Control Project with support from the state of Illinois.

The committee has worked to increase asthma awareness within schools and has organized a presentation to 600 CPS principals to bring asthma-related issues to their attention. A key issue identified was the impact of asthma on a child's ability to succeed in school. The committee has also reviewed and endorsed a school education program now available to CAC members and has endorsed funding for facilitators to visit schools and present information to faculty about asthma care needs. To address the needs of parents of schoolchildren with asthma, the School Committee is developing a brochure for the CPS Early Childhood Education Department parent's orientation describing the principles of appropriate asthma management for the parents of incoming students.

A future goal for the Schools Committee is to help formulate a medication policy for younger children (who cannot self-medicate) similar to that of Head Start, and to facilitate its implementation. The Schools Committee has been, and remains, a natural area of collaboration for members of other committees as the schools system provides almost universal access to children with asthma.

	Appendix 1

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Other members of the Chicago Asthma Consortium Executive Committee include the following: Carol Jackson, RRT, Advocate Health Care, Chicago, IL; Victoria Persky, University of Illinois at Chicago, School of Public Health, Chicago, IL; Sandra DesJardins, MSA, RRT, Resurrection Medical Center, Chicago, IL; William Van De Graff, MD, Department of Medicine, Loyola University Medical Center, Maywood, IL; Peg Dublin, RN, Chicago Health Corps, Chicago, IL; Sandy Cook, PhD, Department of Medicine, University of Chicago, Chicago, IL; Michael Foggs, MD, FCCP, Advocate Health Center, Chicago, IL; Allen Goldberg, MD, FCCP, Department of Medicine, Loyola University Medical Center, Maywood, IL; Ada Gonzalez, RN, MS, CLE, St. Mary of Nazareth Hospital Center, Chicago, IL; Sai Nimmagadda, MD, Department of Pediatrics, Northwestern Medical School, Chicago, IL; and C. Lucy Park, MD, Department of Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL.

	Footnotes

 
The Chicago Asthma Consortium is funded by a grant from the Otho S.A. Sprague Memorial Institute and support from the American College of Chest Physicians.

Abbreviations: CAC = Chicago Asthma Consortium; CASI = Chicago Asthma Surveillance Initiative; CPS = Chicago Public Schools

	References

TOP Abstract Introduction Access to Care Committee Community Committee Data Committee Marketing Committee Public/Patient Education... Professional Education Committee Schools Committee Appendix 1 References

 

1. Grant, EN, Moy, JN, Turner-Roan, K, et al (1999) Asthma care practices, perceptions and beliefs of Chicago-area primary care physicians. Chest 116,145S-154S[Abstract/Free Full Text]
2. McDermott, M, Grant, EN, Turner-Roan, K, et al (1999) Asthma care practices in Chicago-area emergency departments. Chest 116,167S-173S[Abstract/Free Full Text]
3. Thomas, SD, Whitman, S (1999) Asthma hospitalizations and mortality in Chicago. Chest 116,135S-141S[Abstract/Free Full Text]

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