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Bethany Hospital's Asthma Program^*

^* From Bethany Hospital (Drs. Greene and Boyle, and Mss. Jackson and Bruce), Chicago, IL; Advocate Health Care (Dr. Greene), Chicago, IL; Advocate Health Center at Laramie and Jackson (Dr. Aniemeka), Chicago, IL; and Advocate Health Center (Drs. Chaudhary and Talathi), Bethany Hospital, Chicago, IL.

Correspondence to: Carolyn Jackson, RRT, 5222 S. Ingleside, Chicago, IL, 60615

	Introduction

TOP Introduction

 
Bethany Hospital is a 150-bed inner-city hospital located in the Garfield Park community on Chicago's West Side. It is one of eight hospitals that constitute Advocate Health Care—one of the largest not-for-profit health-care systems in the city. The majority of Bethany's patient population is low-income and African-American, and a significant number of patients have asthma.

Since 1989, Bethany has taken a special interest in asthma, and, over the years, has developed this interest into a comprehensive community-based approach to asthma management. Bethany's asthma program began with specific concerns over patient management, both in the inpatient setting and in the emergency department (ED).

At the time, the hospital had no asthma-specific protocols; treatments were ordered haphazardly and "stat" calls were common. In response to these concerns, the hospital developed asthma treatment guidelines and care paths, and over the course of several years began to standardize care and improve inpatient management. However, many staff members remained concerned that the same patients were returning to the ED time after time. They began to recognize that the only way to achieve success in asthma management would be to extend their reach out into the surrounding community. For that, they would need to seek out additional resources.

In 1995, Bethany Hospital applied for and received funding from the Otho S.A. Sprague Memorial Institute for the purpose of developing an asthma education program. The grant covered the cost of patient education materials and allowed them to hire a respiratory therapist to go out to the clinics in the community. The respiratory therapist discovered that the hospital-based asthma education was not always effective at the community level. The community physicians, who often had patients come to their offices in a state of acute exacerbation, agreed with need to focus on continual asthma management rather than acute treatment.

Today, Bethany has an asthma team comprising representatives from the Departments of Medicine, Respiratory Therapy, and Quality Management, the ED, and other asthma specialties. In addition to providing care for asthma patients attending the hospital-based Ambulatory Care Center, the team continues to look for ways to reach out into the community. The team sends respiratory therapists to three community clinics once a week to help monitor and educate asthma patients and their families. It has worked with the Midwest Community Council Block Club Convention, a local community action group, to conduct community asthma screenings and on-site referrals. It has worked with the West Side Health Partnership, a local community health advocacy organization, to develop an asthma initiative. The team also conducts professional education for office-based physicians.

Although Bethany's asthma team has conducted no formal evaluation of their program, it has been collecting data on the asthma patients seen at the hospital and in the surrounding community. The team developed a cumulative data form to collect information on asthma diagnosis, duration, health-care utilization, etc. The respiratory therapist (hired specifically for the asthma program) is responsible for entering this information into an electronic database. Currently, the database holds information on more than 600 asthma patients.

The team has received informal feedback from the clinics that have noted an apparent increase in office visits from patients who used to go to the ED for routine asthma care. The team realized that one of the main reasons many individuals went to the ED for routine care was because they had no money to pay for asthma medications. Thus, the team created an arrangement with the hospital pharmacy whereby the cost of the asthma medications could be paid out of the Bethany Hospital asthma fund if the patient could not afford them.

The concept of the asthma fund evolved as a result of Bethany's commitment to create a permanent, comprehensive, asthma program, which meant securing the resources necessary to maintain the program beyond its initial start-up. The Otho S.A. Sprague Memorial Institute provided the initial start-up funds, and has continued to support program efforts. However, Bethany's asthma program also obtained additional support in the form of both external and internal resources. They have received a small amount of support from pharmaceutical companies and other industry sources. These resources were combined to form the Bethany Hospital asthma fund. The asthma program also attracted the attention of several members of the medical and administrative staff of Bethany Hospital, who specifically earmarked their contributions to the Employee Giving Campaign for the asthma fund.

Through the asthma fund, Bethany has been able to consistently give away peak flowmeters and spacer devices, and to cover the costs of medications for patients who could not otherwise afford them. The fund also covers the costs of printing and distributing a variety of asthma education materials, including a booklet currently used for professional education.

As a result of Bethany's success, Advocate Health Care decided to expand the asthma program to other hospitals in the system. The asthma team shared many of its materials with the Advocate system, including care paths for ED and inpatient care, preprinted standing orders for use in transfer from ED to inpatient wards, and physician asthma education materials. The Bethany Hospital asthma team is extremely proud of its program to date. Asthma team members hope that, through their participation in the Chicago Asthma Consortium, they can serve as a model and resource for other community-based hospitals interested in improving the care of persons with asthma.

	Footnotes

 
Abbreviation: ED = emergency department

Funded in part by the Otho S.A. Sprague Memorial Institute, Glaxo Wellcome, Inc., Amoco Foundation, and The Bethany Hospital Employee Giving Campaign.

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