Clinical‐Settings Break In
g
Wilson/Roosevelt Room
Boston Medical Center
Delivering Clinic‐Based Tailored Environmental Interventions
Environmental Interventions
Dr. Megan Sandel
Boston Medical Center
• Private, not‐for‐profit academic medical center and safety net hospital for Boston
center and safety‐net hospital for Boston
• Population Served: Nearly 1 million patient visits per year; about 70% from underserved b
f
populations
• Key Partners: Boston Public Health Commission, Boston Urban Asthma Coalition, Committee for Boston Public Housing, Boston Housing Authority, Inspectional Services, and Department of Public Health
Environmental Interventions in Clinic Settings
• BMC delivers environmental interventions in clinic settings by:
li i
i
b
– Training clinical staff to conduct environmental exposure assessment in clinical settings
i li i l
i
– EHR prompts for exposure assessments
– Delivery of asthma action plans
– Clinical counseling on trigger mitigation and avoidance
id
– Referral to home‐based intervention inspections
– Recent addition of Community Health Workers
Environmental Interventions in Clinic Settings
• Home‐based environmental management is coordinated with clinical care through:
coordinated with clinical care through:
– Close communication among medical home, public health and housing agencies to address structural
health and housing agencies to address structural environmental factors
– Internet
Internet‐based
based referral and home
referral and home‐visit
visit tracking tracking
system that creates feedback loop for clinicians
– Partnerships with BPHC, Boston Urban Asthma p
,
Coalition, BHA, and Neighborhood Health Plan
– New pilot study having Community Health Workers in partnership with Dept of Public Health
Environmental Interventions in Clinic Settings
Activities
Outputs
Outcomes
Impact
• Train clinical • Percent of • Reduced •Reduced ED teams to patients with exposure to visits and assess
assess trigger
trigger environmental
environmental hospitalizations
hospitalizations exposures to exposures triggers that for asthma
environmental documented in exacerbate • Improved triggers
EHR
asthma
patient QOL
patient QOL
• Referrals for high risk patients for ti t f
home visits and social support
Evaluation of ClinicClinic-Based
Environmental Interventions for
Asthma: Practical Aspects
CAPT David Callahan, MD
National Center for Environmental Health
Centers for Disease Control and Prevention
The findings and conclusions in this report are those of the
author and do not necessarily represent the official position
of the Centers for Disease Control and Prevention.
Objectives
Participants will be able to:
• List the six steps of the CDC Framework for
Evaluation
• Explain an excerpt from a sample logic model
for clinic
clinic-based
based environmental interventions
• Consider possible output and impact
measures,
easu es, a
and
d sou
sources
ces o
of c
credible
ed b e data for
o
those measures
CDC Evaluation Framework
http://www.cdc.gov/eval/framework.htm
Six Steps for Program Evaluation
Engage stakeholders
Those involved,, those affected,, primary
p
y intended users
Describe the program
p g
Need, expected effects, activities, resources, stage,
context, logic model
Focus the evaluation design
Purpose users
Purpose,
users, uses
uses, questions
questions, methods,
methods agreements
Six Steps for Program Evaluation
Gather credible evidence
Indicators sources
Indicators,
sources, quality
quality, quantity
quantity, logistics
Justify
y conclusions
Standards, analysis/synthesis, interpretation, judgment,
recommendations
Ensure use and share lessons learned
Design, preparation, feedback, follow
follow-up,
up, dissemination
Generic Program Logic Model
INPUTS
Program
Reso rces
Resources
ACTIVITIES
What we do
with program
reso rces to
resources
fulfill mission
OUTPUTS
OUTCOMES
Direct
p
products
of activities
Benefits for
participants
during and
after program
acti ities
activities:
short term,
intermediate,
long term
Source: Rebecca Murphy-Hoefer, PhD, MPH
Environmental Interventions in
Cli i l Settings
Clinical
S tti
Activities Outputs Outcomes Impact
Train clinical
teams to
assess
exposures to
environmental
triggers
Percent of
patients with
trigger
exposures
documented in
EHR
• Referrals for
high
g risk
patients for
home visits
and social
support
Reduced
exposure to
environmental
triggers that
exacerbate
asthma
Reduced ED
visits and
hospitalizations
for asthma
• Improved
patient QOL
Environmental
Environmental Interventions in
Cli i l Settings
Clinical
S tti
– Training clinical staff to conduct environmental
exposure assessmentt iin clinical
li i l settings
tti
– EHR prompts for exposure assessments
– Delivery of asthma action plans
– Clinical counseling on trigger mitigation and
avoidance
– Referral to home based intervention inspections
– Recent addition of Community Health Workers
Possible Measures and
S
Sources
off Data
D t
Of Outputs:
EHR prompts (Y/N)
Asthma Action Plans in EHR for all ICD
ICD-9
9 493
Documentation (notes) of clinical counseling
on triggers
Of Impacts:
Same patient reduction in ER visits over time
Same-patient
from admin/billing/claims data
Total ER visits (billing
(billing, EHR
EHR, etc.)
etc )
ATAQ scores from EHR, simple paper tracking