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The Asthma Toolkit Bootcamp to Improve Rural Primary Care for Pediatric Asthma
Bruce G Bender1, Bryan Simmons1, Nicole Konkoly2
1Center for Health Promotion, National Jewish Health, Denver, Colo.
Insights
The Asthma Toolkit Bootcamp significantly improved asthma care for rural children by enhancing primary care provider adherence to guidelines. This led to reduced emergency visits, hospitalizations, and medication use.
Area of Science:
- Implementation Science
- Pediatric Pulmonology
- Primary Care Medicine
Background:
- Rural children with asthma often receive care from primary care providers with inconsistent knowledge of evidence-based management guidelines.
- This variability in expertise can lead to suboptimal asthma control and increased healthcare utilization.
Purpose of the Study:
- To evaluate the Asthma Toolkit Bootcamp's effectiveness in improving primary care provider adherence to asthma guidelines.
- To assess the program's impact on reducing healthcare utilization among rural children with asthma.
Main Methods:
- The study implemented the Asthma Toolkit Bootcamp, featuring online and in-person training on National Heart, Lung, and Blood Institute guidelines, for primary care practices in rural Colorado.
- Training covered spirometry, severity assessment, medication management, and standardized protocols, evaluated using the RE-AIM framework.
Main Results:
- Provider adoption of evidence-based practices, including spirometry use (22% to 86%), severity assessment (47% to 88%), and action plan utilization (40% to 86%), significantly increased.
- Trained practices saw a 10% decrease in emergency department visits, a 35% decrease in hospital admissions, and a 29% decrease in oral corticosteroid prescriptions.
Conclusions:
- The Asthma Toolkit Bootcamp effectively enhanced pediatric asthma care delivered by rural primary care providers.
- The program demonstrated significant reductions in healthcare utilization for rural children with asthma, highlighting its successful implementation.
Background:
Children with asthma living in rural areas receive most of their care from primary care providers who have variable knowledge of evidence-based guideline management.
Objective:
To test the capacity of the Asthma Toolkit Bootcamp program to improve primary care provider guidelines adherence and reduce health care utilization in rural children with asthma.
Methods:
The Asthma Toolkit Bootcamp program provided intensive training in National Heart, Lung, and Blood Institute guidelines-based asthma care, evaluated within a RE-AIM implementation science framework. All primary care practices serving pediatric patients in rural La Plata County, Colorado, received (1) online instruction, (2) full-day training, and (3) follow-up, in-practice training 1 month later. Training focused on spirometry use, severity and control assessment, medication management, asthma action plan utilization, and adoption of a standardized visit protocol.
Results:
RE-AIM evaluation determined successful enrollment of practices in La Plata County (Reach) and provider uptake of evidence-based practices including spirometry (Adoption). Pediatric asthma patients receiving spirometry increased from 22% pretraining to 86% posttraining; severity assessment from 47% to 88%; and action plans from 40% to 86%. Significant improvements in health care utilization were observed among trained practices including a 10% decrease in emergency department visits, 35% decrease in hospital admissions, and 29% decrease in oral corticosteroid prescriptions (Effectiveness). Comparison practices showed no significant reductions in health care utilization. Participating providers reported that having the training in their own community, intense practice, a team-based approach, and cost-free materials including the spirometer and patient education materials were particularly helpful.
Conclusions:
The Asthma Toolkit Bootcamp improved pediatric asthma care given by rural providers and reduced health care utilization among their patients.
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