Applying implementation science to improve adherence to clinical guidelines in asthma care: a public health practice dissertation to improve the utilization of asthma action plans in Tennessee

Abstract

Thesis (Dr.P.H.)--Boston UniversityBackground: Tennessee made a commitment to improve the quality of care provided to children with asthma, which affects approximately 10% Tennessee's public school population. Asthma is chronic respiratory condition that can be managed with medications and behavioral and environmental interventions. Asthma action plans (AAP), which document an individual's asthma management plan, are a proven strategy associated with improved asthma outcomes. To improve the utilization of AAPs among children with asthma enrolled in public schools, the Tennessee Department of Health (TDOH) established the Tennessee Asthma Learning Collaborative (TALC), a multidisciplinary, multiagency stakeholder group that engaged in quality improvement activities at selected local sites across the state. This dissertation is an evaluation of TALC and its activities. Methods: TALC members and their community partners from local sites were interviewed about their experience participating in the learning collaborative. The Consolidated Framework for Research (CFIR) guided this qualitative data collection and analysis. AAPs were reviewed at local sites. A run chart tool was used to analyze quantitative data obtained from the review of AAPs to determine if a change in the number of forms collected occurred. Results: Participant interviews yielded information about barriers and facilitators to AAP collection in selected schools. Barriers included school nurse availability, inconsistent AAP forms across school systems, and lack of school nurse leadership at the state level. Facilitators included purposeful communication and collaboration between community healthcare providers and local school nurses. Analysis also revealed strengths and weaknesses in implementing the learning collaborative. Translation: This project informed two public health practice products. A manuscript was prepared for submission to the Journal of School Health that addresses the original state objective to reach 100% AAP compliance in schools and describes challenges related to implementing improvement strategies. A state report was produced for use by the TDOH which included recommendations for continued quality improvement efforts. Conclusion: CFIR framework provided a useful tool for evaluating the complex challenges and opportunities associated with implementing a state level multidisciplinary quality improvement effort and generated information that will inform future public health efforts to improve school-based management of chronic health conditions