Innovative Pediatric Asthma Care Program at SFGH Wins National Award

By Phyllis Brown

Shannon Thyne

Treating pediatric asthma has long been appreciated as a complex endeavor requiring the collaboration of children, their families, health care providers and school officials, among others. Various models - including primarily medical care, social intervention and efforts that combine the two - have been tried. Yet these programs struggle to find effective methods of managing the disease. One notable success has been the YES WE CAN Urban Asthma Partnership, a multidisciplinary collaboration of San Francisco State University, City College of San Francisco and the UCSF Department of Pediatrics at San Francisco General Hospital (SFGH). In May, the Ambulatory Pediatric Association will honor the YES WE CAN program with the 2007 Health Care Delivery Award, which recognizes "innovative and effective programs that deliver health care" at the annual meeting of the Pediatric Academic Societies in Toronto, Canada. Shannon M. Thyne, MD, a nationally recognized expert in pediatric asthma, associate clinical professor in the UCSF Department of Pediatrics and medical director of the Pediatric Asthma Clinic at SFGH, will deliver an address highlighting the innovative aspects of the program's service delivery model and its focus on medical training. Other honorees will include clinic director Nan Madden, RN, PNP, and educational director Andrea Marmor, MD, MSEd. "This is an outstanding achievement and marks the first time the UCSF Division of General Pediatrics has been honored with this award," said Division Chief Michael Cabana, MD, MPH, who nominated the program for the award. YES WE CAN combines the efforts of UCSF faculty, residents, medical students and nurse practitioners with those of community health workers and community organizations such as schools and advocacy groups. In the YES WE CAN model, UCSF clinicians provide patients with medical treatment and action plans for controlling their asthma. They work with community health workers who provide in-home, culturally appropriate health education and support to families to augment their clinical care. Issues that include environmental triggers in the home - like pets and smoking - and health insurance concerns are considered in the home visits. Initiated in 1997, the partnership program has consistently demonstrated leadership in treating asthma among children, and in the past has been honored by the American Medical Association and the national Centers for Disease Control and Prevention, which features the program on its website. A toolkit outlining how to replicate the program was published in 2004. The program also has been replicated at two other local sites in the San Francisco community, three other US sites and in Puerto Rico. Documented Results Last November, Thyne and others published a study on the program in the Journal of Asthma. They noted that the combined medical-social approach to treating asthma is effective in decreasing the incidence of asthma among its participants. Among other results, the study found that YES WE CAN participants experienced an average decrease in the number of days and the number of nights during which they experienced asthma symptoms. The number of days with asthma symptoms decreased from 5.1 days to 2.8 days; the number of nights decreased from 5.0 to 2.7, according to the study. Other study authors include Joshua P. Rising, MD, of the UCSF Department of Pediatrics; Vicki Legion, MPH, of the Health Education and Community Health Studies Department of City College of San Francisco; and Mary Beth Love, PhD, chair of the Department of Health Education at San Francisco State University. "Our own experiences and interactions with colleagues underscored the importance of integrating medical and social interventions for childhood asthma," the study authors noted. Asthma is the most common chronic disease condition among children, and is the leading cause of school absences nationwide, which results in the loss of an estimated 100 million school days each year. Some 10 percent of all youths experience exercise-related asthma, with low-income and minority children experiencing some of the highest asthma rates. Asthma is a disease of the lungs in which the airways become blocked or narrowed, causing breathing difficulty. Depending upon its severity, asthma can cause recurrent attacks of symptoms such as wheezing, chest tightness, shortness of breath and coughing. In severe cases, these symptoms can be physically and mentally disabling.
The Yes We Can Urban Asthma Partnership: A Medical/Social Model for Childhood Asthma Shannon M. Thyne, MD, Joshua P. Rising, MD, Vicki Legion, MPH, Mary Beth Love, PhD Journal of Asthma2006;43(9):667-673 Abstract | Full Text | Full Text (PDF)
Treating Asthma, Improving Lives UCSF Today, February 10, 2006 YES WE CAN Urban Asthma Partnership