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One Minute Asthma Training Report

Asthma distance learning program for staff increases practice effectiveness and revenue.
Thomas F. Plaut, MD and Lester Hartman, MD

Introduction. To improve the effectiveness of their care, a pediatric group with 6,500 patients (350 with asthma), a staff of 22 pediatricians and nurses (15 FTEs) in two sites piloted the One Minute Asthma Training in December 2001. This peer based, distance learning program, designed for nurses and respiratory therapists, is consistent with the NHLBI Guidelines.

Method.
Three staff nurses and the senior pediatrician prepared individually for a group session by answering a detailed questionnaire and then reading the booklet, One Minute Asthma, and a supplement to learn the answers to the questions they had missed. They then watched a video illustrating the use of four asthma devices. During a three hour group session, they discussed basic asthma topics, and practiced using a metered dose inhaler (MDI), a holding chamber, a compressor driven nebulizer and a peak flow meter. Following this they were videotaped and scored on their use of each device. After the group session they retook and scored the questionnaire. Two weeks later they had a teleconference with the first author to discuss the video and various questions.

Results.
The four participants increased both their asthma knowledge and their skill. Their average score on the questionnaire increased from 59 to 92. All improved their skill in the use of an MDI and three improved in the use of the other devices. The 350 asthma patients are seen, on average, three times a year (1050 visits). Transferring peak flow measurement and device instruction to the nurses saved three minutes per visit, and the two pediatricians who assigned reading to parents saved three minutes per visit. If all this time were used for appointments, it would allow an additional 316 fifteen minute visits generating $16,432. Increasing the number of peak flow measurements improved care and added $2,800 in revenue. The initial cost of the program was $5,050 The only recurring cost is $2,310 in pay for the nurses to perform the tasks transferred to them.

COST AND BENEFIT

Training time for nurses
$660
Training time for pediatrician
$2,080
Transfer of tasks to nurses (recurring)
$2,310
Training license (waived)
($995)
COST $5,050
Additional Appointments
$16,432
Additional peak flow measurements
$2,800
BENEFIT $19,232
NET BENEFIT $14,182

Conclusions. A distance learning program based on One Minute Asthma increased staff knowledge and skill. This ten hour program led to improved care due to increased consistency, more effective use of office resources, more effective teaching and an increase in peak flow measurements. Potential net dollar gain to the practice was $14,182 during the first year of the program.

Summary
Training Process
Sample Questions & Answers
Report of the Training in a Boston Area Pediatric Office
Report of the Training by Chicago School Nurses

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