Mount Sinai School of Medicine

Problem:

Asthma affects over 5 million children in the United States and it is a major cause of morbidity and mortality. The increase in asthma has been most marked in African Americans and Puerto Rican Hispanics. The community we serve has the highest incidence of childhood asthma in the United States.

Goals and Objectives:

Goal 1: Assure a qualified PPC faculty that possesses the knowledge, skills and MCH leadership competency to serve a racially and ethnically diverse MCH population. Objective 1: Maintain for each year of the project a qualified faculty representing the core disciplines of medicine, nursing, nutrition, respiratory therapy, social work with appropriate faculty appointments and MCH leadership competencies to perform the functions and responsibilities of the training program. Objective 2: To promote the pursuit of new knowledge through critical inquiry and research publications to meet the unique needs of a racially and ethnically diverse MCH population. One publication or one conference presentation per year. Objective 3: Faculty will advocate for children with special needs and their families and provide the opportunities for trainee participation in advocacy. Goal 2: Prepare and support diverse MCH leaders who will deliver family centered, interdisciplinary, culturally competent care and will influence the quality of health care for the MCH population. Objective 1: To promote family centered, culturally competent, interdisciplinary training at the graduate and post graduate level to trainees of the core disciplines aimed at improving the quality of care for children with chronic pulmonary diseases. Per year: 6 long term trainees and > 15 medium term trainees. Objective 2: To develop recruitment strategies at the national and regional level that will result in securing ethnically and racially diverse, highly qualified trainees who are likely to use their training to enhance systems of care for children with special health care needs and their families. Objective 3: Under the guidance of faculty members trainees will acquire knowledge about different systems of care in diverse community settings and will provide cultural competent care to patients and families of diverse cultures and a language other than English. Goal 3: Develop effective leaders who demonstrate MCH Leadership Competencies. Objective 1: To acquire leadership skills and competencies in the areas of quality improvement of service delivery, policy development, program planning and research through the process of completing the requirements of the core curriculum and the interdisciplinary training program. Objective 2: Achieve familiarity with the key elements of Healthy People 2010 Objectives related to MCH Title V Programs for children with special health care needs and the National Performance and Outcome Measures by participating in two collaborative tasks with PPC faculty. Objective 3: To develop administrative and management skills and achieve basic understanding of the research process by participating in research activities. Goal 4: Translate and integrate new knowledge to enhance MCH training, inform policy, and improve health outcomes for a racially and ethnically diverse MCH population. Objective 1: At the national and regional level collaborate with MCH programs or other related agencies addressing health policy issues aimed at health care providers on improving the delivery and quality of evidence based care for a diverse MCH patient population. Ten activities per year. Objective 2: Collaborate with MCH Title V and EPA programs in Region II to implement the National Asthma Education Panel (NAEPP) recommendations by serving on advisory panels or providing training to health care providers in community settings. 50 activities per year. Objective 3: Provide focus groups, workshops and technical assistance activities to schools, members of the community board and families based on their identified needs. Goal 5: Develop an evidence and scientific knowledge base to build analytical capacity to assess and improve quality of care. Objective 1: Develop scientific knowledge base specifically addressing the MCHB Strategic Plan and Healthy People 2010 Objectives on topics related to pulmonary diseases. One research publication per year. Objective 2: Disseminate research findings of the national and regional level to influence health care policy and clinical practice. Provide TA to assist States and communities to integrate research based evidence into their comprehensive health service system. Objective 3: Advocate for MCHB Health Issues at National, Regional and Local levels by visiting lawmakers and testifying before Congress.

Methodology:

The Mount Sinai PPC will provide each year training to 6 long term trainees of the core disciplines of medicine, nursing, nutrition and social work, to 3 medium term respiratory trainees, and to 20 medium term trainees from medicine, nursing, and nutrition to develop knowledge and skills in providing family centered, interdisciplinary and culturally competent care that will influence the quality of health care for a diverse MCH population. The PPC program serves an ethnically and racially diverse patient population in medical centers and community settings. The program provides basic and clinical research opportunities for trainees, collaborative relationships with city, state and federal resources. Trainees will be involved in interdisciplinary clinical experiences including consultations and care coordinated activities from the medical center to the community setting. As the knowledge of the trainees’ increases during the training, they will be involved or assist, under the direction of faculty members, in collaborative activities with MCH Title V programs by providing technical assistance related services for children with special health care needs. The PPC conducts continuing education activities targeted at health and related care providers in the community settings. These sessions are based on specific needs identified by the groups to be served. Faculty members and trainees participate in issue committees formulating policies for chronically ill children.

Coordination:

We will collaborate with Title V programs at the national, regional and local level to implement the DHHS Strategic Plan to combat asthma. Representatives from Health Departments of States in Region II are members of the PPC Advisory board. We will share information that will lead to the coordination of programs between the PPC and the health departments. PPC faculty participates with state and local agencies by sitting on planning committees, task forces and expert panels.

Evaluation:

Trainees will be consistently evaluated according to the quality of clinical performance, assigned projects, oral or written presentations, quality of research projects and evaluation of the faculty and the program by the trainees. Furthermore, the program continually evolves in response to changes in the health care environment, MCHB priorities, emerging research findings and feedback from trainees. Annual follow-up surveys will evaluate the involvement in leadership roles of former trainees.

Experience to Date:

(2005-2006) At the four sites supervised by PPC faculty members, 3414 patients received medical care. The interdisciplinary team provided training to 4 Long Term Trainees and 74 Medium Term Trainees. All of the 7 former trainees who completed the program five years ago remain in the MCH field and have achieved leadership positions, thereby influencing the quality of care for children. Faculty members and trainees presented 74 training sessions (77 % with CE & CME credits) to health care providers and the public at large with a total of 4869 participants. Faculty members and trainees participated in 87 technical assistance activities with members of Title V programs, State Health Departments, professional and academic programs, schools and community programs. Asthma has a significant impact in States in Region II. New York State’s asthma hospitalization rate is two times higher than the levels targeted in Healthy People 2010. As in the past, the PPC Center Director was invited by New York State to participate as a medical advisor on an Asthma Initiative for the development, implementation and monitoring of partnership, surveillance and intervention strategies, as well as in the review and revision process in future years. It is the PPC’s intention to continue to be actively engaged with State Health Departments in Region II, provide training and technical assistance, translate our research on asthma intervention into programs that benefit the community.