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The Impact of Implementing a Chronic Care Residency Training Initiative on Asthma Outcomes

Greene, Jessica PhD; Rogers, Victoria W. MD; Yedidia, Michael J. PhD

doi: 10.1097/ACM.0b013e31802d90ed
Chronic Care

Purpose: To examine the impact of a chronic care residency training intervention on continuity clinic patients’ asthma-related emergency department use and primary care residents’ application of key elements of the Chronic Care Model (CCM).

Method: In 2002 and 2003, the authors conducted a pre- and posttraining survey of 41 intervention residents at Maine Medical Center to assess residents’ implementation of the CCM. The change in implementation for intervention residents was compared with that of 77 primary care residents not receiving CCM training. Asthma-related emergency department (ED) use by 441 patients cared for by intervention residents was compared with that of other asthma patients at Maine Medical Center using hospital billing records.

Results: At baseline, residents in both groups reported sporadic application of key elements of the CCM. At posttest, Maine Medical Center residents reported significantly greater increases in CCM implementation than the comparison group for 4 out of the 12 items. The greatest increases were in residents’ access to asthma guidelines, the proportion of patients receiving written asthma management plans, and residents’ access to information on community asthma programs. The number of asthma-related ED visits dropped significantly among patients treated by intervention residents (pediatric patients 42%, adults 44%). There was a slight increase in asthma ED use for nonintervention pediatric patients at the hospital (8%) and a very small decrease for adults (3%).

Conclusions: Chronic care training programs for residents may influence the health outcomes of patients treated in their continuity clinics while simultaneously offering an important educational experience in an underemphasized area of medicine.

Dr. Greene is assistant professor, Department of Planning, Public Policy and Management, The University of Oregon, Eugene, Oregon.

Dr. Rogers is director, Kids CO-OP (Clinical Outcomes and Outreach Program), The Barbara Bush Children’s Hospital at Maine Medical Center, Portland, Maine.

Dr. Yedidia is professor, Rutgers Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey.

Correspondence should be addressed to Dr. Greene, Department of Planning, Public Policy and Management, 1209 University of Oregon, Eugene, OR 97403; telephone: (541) 346-0138; fax: (541) 346-2040; e-mail: (

© 2007 Association of American Medical Colleges