Jeri Hepworth

Improving pediatric asthma control among minority children participating in medicaid: Providing practice redesign support to deliver a chronic care model

Background. Asthma, a leading chronic disease of children, currently affects about 6.2 million (8.5%) children in the United States. Despite advances in asthma research and availability of increasingly effective therapy, many children do not receive appropriate medications to control the disease, have overreliance on reliever medication, and lack systematic follow-up care. The situation is even worse for poor inner-city and minority children who have significantly worse asthma rates, severity, and outcomes. National Asthma Education and Prevention Program Guidelines recommend a multimodal, chronic care approach. Objective. The authors assessed the effectiveness of practice redesign and computerized provider feedback in improving both practitioner adherence to National Asthma Education and Prevention Program Guidelines (NAEPP), and patient outcomes in 295 poor minority children across four Federally Qualified Health Centers (FQHC). Methods. In a nonrandomized, two-group (intervention versus comparison), two-phase trial, all sites were provided redesign support to provide quarterly well-asthma visits using structured visit forms, community health workers for outreach and follow-up, a Web-based disease registry for tracking and scheduling, and a provider education package. Intervention sites were given an additional Web-based, computerized patient-specific provider feedback system that produced a guideline-driven medication assessment prompt. Results. Logistic regression results showed that providers at intervention sites were more than twice as likely on average to prescribe guideline-appropriate medications after exposure to our feedback system during the Phase I enrollment period than providers at comparison sites (exp(B) = 2.351, confidence interval [CI] = 1.315–4.204). In Phase II (the postenrollment visit period), hierarchical linear models (HLMs) and latent growth curves were used to show that asthma control improved significantly by .19 (SE = .05) on average for each of the remaining four visits (about 11% of a standard deviation), and improved even more for patients at intervention sites. These results show that implementation of practice redesign support guided by a pediatric chronic care model can improve provider adherence to treatment guidelines as well as patients’ asthma control. Conclusions. The addition of patient-specific feedback for providers results in quicker adoption of guideline recommendations and potentially greater improvements in asthma control compared to the basic practice redesign support alone.

Contributions of Medical Family Therapy to the Changing Health Care System

Medical family therapy is a form of professional practice that uses a biopsychosocial approach and systemic family therapy principles in the collaborative treatment of individuals and families dealing with medical problems. It emerged out of the experience of family therapists working in primary medical care settings in the 1980s and 1990s. This article describes how contemporary medical family therapy can contribute to a transformed health care system in four areas: the patient experience of health care, the health of the population, the containment of health care costs, and enhanced practice environments.

The four pillars for primary care physician workforce reform: A blueprint for future activity

82 Max has been a member of the Governing Board of the Student Outreach Resource Center (SOURCE) at Johns Hopkins for 3 years. He is a co-leader of his medical school’s Urban Health Interest Group and Family Medicine Interest Group, he sat on the board of the Maryland Academy of Family Physicians Foundation, and he served as a Student Delegate to the National Congress of Student Members of the American Academy of Family Physicians (AAFP). Recently, Max was appointed to a 1-year term on the AAFP’s Commission on Health of the Public and Science and was named a Sommer Scholar at the Johns Hopkins Bloomberg School of Public Health. As a future family physician, Max looks forward to practicing community-based primary care and preventive medicine. He wants to bring innovative models of primary care delivery to underserved communities and provide coordinated, comprehensive, and compassionate care to his patients.

The Measurement of Identity: Reliability of Constantinople's Inventory of Personality Development

This paper considers the reliability of a much referenced measure of identity, Constantinoples Inventory of Personality Development. Al- though Constantinople indicated only moderate acceptability of the reliability of the instrument, a review of literature indicates that later researchers utilizing the measure generally did not report independent reliability estimates. This paper reports reliability estimates, computed for the identity subscales with a sample of undergraduate students, which suggests caution in the use of this measure for identity research. Discussion includes the implications of this methodological issue for future identity research.