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Preface*: Civic Support and Leadership as a Catalyst for Addressing the Problem of Urban Asthma: The Otho S. A. Sprague Memorial Institute’s Asthma Initiative FREE TO VIEW

James N. Alexander, JD
Author and Funding Information

*From Alexander Associates (Mr. Alexander), Evanston, IL, consultant to the Otho S.A. Sprague Memorial Institute, Chicago, IL.

Correspondence to: James N. Alexander, Alexander Associates, 2129 Central Park Ave, Evanston, IL 60201-1801; e-mail: alexassocs@aol.com

Chest. 1999;116(suppl_2):129S-130S. doi:10.1378/chest.116.suppl_2.129S
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In 1911, the Otho S.A. Sprague Memorial Institute was created by one of Chicago’s civic leaders. In his will, Otho Sylvester Arnold Sprague set forth a clear and simple mission, “the investigation of the causes of disease and the prevention and relief of human suffering in the City of Chicago.” In the days before the National Institutes of Health, the board of the Sprague Institute sought to achieve this mission through the support of a group of scientific researchers whose accomplishments were noteworthy. The difficulties resulting from a volunteer board managing such an ambitious approach ultimately resulted in a shift to the support of biomedical researchers working within various academic medical centers in Chicago. Beginning in 1989, the board diversified its grant-making strategies in pursuit of outcomes that were within the fiscal reach of a mid-sized independent foundation. As is increasingly the case with grant makers, they sought focus and measurable outcomes for their philanthropy. In 1994, the disproportionately high rates of asthma mortality and morbidity in Chicago caught the attention of several board members.

During the summer of 1995, the board convened several meetings to evaluate the possibility of an initiative focused on asthma. A diverse group of representatives of nonprofit agencies, physicians, researchers, health-care providers, and other grant makers attended these meetings. These focus groups outlined the magnitude of the problem in Chicago. They counseled that although asthma is not a curable disease, with proper diagnosis and treatment, the risk of mortality for persons with asthma should be similar to that of the general population. They observed that many individuals with asthma are not receiving correct diagnoses and may not be following a prescribed program of care. They also questioned whether health-care providers in the Chicago area were providing care in accordance with the asthma guidelines of the National Heart, Lung, and Blood Institute of the National Institutes of Health.

At its fall 1995 meeting, the Program and Grant Committee of the Sprague Institute issued requests for proposals to qualified nonprofit organizations. In December 1995, the board formally launched its Asthma Initiative for a period of 3 to 5 years. The board approved asthma-oriented grants to 11 nonprofit recipients. Several were multiyear awards that were contingent on receipt of satisfactory progress reports. The grants ranged from support of a peer education initiative encouraging asthma awareness among low-income minority populations to support of basic science attempts to identify the asthma gene. In the next two grant cycles, the Sprague Institute increased the number of asthma-oriented grants, building on the visibility of the initiative within the nonprofit community.

Three of the Sprague Institute’s grants launched very ambitious programs. One grant established the Chicago Asthma Consortium (CAC), and a second grant established the Chicago Asthma Surveillance Initiative (CASI). The most recent grant supported the Chicago/Cook County Community Health Council’s Asthma Initiative in five underserved community areas.

The centerpiece of the Sprague Institute’s Asthma Initiative was a grant to the American Lung Association of Metropolitan Chicago to serve as fiscal agent and primary coordinator of a newly established community organization, the CAC. The American College of Chest Physicians, national headquarters of which are located in the Chicago area, was supported as co-conveyer of the project. The CAC was modeled after the National Asthma Education and Prevention Program of the National Institutes of Health. Since its first meeting in February 1996, the membership of the CAC has grown to hundreds, representing many organizations and individuals in the Chicago area. It is governed by a diverse, self-selected executive committee and has hired an executive director and an administrative assistant to supplement the staff borrowed from the American Lung Association of Metropolitan Chicago and other supporting organizations. Although not without administrative difficulties, the CAC has become a premier networking vehicle for community and health-care professionals and a potential model for other US cities. In just over 3 years, the CAC, through its various committees, has accomplished several important tasks, including the following:

• The Marketing Committee of the CAC publishes a CAC newsletter, Web site, and the city’s first resource directory for asthma-related programs and services.

• The School Committee of the CAC has changed the medication policy within the Chicago Public Schools to permit students with asthma to keep their inhalers with them, rather than surrendering them to school office or nursing personnel, who may not be available in times of need. Through joint efforts with the CAC, the Chicago Public Schools now train school personnel on this policy and have co-funded (along with the Sprague Institute) a project to improve asthma care in the schools. As a result, > 300 school nurses and many school principals have been trained to better understand asthma and care for students with asthma.

• Through the Access to Care Committee, the CAC has enlisted nearly two dozen Chicago-area emergency departments to work together in a 1-year collaborative effort to improve emergency department asthma care across the community.

• The Data Committee of the CAC has alerted the media to the magnitude of the public health problem defined by asthma.

• The CASI project has provided the CAC with valuable baseline data characterizing asthma and asthma care in the Chicago area. It has also shown the aspects of care in need of improvement.

The Sprague Institute’s board recognized that much of the effort of the CAC would be aimed at increasing awareness and improving care throughout the Chicago area. Without a formal evaluation component, however, there would be little or no data (except asthma mortality and perhaps hospitalization rates) by which to judge the success of these efforts. Therefore, the Sprague Institute funded the creation of the CASI to provide data that will increase the awareness of asthma-related issues as well as to evaluate changes in asthma and asthma care over time. To date, the CASI has surveyed Chicago-area hospitals, emergency departments, primary care physicians, asthma specialists, pharmacists, managed care organizations, and the general public as well as persons with asthma and their families to learn about asthma care and its outcomes.

This grantee coordinates the community-based health initiatives identified by the leadership in five distinct community areas. Together, they determined that asthma affected them all. With support from the Sprague Institute, they studied the problem, identified community and provider education as a potential solution, and devised a multiphase strategy to effect change. In July 1999, they were awarded a $470,000 matching grant by the Local Initiatives Funding Program of the Robert Wood Johnson Foundation.

The Sprague Institute’s involvement in their Asthma Initiative goes beyond funding. In addition to the social network resulting from the CAC, the Sprague Institute has encouraged collaboration and sharing. It periodically convenes its grantees to meet and discuss their work with each other and with the members of the board. Examples include the following:

• Patient-tracking computer software developed by Children’s Memorial is now used by Bethany, Lawndale, and LaRabida Hospitals.

• A screening instrument developed by researchers at Rush-Presbyterian-St. Luke’s Medical Center has been validated and used by grantees at LaRabida Hospital and the University of Illinois at Chicago to predict the likelihood of asthma.

• AmeriCorps members of the Chicago Health Corps are collaborating with the staff of the American Lung Association of Metropolitan Chicago to make the curriculum of the Open Airways Program more culturally appropriate for the diverse school population of Chicago.

• The American Red Cross of Greater Chicago used the expertise of many of the Sprague Institute’s grantees in creating and field-testing their first asthma education program.

The board defines a research grant to be a project that is likely to be submitted for publication in a professional or scientific journal. Much of their funding is based on a 50:50 formula. Approximately 50% of its grants are invested in research, and 50% are invested in nonresearch activities that meet the Sprague Institute’s mission. Since its inception, the Asthma Initiative has awarded > $3.1 million in total grants.

Although the Asthma Initiative has done well in many areas, there have also been some impediments to success. At least one of the community-based initiatives did not fare well. In addition, many of the grantees have focused their efforts on low-income populations, in which it is not uncommon to experience difficulties in maintaining contact for purposes of long-term follow-up. Also, whereas the work with the Chicago Public Schools is going well, the velocity of this work is less than is needed based on the urgency and magnitude of the problem. Finally, although the CAC has become a strong, self-determined community organization, it has only recently felt capable of incorporating itself as an independent 501(c)(3) tax-exempt nonprofit organization.

It is too soon to expect conclusive outcomes from the Asthma Initiative, at least in terms of its impact on asthma morbidity and mortality. When dealing with a problem of this magnitude, improvement cannot be instantaneous. At the end of 1998, the board evaluated the Asthma Initiative’s first 3 years. The board concluded that it had been successful at focusing its grant-making energies, had induced other funding organizations to recognize the need to support asthma projects within Chicago, and had commissioned the publication of this supplement to CHEST to document the best practices and outcomes for others in the philanthropic and health communities. In the short term, the Sprague Institute will continue its support of select asthma-oriented projects even as it convenes a new series of focus groups to help the board identify their next priority. It is clear, however, that the Sprague Institute’s investment has jump-started the issue of asthma for the Chicago community. It has brought together and energized a variety of well-qualified academic and nonprofit organizations, along with a diverse group of health-care professionals, to work with community leaders in addressing this problem. In just 3 years, it has demonstrated what a local philanthropy can do when it focuses its resources in a timely fashion on an important public health concern.

Abbreviations: CAC = Chicago Asthma Consortium; CASI = Chicago Asthma Surveillance Initiative




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