ICAAP has recently used an office-based approach for its programs that address asthma diagnosis and treatment, vaccine administration and handling, developmental screening and referral processes, and tobacco cessation. Presenting programming at the site where health care is delivered not only enables the sponsor to reach all health professionals and office staff involved in the delivery of care but also facilitates personalization of the content and its recommended techniques to the actual processes employed in the host health care center. For the physician, the challenges of adapting information received through continuing education to the practice setting and educating practice colleagues unable to participate in remote events is greatly reduced through the office-based approach.

In addition, reaching a relatively small number of providers through office-based education can have a significant impact on children. According to the national AAP Division of Health Policy Research, which produces a biennial report of the number of pediatricians and other pediatric specialists and children in each U.S. county, there are approximately 1,700 children per general practice pediatrician in Illinois (http://www.aap.org/research/workfrc.htm). Research from the AAP PROS (Pediatric Research in Office Settings) Network agrees, showing that the average patient population for private pediatric practitioners nationwide about 1,500. Therefore, presenting a program in a medium to large (4 or more practitioners) pediatric practice can ultimately impact literally thousands of children.

Finally, presenting office-based programming can provide benefits in terms of the dissemination of quality improvement strategies for practicing physicians and research into pediatric practice. While lecturers at traditional education events interact with audience members through discussions and question/answer sessions, they rarely see the practice environment or meet all participants involved in the delivery of care in a particular setting. Office-based education programs not only provide speakers with insight into application of the curriculum in each practice environment but allow them to identify new challenges and strategies that can then be incorporated into the presentation itself. Practice-based research, not unlike that conducted by the AAP PROS Network and the Pediatric Practice Research Group (PPRG) of Children's Memorial Hospital, can also be conducted in conjunction with practice-based educational programs.

Components of a Successful Office-Based Educational Program

Identify a Topic
Topics for office-based education programs are decided when a need for continuing education on that topic is evident in current pediatric publications, at ICAAP/AAP meetings, and/or at members' requests. Once a topic is chosen, a formal literature review is undertaken and a needs assessment is conducted by ICAAP or another organization to verify the need for a program on this topic.

Find a Sponsor/Grantor
Many state and federal government agencies providing child and family health and social services request applications for potential grant-funded programs or seek out organizations that serve particular audiences for collaboration. Pharmaceutical companies also provide project funding for continuing medical education, however, ICAAP will only accept these funds if the Chapter has complete control over the program's curriculum. ICAAP has contracted to provide office-based education for physicians with the following sources: Illinois Department of Public Health, Cook County Department of Public Health, Chicago Department of Public Health, Illinois Council on Developmental Disabilities, and GlaxoSmithKline.

Establish a Project Advisory Committee
Once grant funding is secured, the Chapter recruits members for the project's advisory or planning committee. Advisory committee members usually consist of physician and nurse specialists in the topic's field and one or two practicing physicians. Some project committees also have curriculum reviewers and project liaisons to organizations that concern the program's topic. After this committee is established, an initial meeting is conducted to discuss primary planning of the project and its curriculum.

Develop a Curriculum
Curriculum is developed by the project staff and the advisory committee. Typically, an initial outline is composed and circulated among committee members. Then, the presentation itself is drafted by the committee and revised/edited by project staff. Each program develops project curricula differently. For example, the Get in the Zone asthma education project curriculum was drafted by one primary physician and one nurse educator. Experts prepared and presented individual papers on adolescent smoking cessation at a one-day panel discussion, after which a professional medical writer developed a curriculum and materials based on the presentations. And segments of the developmental screening and immunization education programs were drafted by multiple advisory committee members and others and reviewed for consistency and redundancy by staff. Similarly, the materials collected as resources and handouts for the programs - including relevant articles, patient education handouts, tip sheets, and even entire manuals - are identified by multiple participants and collated by staff into a comprehensive presentation kit.

Curricula for each project also vary between programs. The teen tobacco use program consists of a one-hour PowerPoint lecture followed by a question and answer session. The Reaching our Goals immunization program consists of a comprehensive curriculum that can be segmented into modules and presented as necessary based on practices' needs.

Identify Incentives for Participation
Incentives for a practice to host an office-based program includes flexible scheduling and the opportunity to integrate the program into the practice's routines, provision of food or a light meal, and most importantly continuing medical education (CME) and continuing education (CE) credits. ICAAP staff applies for and secures continuing medical education hours for participating physicians and contact education hours for participating nurses. CME/CE certificates are distributed to program participants after the presentation for the number of hours attended. Practice leaders also appreciate the opportunity to provide professional development experiences to members of their staff while simultaneously increasing their own skills. Finally, ICAAP has worked with insurers and state and county agencies to promote programs to providers in their networks, thereby lending weight and authority to the offer for programming.

Train-the-Trainer
Once grant funding is secured for the program and while curriculum development occurs, presenters are recruited via the "illinois pediatrician" newsletter, ICAAP broadcast faxes, and other promotional means. These presenters are then trained by the advisory committee members and curriculum authors at a "Train-the-Trainer" workshop. This workshop provides master trainers with the program materials and information necessary to train physicians and office staff on the project's topic.

Often, these trainers are community-based practitioners themselves and commit to teaching local colleagues - practitioners they already have relationships with and who share an understanding of unique challenges in particular communities. Depending on the content, teams of pediatricians, nurses, physician assistants, and office staff have been identified to handle components of the curriculum and to train different groups of professionals. This multidisciplinary, peer-to-peer education approach is key to the success of these programs.

Presentations
The programs are promoted through advisory committee members, ICAAP executive committee members, and Chapter members at their practices and colleague's practices. Promotion is also conducted through the newsletter, broadcast faxes, and mailings.

ICAAP staff and Advisory Committee members schedule presentations at pediatric practices and clinics throughout the project target area. For example, the teen tobacco program was conducted on a statewide basis, so presentations were scheduled from Champaign and Springfield to Rockford and Barrington. The immunization program was funded by the Chicago Department of Public Health, so programs were only scheduled in Chicago. Other programs may target low-income areas with high Medicaid populations or focus on a particular county or region in order to better collect outcomes data.

The presentation is given by the program's master trainers using PowerPoint, case study, and problem-based/hands-on learning tools. An ICAAP staff member is usually present at each presentation to facilitate the CME requirements (sign-in and evaluation procedures), to distribute food (for applicable programs), and to support the presenter. Programs that require longer than 90 minutes to present are typically scheduled for two or more office visits.

Evaluation Procedures
Each program has an evaluation component necessary for CME/CE accreditation and required by most grantors to assess the effectiveness of the program. Some programs include a needs assessment to identify the practice's specific problem areas and requests. All programs utilize a short course evaluation form that each attendee completes concerning the program presenter, quality of the program materials and handouts, the question and answer session, etc. Individual programs have also used different means to evaluate the overall program's effectiveness including follow-up surveys, focus groups, and/or chart reviews.

Follow-up/Technical Assistance
The office presentation is not the only assistance offered to participating practices. Most programs conduct monthly newsletters, mailings, teleconferences and/or live sessions to provide participants with updates and changes to program recommendations. In addition, the Get in the Zone asthma project and the Reaching Our Goals immunization project provide phone consultations and other technical assistance to practice leaders by presenters. Consultations and maintaining contact with the offices support the goal of assessing each practice's need for repeat or refresher presentations, either to improve the first visit's impact or to educate new staff members.