Parkview Health System (Asthma Education and Management Program)

Use Data to Demonstrate Your Program’s Value
Parkview is philosophically and organizationally committed to improving the health of its community. Parkview’s leadership has stated that a program that provides as much benefit to the community as the Asthma Education and Management Program merits a commitment to continuing it. To ensure the translation of beliefs into practice, each hospital within the Parkview system allocates a portion of its net income to the Community Health Improvement Program, which includes the Asthma Education and Management Program, contributing an average of $3.5 million annually over the last three years.

The return on investment that the ISDH evaluation of the ED Asthma Call Back Program demonstrates has also helped to sustain the program. In the program’s first year, it returned $20 in avoided health care savings for every $1 invested in the program. In 2012, the program returned $23.75 for every $1 invested. Because of the success of the ED Asthma Call Back Program, it was recently expanded to all six campuses within the Parkview Health System. It is also being used as a model in the health system to help develop additional navigation programs for patients with other chronic diseases.

Building The System: 

Let the Data Guide the Program
Parkview’s Asthma Education and Management Program was developed to address the growing incidence and impact of asthma-related illness in Parkview’s service area. Data demonstrating the need for the program were compiled from multiple sources including the Centers for Disease Control and Prevention, ISDH and county health department asthma surveillance data, local school districts, physicians and ED staff, and two community health assessment surveys. One of the community health assessment surveys gathered general health status information, and the other focused on the needs of low-income individuals. The data showed that asthma prevalence was increasing, particularly among Parkview’s lowest-income service areas, which include a federally-designated Medically Underserved Population. The data also indicated asthma was a major self-reported health concern for Parkview’s population and that asthma-related symptoms were one of the most frequent reasons for ED visits and the leading cause of school absenteeism. Discussions with community partners further revealed that people with asthma needed more information and support in order to self-manage their asthma and that many ED visits for asthma resulted from a lack of regular medical care, lack of appropriate controller medication use, and/or the inability to effectively self-manage.

Conduct Needs-Based Planning
In response to both the community health needs assessment and needs of partner agencies, Parkview, in conjunction with numerous community partners, developed strategies to target the identified needs. The program’s goals were to help patients manage and control their asthma, reduce asthma-related ED visits, establish a medical home, provide financial assistance for medication as needed, support effective asthma trigger management and improve quality of life.

Start Small to Get Big
Today, Parkview’s Asthma Education and Management Program is a multi-component initiative that identifies people with asthma through local schools, social service agencies and the ED. The program delivers self-management education and resources, as well as environmental asthma management services to those identified through the initiative. When the program launched in 2004, it focused on delivering age-appropriate educational materials to school children and adults; supporting school nurses in asthma care planning and case management; educating teachers, coaches, bus drivers, social service agency staff and nursing students on asthma symptoms and attacks; and working through the county Healthy Homes Program to deliver environmental home assessments. Five years later, Parkview added the ED component to its program to further support people whose asthma may not be under control.

Every year, Parkview and its partners provide asthma education to people including young children, adolescents, adult caregivers, school nurses, teachers, coaches, bus drivers and other school staff. They receive tailored comprehensive asthma disease management education, including counseling on environmental asthma triggers and how to avoid them. They also receive asthma management resources, such as spacers for inhalers and back-to-school asthma checklists. As needed, they receive referrals for home visits, treatment of comorbid conditions, financial support for medication and assistance in establishing a relationship with a primary care provider. The ED Asthma Call Back Program serves over 1,200 individuals on an annual basis and recruits patients after asthma-related ED visits rather than through schools and social service agencies. This program delivers the same education, support services and resources as described above.

Key Players: 
East Allen, Northwest Allen and Fort Wayne Community School Districts; Central, West and East Noble County School Districts; Fort Wayne-Allen County Department of Health; Indiana State Department of Health
Results: 
Emergency Department (ED) Asthma Call Back Program reduced ED recidivism for asthma from 21.95% at baseline to 15.04% in the intervention year, and demonstrated a positive impact on increasing access to medical homes and access to controller medication. Return on investment for the ED Asthma Call Back Program improved from $20 saved for every $1 invested in the baseline year to $23.75 saved per dollar invested in 2012.
Type: 
Not-for-Profit Health System
Introduction: 
Population Served: 
Binary Data
Community Program: 
Key Driver: 

STRONG COMMUNITY TIES: Make It Easy to Accept Services
All home visits for patients include asthma and allergy education, trigger assessment and management assistance. Visits also include smoking cessation information and referrals for management of comorbid diseases. During visits, smoking cessation resources and information on financial assistance for medication and making a connection to a medical home are provided. Staff follow up at two-month, six-month and one-year intervals to monitor compliance and retained understanding of asthma management.

INTEGRATED HEALTH CARE SERVICES: PROMOTE ROBUST PATIENT/PROVIDER INTERACTION
Through group classes, home visits, educational materials and other communications with people with asthma and their families, Parkview’s Asthma Program makes clear the importance of appropriate controller medication use and regular contact with a primary or specialty care physician for ongoing asthma monitoring and management. Qualified patients who cannot afford asthma controller medication are enrolled in Parkview’s Medication Assistance Program. Those without a medical home are referred to a physician within Parkview’s system, a Federally Qualified Health Clinic, or a free community clinic.

Northeast Indiana and Northwest Ohio
Fort Wayne, IN

Evaluate Program Impact
In addition to cost-per-visit and visit reoccurrence data, Parkview’s main source of data to assess the impact of its community-wide Asthma Education and Management Program is ISDH asthma surveillance data. ISDH’s county-stratified data indicate that Indiana counties that are demographically similar to those served by Parkview have experienced significantly higher rates of asthma-related hospitalizations and ED visits than seen in Parkview’s service community since Parkview initiated its Asthma Education and Management Program.

Use Evaluation Data to Demonstrate the Business Case
Parkview can compare data from before the ED Asthma Call Back Program’s implementation (baseline) to post-intervention results. ISDH analyzed Parkview’s data and found the intervention group had lower rates of repeat ED visits for asthma than did the baseline group (15.04% to 21.95%, respectively). Also, 11.2% of the intervention group had acted on referrals to find a medical home, and 16.4% had acted on referrals for prescription services. ISDH also determined that the average cost per asthma patient encounter has decreased continuously from the baseline year. The number of inpatient visits per year has decreased since baseline, and the average cost per inpatient visit has decreased (from $35,668 in the baseline year to $12,105 in the most recent year (2011-2012)). The ISDH concluded that the program is successful and provides a cost-efficient method for reducing the burden of asthma.