AsthmaCommunityNetwork.org

2013

Parkview Health System (Asthma Education and Management Program)

Winner Blurb: 

Parkview Health System is a nonprofit health care provider that delivers care to more than 875,000 people in a five-county area in northeast Indiana. Parkview’s community consists of urban, suburban and rural populations that have seen increasing asthma prevalence over the past 15 years. In response to data indicating that asthma is a frequent cause for emergency health care services, particularly among low-income communities served by Parkview, as well as input from community partners, the hospital developed a comprehensive Asthma Education and Management Program in 2004.

 

Parkview’s Asthma Education and Management Program identifies children and adults with asthma and improves their ability to self-manage by providing support services, resources and age-appropriate education. The program is run by the hospital’s Integrated Community Nursing Program and relies on Parkview’s partnerships with local school districts and social service agencies to enroll patients and deliver program services. Parkview also partners with the Fort Wayne-Allen County Department of Health and Indiana State Department of Health (ISDH) to provide environmental home visits and to evaluate the Asthma Education and Management Program’s impact. With its partners, Parkview also educates school staff, including school nurses, teachers, coaches and bus drivers on the signs and symptoms of asthma and instruction on how to address a severe asthma attack. Parkview also works with the county’s Healthy Homes Program to provide environmental home visits and in-home asthma/allergy education.

 

One important program component is the Emergency Department (ED) Asthma Call Back Program, which began in 2009 and serves over 1,200 individuals annually. The Call Back Program equips people who have visited the ED with the knowledge and tools they need to manage their asthma and avoid future ED visits. All patients who visit the ED for asthma-related illnesses receive calls from an asthma educator after they are discharged to discuss asthma control and access to and appropriate use of medications. Where indicated, nurses can order home visits to provide environmental asthma trigger assessment and mitigation. Home visitors typically provide supplies, including bedding encasements, HEPA vacuums and green cleaning supplies, at no-cost, and they provide asthma education. Qualified patients who cannot afford their asthma medications or do not have a medical home are enrolled in Parkview’s Medication Assistance Program and referred to a physician in the Parkview system, a federally qualified health clinic, or a free clinic.

 

Through its partnership with ISDH, Parkview has access to evaluation data that demonstrate the impact of its asthma program. Surveillance data show improved asthma outcomes over time in counties served by Parkview as compared to demographically similar counties within the state. ISDH’s evaluation of the ED Call Back Program found that it is effective at reducing ED readmissions: ED recidivism dropped to 15.04 percent in the intervention group compared to 21.95 percent in the baseline group. The ED Asthma Call Back Program also demonstrated an impact on school and work attendance and quality of life, with nearly 59 percent of participants reporting they had missed zero school or work days since involvement in the program. The program has also demonstrated a positive impact on increasing access to medical homes and controller medication with 11.2 percent of participants acting on physician referrals and 16.4 percent receiving prescription support services. Finally, Parkview’s own data demonstrate a reduction in inpatient visits for asthma over time and reduced average costs per patient encounter. Parkview has been able to demonstrate a steadily improving return on investment (ROI) from the ED Asthma Call Back Program – from $20 saved for every $1 invested in the baseline year to $23.75 saved per dollar invested in 2012. These ROI data helped Parkview’s leadership decide to expand the ED Asthma Call Back Program to all six campuses within the health system.

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Pictured l-r: Deb Lulling and Jan Moore

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North East Independent School District (Asthma Awareness Education Program)

Winner Blurb: 

The North East Independent School District (NEISD) is a large urban district that serves 67,000 students, including more than 8,000 with asthma. In 2006, NEISD hired a registered respiratory therapist/certified asthma educator (RRT/AE-C) to launch an asthma management program to improve students’ asthma control and attendance in order to positively contribute to the district’s academic performance.

 

NEISD’s investment in the Asthma Awareness Education Program (AAEP) reflects its leadership’s recognition that asthma control is fundamental to student achievement. The AAEP’s evaluation data have demonstrated that comprehensive school-based asthma management programs can improve disease management, reduce emergency health care utilization, and increase school attendance, thus impacting academic performance and generating a return on investment. In Texas, as in a handful of other states, average daily attendance rates are at the foundation of the state’s formula for distributing school revenue. An effective school-based asthma control program like NEISD’s can quickly increase attendance and thereby pay for itself.

 

The AAEP provides education, disease management tools, and other support to help school nurses identify and monitor students with asthma and to improve communication with clinical staff. NEISD also provides case management services for children with hard-to-control asthma, including RRT/AE-C-led home visits, personalized counseling and coordination with asthma specialist physicians. The Asthma Blow Out (ABO) is the AAEP’s community engagement component, which is delivered in areas with the largest disparities in asthma outcomes. The ABO brings RRT/AE-Cs and physician partners to local schools where they explain disease management strategies and medication use, dispense flu vaccines and provide age-appropriate asthma education to students, parents and caregivers. To decrease healthcare barriers, where indicated, NEISD provides bus transportation to and from the schools, free meals, English-Spanish translation services, and offers academic incentives for students to attend the ABO events.

 

The AAEP addresses environmental asthma triggers in schools through training for custodial staff, principals and teachers, as well as through monthly meetings with facilities staff. The district also incorporates an asthma management component in the high school’s Healthy Lifestyles course; has implemented an air quality health alert policy to ensure the campus community knows when unhealthy outdoor air conditions occur; and conducts regular monitoring of asthma symptoms and possible environmental exposures in schools. The AAEP also promotes environmental asthma management at home.

 

In the six and a half years since the program’s launch, the AAEP has reduced asthma symptoms in school as measured by declines in rescue/reliever medication use. For example, inhaler use declined by 50 percent during the first six weeks of school from the first year to the next. Emergency medical service transports during the school day also decreased from 80 transports per year to 24 transports per year. The AAEP has delivered asthma education to every district campus by reaching every physical education teacher, nurse and campus administrator. ABO survey results also demonstrate improved student and parent understanding of appropriate asthma management strategies – 95 percent of parent attendees surveyed said they would recommend the ABO program to a friend. Additionally, the district has seen yearly attendance averages increase from 95.3 percent to 96.1 percent since the AAEP’s inception, including significant increases during flu season. NEISD has achieved state recognition for its academic performance four years in a row. There is widespread agreement that the AAEP-led environmental improvements and involvement in student health contributed to improved student performance and the district’s academic accomplishments.

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[Pictured front row] l-r: Diane Rhodes and Kathy Hardin [Pictured back row] l-r: Girish Nair, Larry Fowler, Nick Kellar In cooperation with campus nurses, custodial staff, PE teachers, administrators and district facility maintenance staff.

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Greenville Health System’s Pediatric Asthma Action Team

Winner Blurb: 

The Center for Pediatric Medicine (CPM) with the Greenville Health System Children’s Hospital is the major clinical provider of outpatient care for children with limited health care access in Greenville, South Carolina. A diverse community, Greenville is South Carolina’s most populous county and asthma/bronchitis is the leading cause of hospitalization for children under 18 in the area. Ninety percent of the population served at CPM receives Medicaid funding.

 

The Asthma Action Team (AAT) is a multidisciplinary, multilingual, family-centered program that was formed in 2008 to address increasing asthma prevalence, increasing pediatric emergency department (ED) visits and hospitalizations and ED recidivism for asthma, and growing asthma disparities in greater Greenville. The AAT is staffed by pediatricians, certified asthma educators, respiratory therapists, case managers, nurses, social workers, translators, an electronic medical record (EMR) technician, and community home visitors. Residents training in pediatrics, internal medicine, family practice and third and fourth year medical students also rotate through the AAT clinic where they learn an evidence-based approach to asthma care according to the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma.

 

The program strives to ensure that patients and families receive consistent asthma education and support services in clinics, homes, schools and daycares, including support for environmental asthma control, in order to promote effective self-management and avoid emergency health care utilization. The AAT coordinates with payers, local schools, community-based organizations and others to identify patients in need and to provide case management for children and adolescents with hard to control asthma. Case management includes asthma education, home visits, office visit coordination and school visits with a certified asthma educator from CPM serving as the case manager.

 

All AAT patients receive personalized pictorial asthma action plans written in their primary language which AAT staff review and update at every patient interaction and share with providers across the Greenville Health System (GHS) network and with school and daycare providers. The action plans are stored in the patients’ EMR and on a web-based platform where clinical providers and educators working across both inpatient and outpatient settings can access and update them. The AAT also maintains a registry and alert system to help manage 4,338 pediatric patients with asthma, to track their asthma outcomes in real time, to stratify patients for care and to ensure high quality and appropriate care is consistently delivered.

 

The AAT focuses on delivering comprehensive and guidelines-based clinical and environmental care everywhere people with asthma spend time. The team is acutely aware of the social, economic and cultural factors that affect pediatric asthma outcomes for the diverse community GHS serves. To help children with asthma and their family’s access appropriate clinical care and avoid emergency health care use, CPM offers extended evening and weekend hours, same day service to children experiencing asthma exacerbations, and an after-hours telephone triage line. The AAT also partners extensively to provide education, diagnostics, in-home services and social supports for environmental interventions in the community. Partners include the Family Connection of South Carolina’s Project Breathe Easy (PBE), the South Carolina Asthma Alliance, the Greenville Pediatric Asthma Community Collaborative, the Greenville County Schools and many others.

 

Perhaps the strongest evidence of the AAT’s impact is the fact that at the same time that the population of children with asthma in the CPM system grew by an annual rate of 63 percent, rates of ED visits for asthma declined. Data from the AAT’s partnership with PBE – which applies only to AAT clients who receive referrals to PBE – demonstrate a 71 percent decrease in urgent health care utilization, a 21 percent decrease in unscheduled clinical care visits, a 51 percent decrease in missed school days, and a 41 percent decrease in missed work days for parents post-intervention.

Winnner Photo: 
Winner Photo Caption: 

[Pictured left of sign] l-r: Tom Moran, Jane Teague, Karla Mora, Dr. Josh Henry, Dr. Andrew Wilt, Katy Smathers, Tiffany Timms [Pictured right of sign] l-r: Dr. April Buchanan, Dr. Jill Golden, Dr. Lochrane Grant, Joann Wilson, Rita Rivera, Kristi Caballero, Cindy Garnett, Dr. Amanda O’Kelly, Dr. Cari Sanders, Cheryl Kimble, Debra Powers, Pam Kruzan, Dr. Elizabeth Shirley

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