Make it Easy to Support Your Program
Budgetary and administrative support for the RADMP is provided by Mission Children’s Hospital. An annual budget of $129,000 is supported by public and private grants. RADMP has applied for Medicaid licensure in order to bill for services provided, which is expected to be issued within three months. The program budget pays for the full-time RADMP clinical coordinator, a half-time case manager and a half-time administrative support person.
RADMP also has access to the full support of Mission Health System resources inclusive of the Institutional Review Board and Mission Research Institute for research and data analysis. Interpreter and American Sign Hospital and partnering school systems provide in-kind language services. The program also benefits from donations to restricted funds within the Mission Healthcare Foundation – the philanthropic arm of Mission Hospital.
Mission Health, founded in 1885, is the regional care center for Western North Carolina and operates the only children’s hospital in that area of the state – Mission Children’s Hospital. One out of every four children in this area lives in poverty, which has a high minority population of Native Americans, African Americans and Hispanics. Over 56% of local children receive care at Mission and are Medicaid recipients; another 37% have no insurance at all. A temperate climate with over 100 species of trees and 1600 species of flowering plants, the legacy of tobacco, and high levels of poverty, combine to create relatively high rates of pediatric asthma and significant exposure to environmental triggers that exacerbate asthma severity. In 2011, Mission treated 505 pediatric cases with asthma as a primary diagnosis, and 172 of those were ED visits. An additional 1,311 pediatric cases presented with asthma as a secondary diagnosis, 589 of whom came in through the emergency department. Mission Health created the Regional Asthma Disease Management Program (RADMP) to address health disparities in minority children suffering from asthma.
Every five years, the Buncombe County Health Center, in cooperation with other local health agencies, conducts a Community Health Assessment. In 2001, the results prompted Mission Health to develop the RADMP which acknowledges the local population’s health care habits and asthma care needs – specifically delivering asthma education and interventions beyond the clinical setting in homes, schools and other care facilities. The RADMP incorporates the six key messages of the GIP Report and the underlying EPR-3 Recommendations: assess asthma severity; assess level of control; use of inhaled corticosteroids; written asthma action plans; allergen and irritant exposure control; and follow-up visits. Environmental assessments are conducted at child care sites, elementary school sites, as well as homes of children diagnosed with asthma. Each assessment lasts approximately one to three hours and results are discussed with the site/home owner. Additional follow-up is conducted if remediation is required.
Focus on Resource Strategy at Every Step
Community partnerships are critical to RADMP’s success. It has a strong, core network of partners throughout the Western region of North Carolina that includes health departments, primary care physicians, hospitals, school systems, child care centers, state and national partners, non-profit organizations and faith based organizations. The Cherokee Indian Hospital Authority, representing the Eastern Band of Cherokee Indians, is another important partner. RADMP, in partnership with the National Asthma and Allergy Supply Company, provides bedding encasements to 80% of the program’s case load. RADMP utilizes faith-based organizations and charitable community partners to provide cleaning supplies, pest control services, home remediation needs and to address psychosocial issues for 100% of its caseload. The RADMP's program components include lung spirometry, exhaled nitric oxide, peak flow monitoring and symptom diaries to assess the severity, as well as exercise challenge tests when necessary. Each patient is seen every eight to 12 weeks unless poor symptom control dictates more frequent intervention. Communication across the continuum of care is critical and constant.
The RADMP also takes its message of asthma awareness into the rest of the community through regional workshops on asthma and the identification of indoor and outdoor environmental triggers. These workshops are usually held in elementary schools, childcare centers and primary care offices, and residents throughout Western North Carolina are invited to attend.
FACILITATE COMMUNICATION ACROSS THE CARE TEAM
All patients served by RADMP receive individually tailored Asthma Action Plans (AAP). Clinicians, patients and families jointly develop the AAP and share it with all their caregivers, including teachers, school nurses, primary care physicians and others. This same group receives regular updates on the child’s health status throughout enrollment in the program.
SUPPORT CONTINUOUS CLINICAL IMPROVEMENT
Comprehensive data collection is critical to the evolution of the program. Mission Hospital maintains a permanent asthma registry of data on each child in the program. Mission Hospital sends ED reports to the RADMP daily.
The RADMP has matured into a results-oriented program – collecting data and measuring and reporting outcomes – and Mission Children’s Hospital is currently piloting an Electronic Health Registry. Health data collected includes the level of severity, exposures to environmental triggers including tobacco smoke, allergens and chemical irritants, ED visits, hospitalizations, schools absences and quality of life questions. The program also encourages people to pledge to create an “asthma friendly” environment; these pledges are tracked as a part of the program’s evaluation efforts. Between 2009 and 2011, RADMP encouraged 3,415 children and 244 adults to create “asthma friendly” environments.
The RADMP examined 50 patient charts to assess several different indicators of program effectiveness, and found statistically significant improvements across all variables. ED visits decreased from 158 pre-intervention to 9 post-intervention (95%), and hospitalizations decreased from 60 pre-intervention to three post-intervention (95%). Quality of life was measured by school absences, with 17 days missed prior to intervention. This decreased to nine days missed post-intervention. Clinical variables also indicated significant improvement in lung spirometry – FVC, FEV1, FEF25-75 and exhaled nitric oxide measures all improved for participating patients. Significant cost reductions for ED care ($142,006) and hospitalizations ($687,477) were also recorded for participating children with asthma.