We are in year one of intiating a district wide asthma action plan. We are collaborating with our Green and Healthy Homes program and one physician's group in our city. Buy-in from our two hopsital ERs is very slow. Ideas to help with this? Also, who did you say you were able to access for seminars for your nurses (money always an issue)? We do have two nurses attending the asthma educator institute this summer through the Amercian lung association. Can the Texas school district share their policies, protocols, and tools developed? It sounds like a great program!!

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.