Learning and Earning with Gateway Professional Education CME/CEU Webinar Series. Pediatric Asthma: Assessment & Control August 2, :00pm 1:00pm

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1 Learning and Earning with Gateway Professional Education CME/CEU Webinar Series Pediatric Asthma: Assessment & Control August 2, :00pm 1:00pm Allyson S. Larkin, MD Assistant Professor of Pediatrics University of Pittsburgh Asthma Institute Children's Hospital of Pittsburgh of UPMC Jessica Smith-Amara, BSN, RN, CPN Clinical Specialist, Care Management Gateway Health

2 Shout Out! Children s Hospital of Pittsburgh of UPMC Primary Care Center CTC: Kerri Bentz Washington Health System Washington, PA CTC: Carol Rhodes To arrange for a group viewing and lunch at your practice for a future webinar, please contact your Gateway Clinical Transformation Consultant (CTC). 2

3 Today s Presenters: Allyson S. Larkin, MD Assistant Professor of Pediatrics University of Pittsburgh Asthma Institute Children's Hospital of Pittsburgh of UPMC Jessica Smith-Amara, BSN, RN, CPN Clinical Specialist, Care Management Gateway Health Jsmith-amara@gatewayhealthplan.com 3

4 Asthma Assessment and Control Allyson Larkin, MD Assistant Professor of Pediatrics Allergy and Immunology Children s Hospital of Pittsburgh of UPMC

5 Disclosures none

6 Outline Scope of the problem Case Definition and Diagnosis Basic Pathophysiology Assessment and Control with a focus on the ACT Treatment options

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10 Scope of the Problem

11 Scope of the Problem

12 Scope of the Problem

13 Scope of the Problem Children with asthma were more likely than children without asthma to visit a health care provider(s) 3 or more times during the past 12 months.

14 Percentage of children with Persistent Severity Nearly 60% of children with current asthma have persistent asthma 40% have intermittent asthma Asthma severity determines type and duration of treatment Percentage with Persistent Severity

15 Case 13 y/o male presents to outpatient office with cough and wheeze for three days Has had asthma since he was 5 Prescribed a low dose inhaled steroid but only uses it as needed Was in the ER 3 weeks ago and received prednisone and several weeks prior to that was hospitalized in the ICU Needs his albuterol 3-4 times a week Wakes up at night 2-3 times a week with cough and feels tight when he runs

16 Definition and Diagnosis

17 NAEPP 2007: EPR3 Asthma Guidelines

18 Definition- Clinical and Physiological Chronic inflammatory disorder of the airways Variable, recurring symptoms Airflow obstruction Bronchial hyper responsiveness NAEPP 2007: EPR3 Asthma Guidelines

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20 Phenotype and Inflammation Wenzel, S. Nature Medicine. 2012

21 EPR

22 EPR

23 EPR

24 EPR

25 Assessment and Control

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29 Assessment and Control

30 EPR

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33 EPR

34 EPR

35 Asthma Control Test

36 Asthma Control Test: ACT Validated, self administered questionnaire Childhood ACT (age 4-11): 4 questions child, 3 questions parent ACT (age 12 and up) Developed to help provide a quick assessment of a child s asthma control 7 items most predictive of asthma control Child global report of asthma Child report of activity limitations Child report of cough Child report night time awakenings Parent global report of asthma Parent report wheeze Parent report of night time

37 SCORE Asthma well controlled (score >20) Not well controlled (13-19) Poorly controlled (<12)

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39 Case 13 y/o male presents to outpatient office with cough and wheeze for three days Has had asthma since he was 5 Prescribed a low dose inhaled steroid but only uses it as needed Was in the ER 3 weeks ago and received prednisone and several weeks prior to that was hospitalized in the ICU Needs his albuterol 3-4 times a week Wakes up at night 2-3 times a week with cough and feels tight when he runs

40 Treatments

41 Options Rescue therapy Controller therapy

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44 Conclusion Scope of the problem: common, life threatening, getting worse, expensive Definition and Diagnosis: chronic inflammation, variable symptoms, airflow obstruction, bronchial hyper responsiveness Basic Pathophysiology: Multiple different types of inflammation, this might help guide future treatment options Assessment and Control: ACT useful tool for assessing control Treatment options: SABA, ICS, LTRA, LABA/ICS, monoclonal antibodies (IgE, IL5)

45 Asthma Assessment & Control Jessica Smith-Amara, BSN, RN, CPN

46 Department Initiative CDC 6 18 Initiative Asthma Control Promote the 2007 National Asthma Education and Prevention Program guidelines (NAEPP Guidelines) for asthma management Promote access and adherence to asthma medications and devices Expand access to intensive self-management education Expand access to home visits to improve self-management education and reduce home asthma triggers

47 Asthma HEDIS Measures Medication Management for People with Asthma (MMA) Percentage of members with persistent asthma on an asthma controller medication 50% and 75% of the treatment period Asthma Medication Ratio (AMR) Persistent asthma with ratio of controller to total asthma medications of 0.50 of greater

48 GPE and Asthma Control Test (ACT)~ PA Medicaid only

49 ACT Forms

50 Medication Adherence Outreach Educate members with asthma about proper medication use and Asthma Action Plans Goal: increase medication adherence of members with asthma controller medication compliance rating of >20% to <85%. Target Population: PA Medicaid 1 telephonic outreach & 1 follow-up

51 Medication Adherence Incentive Member Incentive: PA Medicaid Controller medication fills July-December 2017 $ (6 opportunities - $5 per fill)

52 Care Management and Disease Management Care Managers available Gateway to Lifestyle Management (GTLM) Self-management educational materials Asthma sticker letter for controller vs. rescue medications

53 Summary What can you do for your members with asthma? Asthma Control Test (ACT) via the GPE program Encourage controller medication fill and remind patients of the current incentive program for filling their controller medication Referral to Care Management and/ or Disease Management materials

54 Environmental Home Assessments EPA, CDC, and AHIP recommendation for Environmental trigger assessment and remediation Community partnerships

55 Access slides by navigating to: Provider>Provider Resources> Educational Tools>What s New (CME credit only for enrolled participants in live webinar) 55