Successful School- based Asthma Programs Missouri Asthma Preven on and Control Program Peggy Gaddy, RRT, MBA peggy.gaddy@health.mo.gov (573) 522-2876
The tle is not accurate. Let s change it. Successful School- based Asthma Programs Nurse Successful School- led Asthma Programs V
Our plan includes schools State Plan 2005 State Plan 2010 and health improvement depends on them.
School- led Asthma Programs
What is our role? (Missouri Asthma Preven on and Control Program) YES Encourage and enable local solu ons Fill gaps in tools Develop competent workforce Make strategic connec ons NOT Source of funding Direct service provider
Guiding Principles Missouri Asthma Preven on and Control Program 1. Ask, Listen and Act (on what you hear)
School Nurse Manual Development Evalua on Revisions and updates AN EXAMPLE
Guiding Principles Missouri Asthma Preven on and Control Program 2. Cul vate Leadership Among School Nurses
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Guiding Principles Missouri Asthma Preven on and Control Program 3. Weave Into Exis ng Infrastructure
Infrastructure Op ons Physician Offices Local Public Health Agencies Schools Child Care Centers Hospitals
Why Schools?
What We Learned about Schools (beyond the obvious that children are located there) IMPORTANT ATTRIBUTES OF SCHOOLS FOR ASTHMA PROGRAMMING huge social service agency a endance and safety are priori es access to parents (but involvement wanes as the child ages) longitudinal access and data (on most kids) primarily func on as care coordinators (not as care providers) schools are community organizers SECONDARY CONSIDERATIONS health status affects educa onal a ainment Note: Our direct experience comes from partnering with mostly rural and suburban schools statewide.
ENVIROCLINICAL integrating environmental and clinical approaches to improve asthma care
philosophy matters Behind the plans and interven ons are people who share a common vision for asthma care and preven on in Missouri. The MAPCP team believes that EPR3 is the best evidence available. Evalua on is a quality improvement strategy. Health dispari es can be reduced. Rela onships ma er to develop and sustain successful interven ons. Data guides, and innova on drives impac ul work. Return- on- investment is measureable. ENVIROCLINICAL integrating environmental and clinical approaches to improve asthma care
Framework for Community- based Approaches to Improving Asthma Care for Children Simple, to- the- point, one- page summary Sets goals and interven ons for integra ng efforts in five areas: schools, home environment assessments, primary care providers, hospitals/emergency rooms, and child care
systems thinking Dunklin Co. (Kenne ) pop.= 31,039 34.4 Greene Co. (Springfield) pop.=269,630
Prevalence 9.5% MO adults current asthma (2009) - up from 7.2% (2000) 10.1% MO children current asthma Disease Severity (Health Service U liza on) Highest hospitaliza on rates: ages 1-4 Elevated rates un l age 14, lower between age 15-44 Significantly for African- Americans Rural vs. Urban ER visits for children: 41%(rural) v. 59%(urban) High hospitaliza on rates in rural coun es Medicaid (aka, MOHealthNet) Asthma prevalence FFS Medicaid: 14.1% [7.9% persistent] (2007) $1,589 paid per asthma c (2007) 35% receive appropriate long- term medica ons (children 0-14) â 7.4% ER visits for asthma while total volume was up á 23% (2000 to 2008) Missouri Department of Health and Senior Services. Behavioral Risk Factor Surveillance System. h p://health.mo.gov/data/brfss/index.php
Pu ng Excellent Asthma Care Within Reach
Pu ng Excellent Asthma Care Within Reach SUCCESS FACTORS School Level 1. School nurse leadership 2. Proac ve, objec ve measurement of asthma status 3. Direct and ac onable communica on for health care providers 4. Focus educa on on medica on administra on and adherence
Pu ng Excellent Asthma Care Within Reach SUCCESS FACTORS Statewide 1. Reliable surveillance data 2. Create opportuni es to collaborate with school nurses (even if doing it alone would be faster) 3. Become a advocate for school nurses 4. Measure and appreciate the value of school nurses 5. Cul vate leadership among school nurses and other school staff 6. Adopt Coordinated School Health Program approach 7. Nontradi onal partners to influence schools (e.g., Missouri School Boards Associa on) 8. Alliance with CDC
Core Priori es 1. Reduce barriers to evidence- based care 2. Build capacity to deliver integrated, comprehensive asthma care 3. Iden fy the children most impacted by asthma dispari es 4. Accelerate tes ng and implementa on of preven on strategies among ethnic and racial minority children
Connected to Na onal Priori es 1. Reduce barriers to evidence- based care 2. Build capacity to deliver integrated, comprehensive asthma care 3. Iden fy the children most impacted by asthma dispari es 4. Accelerate tes ng and implementa on of preven on strategies among ethnic and racial minority children some examples from Missouri Teaming Up for Asthma Control Asthma Ready Clinics Asthma Ready Schools School Nurse Manual under development Drug U liza on Review
Connected to Na onal Priori es 1. Reduce barriers to evidence- based care 2. Build capacity to deliver integrated, comprehensive asthma care 3. Iden fy the children most impacted by asthma dispari es 4. Accelerate tes ng and implementa on of preven on strategies among ethnic and racial minority children some examples from Missouri Workforce Development Ini a ve (AAE Becoming an Asthma Care Manager) Pharmacist Training and Reimbursement System School Nurse Manual Missouri Asthma Coali on under development Home Environment Assessment Network Counseling for Asthma Risk Reduc on (CARR)
Connected to Na onal Priori es 1. Reduce barriers to evidence- based care 2. Build capacity to deliver integrated, comprehensive asthma care 3. Iden fy the children most impacted by asthma dispari es 4. Accelerate tes ng and implementa on of preven on strategies among ethnic and racial minority children some examples from Missouri Public Health Surveillance Systems (MICA, Essence) Analysis of Medicaid Claims Data School Nurse Asthma Status Assessments under development Managed Medicaid Health Plan Case Management
Connected to Na onal Priori es 1. Reduce barriers to evidence- based care 2. Build capacity to deliver integrated, comprehensive asthma care 3. Iden fy the children most impacted by asthma dispari es 4. Accelerate tes ng and implementa on of preven on strategies among ethnic and racial minority children some examples from Missouri Asthma School Nurse Award (Partnering with Parents, Coaches Training) Teaming Up for Asthma Control Early Childhood Asthma Ini a ve under development Counseling for Asthma Risk Reduc on (CARR)
Confucius Chinese teacher and philosopher 551-479 BC Evalua on is a Way of Doing Not Just Something Done. Note: Confucius did not really say this.
Five Point Model: Asthma Program Outcomes Clinical Quality of Life Academic Performance Parent Engagement Self- management
Five Point Model: Asthma Program Outcomes Why Five Domains? Mul - pronged interven ons o en produce mul ple benefits. Not all children are the same... so goals should be tailored too. Hedge your bet by increasing the probability of measuring the benefit you can feel.
Five Point Model: Asthma Program Outcomes FEV1 ACT Score Peak Flow ICS Rx Peak Flow Ra o FEV1 Ra o Guideline- based Rx Assessment (EPR3) ER Visit Clinical Result of Communica on with Child s Physician Standard Advanced
Five Point Model: Asthma Program Outcomes Inhala on Technique Controller Medica on Adherence Diary Use Knowledge Exacerba on Management Self- management Standard Advanced
Five Point Model: Asthma Program Outcomes Absenteeism Any Cause Teacher Assessment of Asthma Control Absenteeism Asthma- specific Classroom Par cipa on Factors In- classroom Time Academic Performance Improvement in Grades Standard Advanced
Five Point Model: Asthma Program Outcomes Inhibited Par cipa on in Physical Ac vity Social Inclusion Sleep Disrup on QoL Ques onnaire Fear or Frustra on Percep on of Risk Perceived Support Quality of Life Standard Advanced
Five Point Model: Asthma Program Outcomes Knowledge Rela onship with School Nurse Asthma Ac on Plan Filed Parent- Child Communica on Rx Refills Rou ne Physician Visits Parent Engagement Standard Advanced
Five Point Model: Asthma Program Outcomes The goal is to achieve success not just measure it.
Photo credit: Cigna.com Partnerships coordina ng ac vity and much more
Do Partnerships Really Help? Missouri Asthma Preven on and Control Program MAPCP s Role: Link statewide and local partners Our Li le Secret : Everyone is welcome, but MAPCP strategically builds partnerships to reach target popula on Our Purpose for Partnership: Leverage resources to the max. HOW DOES PARTNERSHIP IMPROVE ASTHMA CARE? Interdisciplinary Sharing: Exper se and resources Coordina on: Ac vi es are planned and implemented together Innova on: New ideas and collabora ons are fostered between stakeholders Priori es: Partners set priori es for surveillance and interven ons Relevance: Key asthma issues move to forefront of systems- based strategies and public health planning
What we do, in a nutshell Missouri Asthma Preven on and Control Program interven ons are designed to support sustainable asthma care improvements by focusing* on and community- based. * but not exclusively, of course
Thank You.