successful school-‐based asthma programs on is a quality improvement strategy. health ... manual...
TRANSCRIPT
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Missouri Asthma Preven�on and Control Program Peggy Gaddy, RRT, MBA
[email protected] (573) 522-‐2876
Successful School-‐based Asthma Programs
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Successful School-‐led Asthma Programs
Successful School-‐based Asthma Programs
Nurse V
The �tle is not accurate. Let’s change it.
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State Plan 2005 State Plan 2010
Our plan includes schools …
… and health improvement depends on them.
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School-‐led Asthma Programs
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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
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Guiding Principles Missouri Asthma Preven�on and Control Program
1. Ask, Listen and Act (on what you hear)
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School Nurse Manual Development Evalua�on Revisions and updates
AN EXAMPLE
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Guiding Principles Missouri Asthma Preven�on and Control Program
2. Cul�vate Leadership Among School Nurses
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AN EXAMPLE
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AN EXAMPLE
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AN EXAMPLE
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AN EXAMPLE
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AN EXAMPLE
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Guiding Principles Missouri Asthma Preven�on and Control Program
3. Weave Into Exis�ng Infrastructure
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Local Public Health Agencies
Physician Offices
Schools
Child Care Centers
Infrastructure Op�ons
Hospitals
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Why Schools?
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SECONDARY CONSIDERATIONS
health status affects educa�onal a�ainment
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
Note: Our direct experience comes from partnering with mostly rural and suburban schools statewide.
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ENVIROCLINICAL integrating environmental and clinical approaches to improve asthma care
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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
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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
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Dunklin Co. (Kenne�) pop.= 31,039
systems thinking
Greene Co. (Springfield) pop.=269,630
34.4
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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
Missouri Department of Health and Senior Services. Behavioral Risk Factor Surveillance System. h�p://health.mo.gov/data/brfss/index.php
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) â7.4% ER visits for asthma
… while total volume was up á23% (2000 to 2008)
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Pu�ng Excellent Asthma Care Within Reach
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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
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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
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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
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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
Teaming Up for Asthma Control Asthma Ready® Clinics Asthma Ready® Schools School Nurse Manual under development Drug U�liza�on Review
some examples from Missouri
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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
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)
some examples from Missouri
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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
Public Health Surveillance Systems (MICA, Essence)
Analysis of Medicaid Claims Data
School Nurse Asthma Status Assessments
under development Managed Medicaid Health Plan
Case Management
some examples from Missouri
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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
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)
some examples from Missouri
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Evalua�on is a Way of Doing… Not Just Something Done.
Note: Confucius did not really say this.
Confucius Chinese teacher and philosopher 551-‐479 BC
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Clinical
Academic Performance
Self-‐management Parent Engagement
Quality of Life
Five Point Model: Asthma Program Outcomes
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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
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Five Point Model: Asthma Program Outcomes
Guideline-‐based Rx Assessment (EPR3)
Peak Flow Ra�o
FEV1
Peak Flow
Clinical
ACT Score
FEV1 Ra�o
ICS Rx
Standard Advanced
ER Visit Result of Communica�on with Child’s Physician
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Five Point Model: Asthma Program Outcomes
Knowledge
Inhala�on Technique
Controller Medica�on Adherence
Self-‐management Standard Advanced
Exacerba�on Management
Diary Use
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Five Point Model: Asthma Program Outcomes
Absenteeism Asthma-‐specific
Absenteeism Any Cause
Teacher Assessment of Asthma Control
Academic Performance
Standard Advanced
Improvement in Grades
Classroom Par�cipa�on
Factors In-‐classroom Time
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Five Point Model: Asthma Program Outcomes
Social Inclusion
Sleep Disrup�on
Quality of Life Standard Advanced
Fear or Frustra�on
Inhibited Par�cipa�on
in Physical Ac�vity
Percep�on of Risk QoL
Ques�onnaire Perceived Support
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Five Point Model: Asthma Program Outcomes
Asthma Ac�on Plan Filed
Parent Engagement Standard Advanced
Knowledge
Parent-‐Child Communica�on
Rou�ne Physician Visits
Rx Refills
Rela�onship with School Nurse
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The goal is to achieve success … … not just measure it.
Five Point Model: Asthma Program Outcomes
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Photo credit: Cigna.com
Partnerships coordina�ng ac�vity … and much more
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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
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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
What we do,
in a nutshell
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Thank You.