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6/22/2012 1 1

2012 National Award Winners Share Strategies for Reaching Children Most Impacted by Asthma Disparities

Moderator:

• Tracy Washington Enger, U.S. Environmental Protection Agency

Presenters:

• Lisa Jordan, Easy Breathing at Connecticut Children’s Medical Center

• Lisa Diaz, L.A. Care Health Plan

• John Dowling, Michigan Department of Community Health, Asthma Prevention and Control Program

• Melinda Shuler, The Regional Asthma Disease Management Program at Mission Children’s Hospital

Welcome to the Webinar

Wednesday, May 30, 2012 Webinar 1:00 – 2:00 p.m. EDT

Live Online Q&A 2:00 – 3:00 p.m. EDT on AsthmaCommunityNetwork.org

Operator Assisted Toll-Free Dial-In Number: (800) 374-0278

Conference ID: 79424747



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Introduction

Tracy Washington Enger

U.S. Environmental Protection Agency

Operator Assisted Toll-Free Dial-In Number: (800) 374-0278 Conference ID: 79424747



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Purpose of Webinar

1. Learn about four exemplary asthma management programs and how they accelerate improvements in asthma care and address asthma disparities.

2. Identify how these programs are built, evaluated and sustained based on the Asthma Change Package/System for Delivering High Quality Asthma Care.

3. Hear about program outcomes and results.

4. Learn how to improve your asthma management program.



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Agenda 1. Introduce EPA’s National Environmental Leadership Award in Asthma

Management and the Asthma Change Package/The System for Delivering

High-Quality Asthma Care

2. Hear from Award Winners:

– Lisa Jordan, Easy Breathing at Connecticut Children’s Medical Center

– Lisa Diaz, L.A. Care Health Plan

– John Dowling, Michigan Department of Community Health, Asthma Prevention and Control Program

– Melinda Shuler, The Regional Asthma Disease Management Program at Mission Children’s Hospital

3. Q&A Session in AsthmaCommunityNetwork.org Discussion Forum



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Do you have questions? The Award Winners will be available online in the AsthmaCommunityNetwork.org Discussion Forum from 2:00-3:00 p.m. EDT today to respond to questions you post in the Discussion Forum. To post a question in the Discussion Forum, follow these directions:

1. If you are a Network member, log-in to your AsthmaCommunityNetwork.org account.

2. Under the “Interact” tab on the homepage navigation, Click on the “Discussion Forum” link.

3. Click on the “Questions for the 5/30/12 Webinar” link at the top of the page. Click on the “post to the forum” button to post your question.

4. When you have finished entering in your question, click the “Save” button at the bottom of the page.

Questions & Answers Session on AsthmaCommunityNetwork.org Discussion Forum

Not a member? Create an account at AsthmaCommunityNetwork.org by clicking the “Join Now” link at the top of the page. Your account will be approved momentarily and you can begin posting questions.

http://www.asthmacommunitynetwork.org/

http://www.asthmacommunitynetwork.org/interact/forum








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Using the Webinar Technology

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Question/Chat Feature



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Using the Webinar Technology

Type your question

here, then click send

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Using the Webinar Polling Technology

Select one answer and then click “submit”

The question will be listed

here



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Poll Question Audience Snapshot

Which best describes your organization?

• State or local health department

• Community asthma program

• Federal agency

• Health Plan

• Health care provider

• Other



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EPA’s National Environmental Leadership Award in Asthma Management

“This recognition from the U.S. EPA has validated our past efforts, increased our organization’s

visibility in the community, and empowered us to take a risk in creating new programs for the future.”

Dr. Mamta Reddy, 2011 Award Winner, South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center

Learn more at www.asthmaawards.info



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Who: Champions and Leaders of Community Asthma Assets



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Service

Providers Coalitions

Health Plans

Funders

Non-Profits

Sustain

Evaluat

e

Build

Local

Environmental

Public Officials

State Agencies

Public Housing

Schools Tailored

Environmenta

l Interventions

Integrated

Health Care

Services



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Easy Breathing at Connecticut Children’s Medical Center

Lisa Jordan Program Coordinator, AE-C, RPFT



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• Location: Hartford, Connecticut

• Type of Program: Hospital and Public Health Department Collaboration to provide Community Asthma Management Program for Primary Care Practitioners. The Program is designed to translate the national asthma guidelines into a usable format to assist clinicians in diagnosing and treating asthma.

• Service Area: Statewide

• Population Served: Urban, suburban and rural communities throughout the state

• Results: 35% hospitalizations; 27% ED visits; increased use of appropriate medications; 90% of participants receive a written treatment plan.

Program at a Glance



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Conduct Needs-Based Planning

1998

• 41% of children diagnosed with asthma

• 38% receiving care consistent with NAEPP guidelines

Homes

• Majority pre-1950’s

• Overcrowding and pest infestation

Building the System



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Building the System

Today: • 105,000 children enrolled

(26,000 with asthma) • 340 clinicians • 100 practices statewide

1998 2000 2002 2007



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Evaluating the System Evaluate Interventions

• Use database for informative feedback

Evaluate Program Impact – 3 Cohort Studies



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Promote Institutional Change for Sustainability

• Integrate curriculum

• Keep up with current technology

• Work with EMR companies to integrate program into EMRs

Sustaining the System



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L.A. Care Health Plan

Lisa Diaz, RN, MSN Clinical Health Improvement Nurse



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• Location: Los Angeles, California

• Type of Program: Public, non-profit Health Plan

• Service Area: Los Angeles County

• Population Served: 800,000 of Medicaid's vulnerable managed care members residing in low-income communities

• Results: Member satisfaction reported at 97.6% in 2011; from 2010 to 2011, HEDIS rate for appropriate use of asthma medication ↑ to 84.5% for Medicaid and ↑ to 93.94% for Healthy Families

Program at a Glance



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Identifying Patients:

Building the System

Interventions:

• Quarterly monitoring, complex case management, in-home visits, referrals, and educational mailings

Educational Opportunities:

• Health in Motion – Asthma 101 classes

• Materials available by mail, online, monthly classes

• Asthma telephone resource line and quarterly monitoring



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Monthly Tracking of 24,000 Members:

• Reports generated by geographic region, member age and asthma severity level

Healthcare Effectiveness Data and Information Set (HEDIS):

• Track appropriate medication use (2011, 84.58%)

• Awarded – Certification for Savings Measurement Validity

Annual Evaluation Drives Program Enhancements:

• Target asthma members needs

• Revise education materials and update continuously

Evaluating the System



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Funding:

• L.A. Care Health Plan

• Funding assessed annually based on member growth

Reimburse Community-Based Organizations at Established Case Rate for :

• In-home asthma visits, includes

• Follow-up calls

• Environmental management supplies and tools




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Michigan Department of Community Health, Asthma Prevention and Control Program

John Dowling Public Health Consultant & Lead Asthma Coordinator



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• Location: Lansing, Michigan

• Type of Program: Community Asthma Coalition

• Service Area: Statewide, focusing on communities with the highest asthma burden

• Population Served: Low income, urban, suburban and rural communities throughout the state

• Results: 24% asthma mortality; 28% in pediatric hospitalizations; 41% in asthma hospitalizations for children enrolled in Michigan Medicaid programs

Program at a Glance



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Let Data Guide Program Planning, Design and Implementation

Building the System

Today: Third iteration of 2011-2014 Strategic Plan uses collaborative partnerships to achieve success.

High Performing Collaborations: Partnered with University of Michigan School of Public Health to develop presentation to educate participants on asthma triggers in the home.



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• Evaluate Program Implementation

• Utilize partnerships, contract language, funding, application prioritization

• Establish sustainable programs to meet the needs of asthma community


• Results: 24% MI asthma mortality ratio (2000-2007); 28% pediatric asthma hospitalization rates (2000-2009); 41% asthma hospitalization for children in MI Medicaid programs (2005-2009).



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Secure and maintain diverse funding streams:

• NACI

• AHRQ

• EPA

• HUD

Utilize integrated partnerships to make policy recommendations and promote community initiatives:

• Asthma 1-2-3 with American Lung Association of Michigan

• Diabetes, arthritis, cancer, disabilities, tobacco and injury prevention programs




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The Regional Asthma Disease Management Program at Mission Children’s Hospital

Melinda Shuler Regional Clinical Coordinator



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• Location: Asheville, North Carolina

• Type of Program: Non-profit Community Health System

• Service Area: 21 counties in western North Carolina, including the Eastern Band of the Cherokee Indian Reservation

• Population Served: Remote, rural; Urban; Latino and Slavic communities

• Results: 3,415 children received “asthma friendly” environment interventions; 259 staff educated; 91% of 235 adults pledged to create smoke-free environments for children; significant decreases in ED visits, hospitalizations and school absences.

Program at a Glance



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Conduct Needs Based Planning:

Building the System



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Building the System

Focus on Resource Strategy at Every Step

• Utilize Community Partnerships:

• Cherokee Indian Hospital Authority

• National Asthma and Allergy Supply Company

• Charitable community partners and faith-based organizations

• Conduct Regional Workshops:

• Held in elementary schools, childcare centers and primary care offices



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Collect health data

• Severity level, ED utilization, hospitalization, school absences, quality of life questionnaires, environmental trigger exposure

Encourage patients to pledge to create an asthma friendly environment

Examine patient charts to assess program effectiveness:

• ED visits: 158 to 9 (pre- to post-intervention)

• Hospitalizations: 60 to 3 (pre- to post-intervention)

• Missed school days: 17 to 9 (pre- to post-intervention)

• Lung spirometry and exhaled nitric oxide improved

• Cost of care decreased: ED $142,006 and hospitalizations $687,477




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Budget and administrative support provided by Mission Children’s Hospital:

• Public/private grants

• Mission Healthcare Foundation

• Clinical coordinator, PT case manager, PT administrative support

Access to Mission Health System Resources

Applied for Medicaid licensure to bill for services provided

Partners and Mission Health System provide in-kind language services




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Conclusion of the Webinar

Post your questions now on

www.AsthmaCommunityNetwork.org

2012 National Award Winners Share Strategies for

Reaching Children Most Impacted by Asthma Disparities

Moderator:

• Tracy Washington Enger, U.S. Environmental Protection Agency

Presenters:

• Lisa Jordan, Easy Breathing at Connecticut Children’s Medical Center

• Lisa Diaz, L.A. Care Health Plan

• John Dowling, Michigan Department of Community Health, Asthma Prevention and Control Program

• Melinda Shuler, The Regional Asthma Disease Management Program at Mission Children’s Hospital




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Do you have questions? The Award Winners will be available online in the AsthmaCommunityNetwork.org Discussion Forum from 2:00-3:00 p.m. EDT today to respond to questions you post in the Discussion Forum. To post a question in the Discussion Forum, follow these directions:

1. If you are a Network member, log-in to your AsthmaCommunityNetwork.org account.

2. Under the “Interact” tab on the homepage navigation, Click on the “Discussion Forum” link.

3. Click on the “Questions for the 5/30/12 Webinar” link at the top of the page. Click on the “post to the forum” button to post your question.

4. When you have finished entering in your question, click the “Save” button at the bottom of the page.

Questions & Answers Session on AsthmaCommunityNetwork.org Discussion Forum

Not a member? Create an account at AsthmaCommunityNetwork.org by clicking the “Join Now” link at the top of the page. Your account will be approved momentarily and you can begin posting questions.








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