successful school-‐based asthma programs on is a quality improvement strategy. health ... manual...

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Missouri Asthma Preven�on and Control Program Peggy Gaddy, RRT, MBA [email protected] (573) 5222876 Successful Schoolbased Asthma Programs

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Page 1: Successful School-‐based Asthma Programs on is a quality improvement strategy. Health ... Manual under

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  

Page 11: Successful School-‐based Asthma Programs on is a quality improvement strategy. Health ... Manual under

       AN  EXAMPLE  

Page 12: Successful School-‐based Asthma Programs on is a quality improvement strategy. Health ... Manual under

       AN  EXAMPLE  

Page 13: Successful School-‐based Asthma Programs on is a quality improvement strategy. Health ... Manual under

       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.