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Asthma Intervention

Asthma Intervention. Asthma Project Team. Accurso, Kathy, Rochester Public School Ahern, Lois, Public Health Aleman, Marty, Public Health Baumbach, Shaylene, Public Health Beebe, Calvin E., Mayo Clinic Bock-Goodner, Cynthia, Mayo Clinic Donnal, T. M.D., Winona Health

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Asthma Intervention

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  1. Asthma Intervention

  2. Asthma Project Team • Accurso, Kathy, Rochester Public School • Ahern, Lois, Public Health • Aleman, Marty, Public Health • Baumbach, Shaylene, Public Health • Beebe, Calvin E., Mayo Clinic • Bock-Goodner, Cynthia, Mayo Clinic • Donnal, T. M.D., Winona Health • Frazier, Christa, Winona Health • Gunderson, Margene, Public Health • Hart, Lacey, Mayo Clinic • Horton, Ian, Mayo Clinic • Jensen, Dan, Public Health • Juhn, Young J., M.D., Mayo Clinic • Knoebel, Erin E., M.D., Mayo Clinic • Lowe, David. M.D.; Olmsted Medical • Martin, Erin L., Mayo Clinic • McWilliams, Deb, M.D., Mayo Clinic • O’Brien, Michael, Mayo Clinic • Naessens, James, Sc.D., Mayo Clinic • Ravikumar, Prajna, Mayo Clinic • Targonski, Paul, M.D., Ph.D., Mayo Clinic • Wellik, Mary, Public Health • Williams, Linda M.D., Olmsted Medical • Yawn, Barbara, M.D., Olmsted Medical

  3. School aged children Asthma Prevalence Asthma is estimated - to occur in 7% of school-age children nationally 1 - to occur in 12% of school aged children in Rochester, MN 2 CDC. Surveillance for Asthma --- United States, 1960--1995. MMWR 1998;47[No. SS-1]:1—28 Yawn BP, Wollan P, Kurland MJ, Scanlon P. A longitudinal study of the prevalence of asthma in a community population of school age children. J Pediatrics 2002;140(5):576-581.

  4. School aged children: Asthma Impact Poorly controlled asthma can affect a child’s ability to exercise, self-esteem, school performance, school attendance. Asthma action plans can decrease preventable illness. National Heart, Lung, and Blood Institute. 2007. National Asthma Education and Prevention Expert Panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Institutes of Health. Available from URL: www.nhlbi.nih.gov/guidelines/asthma/epr3/index.htm

  5. Collaborative Experience Community Collaborative Asthma Project in Olmsted County (2007 – present) Mayo Clinic Olmsted Medical Center Olmsted County Public Health Rochester Public Schools (ISD#535) Rochester Private Schools

  6. Beacon Proposal Extend the asthma action plan model to the 11-county region, augmented with standards-based HIE. Sharing action plans for children with asthma can: Reduce healthcare utilization Improve school attendance Reduce time parent misses work

  7. Care Coordination Includes processes of care coordination between health professionals, public health and schools.

  8. Asthma Measures Future/Advanced Measures Preventative Care Utilization Appropriate Med Usage Inpatient/ED Utilization Acute attacks in school School Absenteeism Baseline Measures % patients age 5-18 % w/documented Action Plan  % w/Influenza Vaccine  % w/pneumonia Vaccine % of total ED Visits COST – QUALITY – POPULATION HEALTH

  9. AAP Expansion Project • Leverage lessons learned and tools developed in Olmsted County Asthma Action Plan Task Force providing patient-centered care to ensure anyone who cares for a child with asthma has access to and understands that child’s AAP: • Develop a consent process • Approved by schools and state • Templates are available • Process flow sheets created • SE MN Beacon will expand to ALL school districts: • School System AAP FAQs • Consent Form to Share Asthma Action Plan Template • Consent Form Process Flowsheet Template • School Personnel Education : • Access and understanding of AAPs for ALL personnel • When to Consider communication with the Provider & Parent

  10. Technology Pilots • Technology specifications created by the Asthma Action Plan Task Force Data Base pilot program • Resources to scale the infrastructure into the Beacon region • Will pilot first in targeted schools and use lessons learned to generalize the technology approach • Widespread implementation of a technology solution will take time • Strong emphasis on protecting the confidentiality and best interests of patients • Multiple EHRs

  11. Qualitative Study / Focus Groups • Identify perceived needs and potential barriers related to the wide spread use of asthma action plans for school children. • Groups of interest: • Parents of school aged children w/ asthma • School nurses & others that care for children with asthma in schools • School aged adolescents with asthma • Physicians / nurses who provide health care for children with asthma

  12. Focus Group AnalysisOverarching Themes Communication Stakeholders Pairings – parent/school, school/health professional, school/health professional Channels Fax, flyers, walkie talkies, computer interface, paper copies, telephone Frequency and timeliness Asthma severity and control Continuum Individual Self-reliance Support for students’ independence Awareness of potential triggers

  13. Focus Group AnalysisOverarching Themes • Policies and Protocol • Confidentiality • Initiating processes – i.e. updating AAPs • Education of staff • “What are we allowed to do” • Assurance of medication in secondary settings (i.e. field trips, sporting events) • Alignment with state laws, school policies and “unwritten rules” of communication

  14. Survey ResultsNurses and Physicians AAPs are an important tool for schools and families It is important to evaluate whether AAPs make a difference in the care of asthma in schools It would be helpful to the care of patients with asthma to have communications with schools (missed PE, sent home, child’s technique and understanding of disease) 90% agree with the concept that consistency in adhering to guidelines is needed Time to create the AAP is a constraint for physicians and nurse practitioners (80% no more than 3 minutes of time – preference to review, not create) Would like to know more about how the AAP is used at school and the training within the schools of those with access to the AAP

  15. Focus Groups-School Sites(School Nurse, Health office, Teachers & Coaches) • Knowing what to do with Student is Important • Asthma Action Plans are useful to Health Office staff • Coaches rely on 1st Aid Training to know what to do • Issues • Inhalers are kept in Health Office • Communication of Changes in med order or plan • Suggestions • Access to electronic information would help

  16. Parent Input Supportive of Improved Communication with Schools Want Paperwork Process simplified Asthma Action Plans are useful tools Not concerned about confidentiality & communication between provider & school as long as parent in the loop

  17. SE MN Beacon Using our experience with uni-directional sharing of AAP with schools and the community’s expertise in community based participatory work, we will design and develop a program to provide the child with asthma a “cocoon of care” at school, in organized activities and home, based on the healthcare home’s generated asthma action plan.

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