6/7/19 Assembling Your School Asthma Team: An Asthma Quality - PDF document

6/7/19 Assembling Your School Asthma Team: An Asthma Quality Improvement Collaborative Kim Utech, MSN, FNP-C, AE-C Identify a problem or an opportunity for improvement Establish a team/collaborative Identify a project location and set an aim Establish measures and report data monthly Develop ideas, test, and implement change What’s the problem? The burden of asthma in New York State. u NYS has the 2 nd highest rate of asthma in the United States u In 2015, 400,500 children had asthma 30,000 hospitalizations, 170,000 ER visits, and 287 deaths u In 2018, there was an estimated total cost for asthma $3.6 billion 1

6/7/19 What’s the Problem? Buffalo/ Western NY WNY has the 2 nd highest rate of asthma ER visits and the 3 rd highest rate of asthma hospitalizations u ~20% of children in Buffalo have asthma u African-American and Latino children have the highest % of asthma u Buffalo : high poverty rates, old housing stock, Peace Bridge, pockets of neighborhoods with high AA, and Latino children with asthma New York State DOH Asthma Quality Improvement Collaborative (AQIC) Mission is to improve the quality of asthma care and health related § outcomes among child of moderate to high-risk asthma in primary care and SBHCs settings using evidence-based practices (NHLBI/NAEPP , 2007) 14 month project starting in June 2018- July 2019 § 3 learning sessions § Monthly webinars and data collection § Rapid PDSA tests using the Model for Improvement § Act Plan Study Do School Based Health Center (SBHC) P .S. 76 Herman Badillo Bilingual Academy u Provide FREE care in school to all students Enrolled in the SBHC u Primary care services include comprehensive physicals, immunizations, diagnosis and treatment of acute and chronic medical conditions, such as asthma and obesity, and nutritional counseling u Mental health services include assessments, counseling, crisis intervention and referrals as needed u Safety Net to reduce gaps in care, lower emergency department and hospital rates 2

6/7/19 SBHC P .S. 76 Herman Badillo Bilingual Academy u ~800 children in PreK-8 th grade u 212 children have an asthma diagnosis u Over 90% of students are enrolled in the SBHC u Many Spanish speaking children/families Buffalo SBHC AQIC Team P .S. 76 School Based Health Clinic NP , MA, SW, MD, AE-C WNY Children’s Oishei Environment Healthy al Health Kids (OHK) Center (WNY CEHC) Care Mangers, QI Coordinator, Medical Director Buffalo SBHC AQIC Team Kim Utech, FNPC, AE-C Susan Boswell, FNP Melinda Cameron, MD Robert Mowery, Medical Director Quality, Oishei Health Kids Lissette Palestro, MPH Chelsea Kraska Care Manager Coordinator of the WNY Children’s Supervisor, Oishei Health Environmental Health Center Kids 3

6/7/19 NYS AQIC AIM - Reduce # of hospitalizations for asthma patients by 20% in the previous 6 months - Increase the % of asthma patients classified as well controlled by 40% - Increase symptom free days to at least 12 out of 14 days Buffalo SBHC AQIC AIM In 14 months , increase the number of student with asthma with EMR documentation of: u AAPs by 50% u Environmental triggers by 50% u “ Well Controlled ” by 25% Measures Established by NYS AQIC u Asthma Action Plan u Asthma Classified as “Well Controlled” u Documented Control Classification u Documented Severity Classification u Documented Environmental Triggers u Education about Environmental Control Measures u Referrals to Home-Based Services u Hospitalization and ED visits due to asthma u Prescribe inhales Corticosteroids u Documented Self – Management 4

6/7/19 Intervention SBHC 76 Streamline Asthma Visit Process § Staff training: School Asthma Management (SAM) Survey Tool, NHLBI Guidelines, Asthma 101 § Prioritized children with asthma by severity and control § Increase Communication § Posters and Pictures of medications, triggers, lungs, spacer /inhaler technique in all exam room Intervention SBHC 76 Asthma visits were broken down into smaller multiple visits with focus on asthma education § SAM Survey T ool § AAP (medications, spacer and inhaler technique) § Self-management education (what is asthma, signs and symptoms, triggers, AAP) § Every visit: Assess smoking, spacer/inhaler technique, controller use, medication use, control Intervention SBHC 76 Establish Linkage to Community Based Organizations: OHK Health Home: for children with asthma who 1. also have one other chronic health condition WNY CEHC 2. NYS Smokers Quit line 3. Visiting Nurse Association (VNA) 4. Erie County DOH Healthy Neighborhood Program 5. Referrals to Lung Center , Allergy Clinic, PCP 6. 5

6/7/19 Intervention OHK and WNY CEHC: WNY CECH: Educate OHK care managers on asthma and environmental asthma triggers § WNY CEHC : Environmental asthma trigger survey developed in English and Spanish (10 questions) § 2 Education Sessions : for 26 OHK care managers to teach them how to screen for environmental asthma triggers and review Asthma 101 § OHK : Referral tracking system in the EMR, developed a 5 question tool Data Results June 2018 – April 2019 OISHEI HEALTHY KIDS Visits 28 17 11 11 R E F E R R A L S R E C E I V E D R E F E R R A L S E N R O L L E D R E F E R R A L S E N R O L L E D D U R I N G M E M B E R S T H A T R E C E I V E D A N A H O M E V I S I T O H K H O M E V I S I T 6

6/7/19 # of Children that Completed the Full Environmental Asthma Trigger Screen 7 6 5 4 3 2 1 0 October February March April May Chil dren % of Patients with an Asthma Action Plan 100.00 90.00 90.00 88.89 80.00 70.00 66.67 60.00 50.00 40.00 40.00 30.00 30.00 33.33 20.00 AAP created 20.00 in P .S. 76 clinic 10.00 10.00 11.11 0.00 June September Oc tober Novem ber Decemb er January February March April Documented Level of Asthma Control Asthma Control 100 100 90 90 80 80 80 80 70 60 60 60 50 40 30 20 20 20 10 0 Jun-18 Jul-18 Aug-18 Sep-18 Oc t-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 7

6/7/19 Documented Level of Asthma Severity Asthma Severity 100 100 100 100 90 90 80 80 70 70 60 60 60 50 50 40 30 20 10 0 Jun-18 Jul-18 Aug-18 Sep-18 Oc t-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 Patients Whose Asthma is Classified as "Well-Controlled" at the Current Visit 100.00 100.00 90.00 90.00 83.33 80.00 70.00 60.00 66.67 60.00 62.50 50.00 50.00 40.00 30.00 Documented 20.00 during P .S. 76 20.00 clinic visit 10.00 0.00 0.00 June September Oc tober Novem ber Decemb er January February March April % of Asthma Patients with an Office Visit Who Were Evaluated for Environmental Triggers 100.00 100.00 100.00 100.00 100.00 100.00 90.00 80.00 77.78 70.00 70.00 70.00 60.00 60.00 50.00 40.00 30.00 Screened by 20.00 WNY CEHC 10.00 0.00 June September Oc tober Novem ber Decemb er January February March April 8

6/7/19 % of Asthma Patients Whose Asthma is Not "Well-Controlled" Who Received a Referral to Home-Based Asthma Services 100.00 100.00 100.00 90.00 80.00 75.00 71.43 75.00 70.00 60.00 50.00 40.00 33.33 40.00 30.00 Home visits 20.00 22.22 conducted by OHK 10.00 0.00 0.00 June September Oc tober Novem ber Decemb er January February March April Conclusions Barriers u Staff turnover u Time constraints u Engagement u No bilingual team members u Survey return rate low u Parents say “yes”, but can’t reach u Fruitful visits? Conclusions Successes u Established a referral system and linkage between Oishei Healthy Kids, WNY Children’s Environmental Health Center, and the SBHC which has become part of process for SBHCs 9

6/7/19 Next Steps u Increase referrals to EC CEHC and OHK u Introduce EC CEHC to other SBHCs u Spread referral system to other SBHCs u Sustainability u Asthma Coalition Thank you 10