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

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Assembling Your School Asthma Team: An Asthma Quality Improvement Collaborative

Kim Utech, MSN, FNP-C, AE-C

Develop ideas, test, and implement change Establish measures and report data monthly Identify a project location and set an aim Establish a team/collaborative Identify a problem or an opportunity for improvement

What’s the problem? The burden

• f asthma in New York State.

u NYS has the 2nd 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

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What’s the Problem? Buffalo/ Western NY

WNY has the 2nd highest rate of asthma ER visits and the 3rd 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

• utcomes 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 Study Do Plan

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

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u ~800 children in PreK-8th grade u 212 children have an asthma diagnosis u Over 90% of students are enrolled in

the SBHC

u Many Spanish speaking

children/families

SBHC P .S. 76 Herman Badillo Bilingual Academy

Buffalo SBHC AQIC Team

P .S. 76 School Based Health Clinic

NP , MA, SW, MD, AE-C

WNY Children’s Environment al Health Center (WNY CEHC)

Coordinator, Medical Director

Oishei Healthy Kids (OHK)

Care Mangers, QI

Buffalo SBHC AQIC Team

Kim Utech, FNPC, AE-C Melinda Cameron, MD Medical Director Lissette Palestro, MPH Coordinator of the WNY Children’s Environmental Health Center Robert Mowery, Quality, Oishei Health Kids Chelsea Kraska Care Manager Supervisor, Oishei Health Kids Susan Boswell, FNP

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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

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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

• ol

§ 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:

1.

OHK Health Home: for children with asthma who also have one other chronic health condition

2.

WNY CEHC

3.

NYS Smokers Quit line

4.

Visiting Nurse Association (VNA)

5.

Erie County DOH Healthy Neighborhood Program

6.

Referrals to Lung Center , Allergy Clinic, PCP

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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

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 A H O M E V I S I T M E M B E R S T H A T R E C E I V E D A N O H K H O M E V I S I T

OISHEI HEALTHY KIDS

Visits

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1 2 3 4 5 6 7 October February March April May

# of Children that Completed the Full Environmental Asthma Trigger Screen

Chil dren 40.00 66.67 33.33 20.00 10.00 30.00 11.11 90.00 88.89 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00 June September Oc tober Novem ber Decemb er January February March April

% of Patients with an Asthma Action Plan

AAP created in P .S. 76 clinic

Documented Level of Asthma Control

20 80 60 60 20 90 80 80 100 10 20 30 40 50 60 70 80 90 100 Jun-18 Jul-18 Aug-18 Sep-18 Oc t-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19

Asthma Control

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Documented Level of Asthma Severity

60 50 90 70 60 80 100 100 100 10 20 30 40 50 60 70 80 90 100 Jun-18 Jul-18 Aug-18 Sep-18 Oc t-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19

Asthma Severity

0.00 83.33 50.00 60.00 20.00 100.00 62.50 90.00 66.67 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00 June September Oc tober Novem ber Decemb er January February March April

Patients Whose Asthma is Classified as "Well-Controlled" at the Current Visit Documented during P .S. 76 clinic visit

60.00 100.00 100.00 70.00 70.00 77.78 100.00 100.00 100.00 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00 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 Screened by WNY CEHC

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0.00 33.33 40.00 71.43 75.00 75.00 22.22 100.00 100.00 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00 June September Oc tober Novem ber Decemb er January February March April

% of Asthma Patients Whose Asthma is Not "Well-Controlled" Who Received a Referral to Home-Based Asthma Services Home visits conducted by OHK

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

Conclusions

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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

Next Steps

Thank you