Asthma September 10, 2015 Help Us Count If you are viewing as a - - PowerPoint PPT Presentation
How one School-Based Health Center Network Transformed a Community by Addressing Asthma September 10, 2015 Help Us Count If you are viewing as a group, please go to the chat window and type in the name of the person registered and the total
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Debra Gerson, MD Ellette Hirschorn, RN
Debra Gerson, Medical Director Ellette Hirschorn, Director of Clinical Programs Open Door Family Medical Centers
Coalition
Environmental Center
Visiting Nurse Services
Opportunity Program- WestCop/Head Start Programs
Putnam Counties
(Community Schools model)
2014
program
JCAHO accredited
staff
– 200% below poverty level
69%. The county-wide rate, by contrast, is only 28% and the statewide rate is 39%.
($21,000) of the 44 communities in Westchester County
– 6,658 are children – 6%, under 5 years of age – 15%, 5-17 years of age
that more than 75% of Hispanic children are children of recent immigrants
– 18% of children in the district have an asthma diagnosis – 36% of infants had delayed or no prenatal care – 6% of children are born underweight – 45% of children are obese or overweight
Data Sources: New York State Education Department; Open Door Family Medical Centers; Westchester County Department of Health; Westchester Children’s Association 2015 Community Snapshot.
Data Sources: Open Door Family Medical Centers; Port Chester School District, Westchester County Sparks Data 2006-2008
Missed School Days Asthma Severity % with persistent asthma on an ICS Asthma Action Plan % Asthma Well Controlled Acute Care Visits to SBHC ED Visit Rate 376 15% 23% 15% 50% 470 24.7 per 10,000
1. Reduce the number of unscheduled asthma-related visits to OD-SBHC by 50% among the elementary, middle and high school students with asthma enrolled at SBHC 2. Reduce number missed school days by 50% among elementary, middle and high school students with asthma enrolled at SBHC 3. 80% of the elementary, middle and high school students with asthma enrolled at SBHC will have documented levels of asthma severity
5. 90% of the elementary, middle and high school students with asthma enrolled at SBHC with persistent asthma will be prescribed inhaled corticosteroids 6. 100% of the elementary, middle and high school will have updated Asthma Action Plans (AAP) at the SBHC 7. Increase the number of updated AAPs in the school health offices to75% among elementary, middle and high school students with asthma enrolled at SBHC
Prepared, Proactive Practice Team
Productive Interactions
Improved Outcomes
Delivery System Design Decision Support Clinical Information Systems Self- Management Support
Health System
Resources and Policies
Community
Health Care Organization
Care Model for Child Health
Informed, Activated Patient
21
Assessment and Monitoring of Asthma Severity and Control
Education for a Partnership in Care
Control of Environmental Factors and Co-Morbid Conditions that Affect Asthma Medication
20
Prepared, Proactive Practice Team
Productive Interactions
Improved Outcomes
Delivery System Design Decision Support Clinical Information Systems Self- Management Support
Health System
Resources and Policies
Community
Health Care Organization
Informed, Activated Patient
21
Prepared, Proactive Practice Team
Productive Interactions
Improved Outcomes
Delivery System Design Decision Support Clinical Information Systems Self- Management Support
Health System
Resources and Policies
Community
Health Care Organization
Informed, Activated Patient
Asthma Champion identified and integral to
implementation
Identify students with asthma- ensure adequate
health records
Collect baseline data on student attendance
records, acute care visits and ED visits
NHLB guidelines embedded in EMR Planned care visits at least 2x year; more as
needed
Delivery System Design
22
23
24
Asthma Flow-sheet
Prepared, Proactive Practice Team
Productive Interactions
Improved Outcomes
Delivery System Design Decision Support Clinical Information Systems Self- Management Support
Health System
Resources and Policies
Community
Health Care Organization
Informed, Activated Patient
Clinical training on NHLB guidelines for providers Assess asthma severity yearly Asthma control assessed every visit OD and school nurse assess students to determine who
is using pre-exercise meds and children who are appropriate taught about carrying and self- administration
Decision Support
25
26
27
28
Prepared, Proactive Practice Team
Productive Interactions
Improved Outcomes
Delivery System Design Decision Support Clinical Information Systems Self- Management Support
Health System
Resources and Policies
Community
Health Care Organization
Informed, Activated Patient
Asthma registry developed and maintained to track
patient visits
Yearly Spirometry Students who present to the SBHC with respiratory-
related symptoms are assessed by the nurse. Control levels and medication management are reassessed.
Patients get a reminder phone call prior to each
planned care visit and all "no show" appointments are tracked and patients are recalled.
Clinical Information Systems
30
Prepared, Proactive Practice Team
Productive Interactions
Improved Outcomes
Delivery System Design Decision Support Clinical Information Systems Self- Management Support
Health System
Resources and Policies
Community
Health Care Organization
Informed, Activated Patient
Partnering with community organizations for to build a healthy community!
Not-on-Tobacco Adolescent Smoking Cessation
areas, no idling policies.
Asthma Friendly Schools Initiative Day Care Programs Pharmacy’s Health Plans Visiting Nurses ALA
Community Resources and Policies
32
1. Identify students with asthma. 2. Allow students to carry inhalers 3. Create a school-wide protocol for handling asthma 4. Identify and reduce common triggers
coaches, students and staff about pre- medications and participating in sports
personnel about asthma
families, health care providers and school personnel
35
Time-Frame Missed School Days Asthma Severity % with persisten t asthma
Asthma Action Plan % Asthma Well Controlled Acute Care Visits to SBHC ED Visit Rate 2007/2008 376 15% 23% 15% 50% 470 24.7 per 10,000 2014
Data Source- Open Door Family Medical Centers, Port Chester School District,
28 100% 98% 100% 100% 23 S= less than 5-10=Too low to count
Westchester County age 0-17 ED visit data 2010-2012 SPARCS data as of Nov 2013
AN ORGANIZATIONAL APPROACH TO CARING FOR CHILDREN WITH ASTHMA AGES 3-5 AT THE HEAD START PROGRAMS IN PORT CHESTER WHO ARE PATIENTS OF OPEN DOOR FAMILY MEDICAL CENTERS WAS IMPLEMENTED USING THE CHRONIC CARE MODEL.
Day Care Centers
1. Screening with Brief Respiratory Questionnaire (BRQ) 2. Referral to Open Door 3. Education of parents and staff 4. Decrease acute care visits 5. Decrease missed school days 6. Decrease hospitalizations
wheezing or whistling in the chest, or a cough that lasted more than a week?
child experience wheezing or whistling in the chest,
child have trouble sleeping because of wheezing or whistling in the chest, or a cough that lasted more than a week?
medical care provider, or clinic ever used that name to describe your child’s condition: Asthma, RAD (Reactive Airway Disease), Bronchitis or bronchiolitis, Asthmatic or Wheezy Bronchitis or wheezing
provider or clinic prescribed any medicine, inhaler, nebulizer, or breathing machine treatments for any
airway disease, bronchitis or bronchiolitis, asthmatic
child have an emergency visit to a doctor, clinic or an emergency room for asthma, wheezing, cough, chest tightness, or shortness of breath?
child have to stay overnight in the hospital for asthma wheezing, cough, chest tightness, or shortness of breath?
nurse, or clinic for asthma, wheezing, cough, chest tightness, or shortness of breath?
41
50 100 150 200 250 300 PATIENTS CONTROL HOSPITALIZATION ACUTE CARE VISITS TO SBHC
48 37 257
48 48 8 HEAD START ASTHMA OUTCOMES 2010 VS 2014
PRE-PROJECT 2010 SINCE PROJECT 2014
PATIENTS CONTROL HOSPITALIZATION ACUTE CARE VISITS TO FQHC
Guidelines www.nhlbi.nih.gov/guidelines/asthma/
Association http://www.lung.org/lung-disease/asthma/creating- asthma-friendly-environments/asthma-in- schools/asthma-friendly-schools-initiative
Join Now: Individual - $100
the federal level
resources)
materials on influenza (courtesy of MedImmune)
Join Now: Organizational - $500
and products
alerts
Alliance’s annual report and on its website
To learn more, visit: www.sbh4all.org/membership
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