Health Disparities: Residents and Schools Partnering to Optimize Asthma Care

Pediatric Academic Societies

April 29th, 2006

Disclosure Statement

Kate Leonard, M.D. and

Maria Cecilia Mosquera, M.D.

have documented

that they have nothing to disclose.

Overview

Background Objectives Partnership Program Evaluation Lessons Learned

East Palo Alto

Asthma Hospitalizations in San Mateo County

East Palo Alto rates three times higher than

other areas in San Mateo CountySource: San Mateo Childhood Asthma Coalition

Ravenswood City School District (RCSD)

12 schools Kindergarten-8th grade 4,800 students

85% receive meal assistance

1 district nurse

East Palo Alto (EPA) High number of

immigrant families 70% Spanish-

speaking Many single parent

households

EDUCATION

MEDICALSYSTEM

FINANCIALRESOURCES

COMMUNITY

ENVIRONMENT

EDUCATION

MEDICALSYSTEM

FINANCIALRESOURCES

COMMUNITY

ENVIRONMENT

Community

Asthma Task Force Community Leaders

Organizations School District NurseHealth Care Providers

EDUCATION

MEDICALSYSTEM

FINANCIALRESOURCES

COMMUNITY

ENVIRONMENT

Medical System

Asthma Packets Checklist Asthma Action Plan School Authorization for Medications Form

Asthma Guidelines Card Emphasized NHLBI Guidelines Listed Meds Covered by Insurance Programs

School Medication Authorization Form Streamlined Form and Submission Process

Asthma Action Plan Asthma plan written by doctor

Controller meds, dose, instruct.

Relief meds, dose, instruct. 3 Zones:

Green: No asthma (PREVENTION)

Yellow: Not well (CAUTION) Red: Feels awful (ALERT)

3 Copies: Patient, School/Other, Chart

*Asthma Action Plan courtesy of RAMP

Medical System

Created Asthma Packets Checklist Asthma Action Plan School Authorization for Medications Form

Asthma Guidelines Card Emphasized NHLBI Guidelines Listed Meds Covered by Insurance Programs

School Medication Authorization Form Streamlined Form and Submission Process

Guidelines Cards

Approved Asthma Meds Local Health Plan approved Drug, formulation, dose (low,

med, high)

NHLBI Guidelines Asthma classification Symptoms Treatment (age dependent)

EDUCATION

MEDICALSYSTEM

FINANCIALRESOURCES

COMMUNITY

ENVIRONMENT

Education

Teachers 190 Teachers/Staff 11/12 Schools

Parents and Kids Empowerment

Residents Developed & Led

Trainings

EDUCATION

MEDICALSYSTEM

FINANCIALRESOURCES

COMMUNITY

ENVIRONMENT

Environment

Home Visitor Program Home visitors trained

in asthma management

Assess indoor air quality & asthma triggers

School Air Quality Assessment

EDUCATION

MEDICALSYSTEM

FINANCIALRESOURCES

COMMUNITY

ENVIRONMENT

Financial Resources

IndividualCovered MedicationsDurable Medical Equipment

SystemsFunding for Asthma Coordinator

Bridge From Medical System to Community Resources: Asthma Coordinator

EDUCATION

MEDICALSYSTEM

FINANCIALRESOURCES

COMMUNITY

ENVIRONMENT

495 PEDIATRIC ASTHMATICS IDENTIFIEDBefore Now

Med Auth Forms 0 142

Action Plans 0 87

MDIs at School 1 65

Asthma Classes Attended

0 126 Parents

21 Students

Asthma Case Manager

0 1

Asthma Cards 0 300+

Home Visits 0 12

Ongoing Project

Measured OutcomesER visits + hospitalization data

before and after the project Pharmacy data on rescue versus

controller medication prescriptions

Lessons Learned

Priorities of the Community Sustainability is Paramount Mutual Respect Systems Level Changes Outcomes

Acknowledgments

Parents and Children in East Palo Alto Lisa Chamberlain, M.D., M.P.H. Janine Bishop, M.P.H Laurie Bauer, R.N. LPCH Pediatric Residents

Thank You!

Asthma: The Problem

Most common chronic disease in childhood

1 in 10 children in California suffers from asthma

#1 cause of missed school days due to illness

Source: American Lung Association

References

American Lung Association San Mateo Childhood Asthma Coalition Google Images

General Process Outline Recognized Problem

Saw Disparities Asthma Hospitalizations? Asthma deaths in schools?

Triggered to find roots of problem thought to be multi-faceted Financial ability of families to pay Physicians’ abilities to diagnose, treat, educate, prescribe asthma patients Burden of one school nurse caring for so many patients Environmental triggers at home Lack of parental, patient, teacher, physician education about:

Asthma triggers Controller versus rescue meds

Learned about Community Resources Created Partnerships

Learned about Community Needs Created Project

Involved Resident Classes Prioritized Plan/Steps Continually Revised Plan Ensured Sustainability Measured Outcomes

Identified Community Needs (Gaps in Resources) Physician Knowledge

Of medications covered by Insurance programs Created Asthma Card

Streamlined Process for Asthma Care Checklist Asthma Action Plan Fax Numbers Asthma Card Streamlined School Medication Form???

Community Educators Asthma as a disease Controller v Rescue Meds Environmental Triggers

Supplies in Schools School Asthma Coordinator ? Asthma Task Force

Created Project

Faculty Project Coordinator - Lisa Involved LPCH Resident Classes

Peds Intern Classes 2003-2004, 2004-2005Residents chose aspects of their involvementCommunity Advocacy Rotation

Future Projects Needed

Inpatient Asthma Care in different hospitals? Funding in different hospitals?

Obtain Asthma care supplies & distribute? Advocate Health Insurance Plans to:

cover more medicines? To cover spacers? Expedite MediCal coverage? First med/spacer covered regardless of insurance coverage?

Flag all Charts of Kids with Asthma To ensure Action Checklist and Plan completed

Evaluate one year after project completed how outcomes have changed more/less MDIs in schools? more/less Action Plans?

Objectives Decrease health disparities in asthma outcomes Learn more about the Community Create Partners in and out of the Community

Asthma Task Force Laurie Bauer Ravenswood School Distirict

Educate physicians Create med card Create checklist Streamline School Form

Educate families and patients Educate teachers Educate Residents

About asthma care and management About teaching About advocacy in general, advocacy project creation, stimulate interest in working in advocacy

Empower schools Create an Asthma Manager (& fund)

Create healthier environments Home visits

Healthier schools MDIs in schools

Objectives not accomplished? Asthma H&P form? Donated supplies to be distributed?