Asthma Case Management

8/8/2019 Asthma Case Management

1/44

Asthma Alliance of Indianapolis 1

Asthma Case Management:Asthma Case Management:

A Unique Asthma Referral ServiceA Unique Asthma Referral Service

Presented by Robin Costley, CRT

Asthma Educator

Marion County Health Department

Asthma Alliance of Indianapolis


2/44


Who is theWho is the

Asthma Alliance of Indianapolis?Asthma Alliance of Indianapolis? Formed in 1997

3 year grant from NHLBI Multi disciplinary approach to

asthma education, prevention, &treatment

Developed as a result of acomprehensive health assessment


3/44


Mission Statement:

The mission of the Asthma Alliance ofIndianapolis is to arm individuals

affected by asthma with the knowledgeand skills to improve health & qualityof life.


4/44


Coalition GoalsCoalition Goals

Decrease # of emergency room visits forasthma

Decrease school absenteeism & missed work

days due to asthmaIncrease the use of NHLBI guidelines amonghealthcare professionals

Plan, conduct, & evaluate educationcampaign on the impact of the environmentand asthma management


5/44


Coalition ServicesCoalition Services

Education programs targeting school staff,students, parents

Advocating for public policies that aid inincreasing the quality of life for those affectedby asthma

Partnering with other community groups to

increase public awareness of asthma

UniqueAsthma Referral Service


6/44


Asthma a Key Health ProblemAsthma a Key Health Problem 51,000 adults & 25,000 children

are diagnosed with asthma inIndiana

Affects 22.2 Million Americans, 5million are children

Estimated 12.8 million lostschool days & 14.5 million lost

work days Top 10 of prevalent conditions

causing limitation of activity &costs US $19.7 billion inhealthcare costs.


7/44


Top Chronic Health ConditionsTop Chronic Health Conditions

in Indiana Schoolsin Indiana Schools

Surveys were receivedfrom 35 schoolcorporations, ranging

in size from 496-32,000students.

Two private schoolsincluded representing

1,112Making a combined total

of 255,818 students.0

2000

4000

6000

8000

10000

12000

14000

Type IDiabetesType IIDiabetesAsthma

Seizures

Allergies


8/44


Five Key Elements of ProgramEffective Care for People with Asthma

1.

Tailored EnvironmentalInterventions

In-home assessments

School and workplaceassessments

Environmental triggereducation and remediation

Indoor Air Specialist


9/44


2.

Integrated Health Care Services Unique asthma referral service

Home visit database with environmental outcomes

School health coordinator database to trackschools and participants.

Contract to carry asthma medications at school


10/44


3.

High-Performing Collaborations & Partnerships Annual World Asthma Day poster contest

Head Start

Corporate sponsors Neighborhood clinics


11/44


4.

Committed Program Champions County health department administers AAI

Governance Board

Website sponsor

Serves as consultant


12/44


5.

Strong Community TiesLocal university respiratory therapy program

Tailored community outreach activities

Education and resource binder to local libraries

School workshops


13/44


Goals of Asthma ManagementGoals of Asthma Management Maintain normal activity

levels ( including exercise)

Maintain (near) normallung function

Prevent chronic &troublesome symptomssuch as coughing,

shortness of breath atnight, early morning, orafter exertion.

Avoid adverse effects fromasthma medications.


14/44


COMPONENTS ofCOMPONENTS of

ASTHMA MANAGEMENTASTHMA MANAGEMENT

1. Objective measure of lung function toassess & monitor

2. Environmental Control efforts to reduce

or eliminate exposure to allergens,irritants & other triggers that induceairway inflammation & precipitate acuteasthma episodes.

3. Pharmacologic therapy to prevent,reverse, & control airway inflammation &

obstruction.4. Education to help clients prepare & follow

their daily mgt. plan and their plan fordealing with symptoms.


15/44


Asthma Referral ServiceAsthma Referral Service To provide an extension of resources

and free services to residents in

Marion County with a diagnosis ofasthma or allergies

Integration of health care services

Improve & coordinate care Initiated in 2001

To instill healthy habits for life


16/44


Common ReferralsCommon ReferralsPublic

Health

Nurse

Indoor

Air

Specialist

Asthma

Educator

Social

Worker

Insurance

CoverageSpecialist

SmokingCessation

Specialist

Other

Identifiedresources


17/44


Development of theDevelopment of the

Asthma Referral SystemAsthma Referral System Took a strong stand in the benefits of

managing the indoor environment vs.

prescribing medications as the firstline of defense.

Found most clients in need of

additional services and referralsoutside of asthma education


18/44


Where Do Referrals Come From?Where Do Referrals Come From?

Hospitals

MCHD Programs

Schools

Self referrals Head Start Centers

Other daycares

HCP offices

Neighborhood clinics

Health Centers


19/44


Reporting InformationReporting Information Parent or Guardian Primary Care Physician

Allergy/ Asthma Specialist

Source of referral

Health Insurance Portability & Accountability Act of1996 (HIPAA)

Acknowledgement of receipt of notice of privacypractice

Authorization for release of information


20/44


Barriers & ChallengesBarriers & Challenges

Transient clients Family not ready to initiate education and

management

Other STUFF is priority

Not an earlyintervention Too many caretakers

New asthma guidelines

Addictions Language barriers

Cultural behaviors


21/44


Services Noted Outside ofServices Noted Outside of

Asthma CareAsthma Care Medical equipment & providers

Education & Information

Support

Resources

Disease management Crisis management

Life care planning


22/44


Services continuedServices continued Pharmaceutical companies

Rx for Indiana

Rodent control

Family services

Child development services

Sources to obtain needed managementitems

Dietician


23/44


Real Life ExampleReal Life Example

OLDER ADULT ARTISTOLDER ADULT ARTIST

Referral from neighborhood clinicProblems identified:

1. Second Hand Smoke in apartment complex

2. Dust no upholstered furniture, washes bedding 1X/Wk,dust mite protectors in place. Home appeared clean but

cluttered with books, papers, etc.3. Paint supplies- works with acrylic paints & cleaning

solutions. Feels like this may be contributing to herexacerbations

4. Suggested mask, consulted Indoor Air Specialist forrecommendation. Sent her a listing of local distributorsfor an appropriate mask.


24/44



DESPERATE CAREGIVERDESPERATE CAREGIVER

Self Referral- Grandmother, Great Grandmother, 2 smallGrandchildren, and 1 teenage Daughter

Problems identified:

1. Deplorable living conditions ;

Standing water in all of the bedrooms, closets,with visible mold throughout the house.

2. Windows not placed properly. Heat at 95 degreesin winter to overcome cold temperatures in the

home. Bugs in home, fly paper placed in allrooms.

3. Toilet not seated properly with human wastecoming up on the floor with each use.


25/44



MULTIPLE ISSUESMULTIPLE ISSUES

Referral from Head Start-Mother, 2 children with asthma, 4 childrentotal, unemployed father.1. Father not involved with care, playing video games at each visit.

Also smokes.

2. Mother not able to hold job due to childrens uncontrolled asthma.

3. Home very cluttered and dirty. Dirty dishes & food laying about.Cockroaches visible all over.

4. Vacuum is broken.

5. Pet cat

6. Plumbing and ceiling leaks. Mold & mildew developed.

7. Landlord & client sited

8. 3 ER visits in 5 months


26/44



CHILD WITH AUTISMCHILD WITH AUTISM

MOTHER DISABLEDMOTHER DISABLEDSelf Referral


1. Single Mother desperate for help. Has CP with a

severe speech impediment.2. Two sons; a 6 y.o. with asthma & newly

diagnosed autism, & a 10 y.o.

3. No medical home- numerous medications that

she didnt know what to do with4. Collaborated with school nurse to develop a

more effective management plan for the schoolenvironment.


27/44


AUTISM Case continuedAUTISM Case continued

Services utilized:

1. About Special Kids (ASK)

2. Inadequate equipment-DME donated portable

neb.3. Provided neb machine for

before school care.

4. Staff education at school

and before care.5. Allergy testing finally

completed with new MD.


28/44



CHILD WITH LEARNING DISABILITYCHILD WITH LEARNING DISABILITY

Referral from SchoolProblems identified:

1. Mother not comfortable letting son carry his inhaler. Previouseducation & instruction have failed to improve his technique.

2. Son was instructed in the home with Mother present using a

picture format containing pictures for each step to take his inhalerwith spacer.

3. Follow up phone call 3 months later revealed that Son had a flare-up since the instruction & is doing a great job with his inhaler &spacer. He now takes his rescue medicine with him and feelscomfortable using it.

4. Mother doing a great job of managing sons asthma & was alreadyeducated on common triggers & has already taken measure toreduce them in the home.


29/44



CHILD WITH DOWNS SYNDROMECHILD WITH DOWNS SYNDROME

Referral from co- workerProblems identified:

1. Child currently on ventilator due to severe asthma exacerbation.Parents wanted home environmental assessment before she wasdischarged from the hospital.

2. Concern over carpets. Have a HEPA vacuum but family structure isso hectic that they do not vacuum regularly.

3. Questions regarding furnace filters. Consulted Indoor AirSpecialist for recommendations on most effective filters available.Also suggested running fan continuously versus automatic so that

it continually filters the air.4. For furnace humidifiers it was suggested that they have a humidity

gage to keep it no more than 40% humidity level. Stressedimportance of keeping unit clean.


30/44



MULTIPLE FAMILY MEMBERS LIVINGMULTIPLE FAMILY MEMBERS LIVING

AT RESIDENCEAT RESIDENCEReferral from Health Clinic


1. Non compliant with medications. Son 7 y.o. ,3 y.o. & 2 y.o.daughters with severe asthma.

2. Very transient3. Home not kept clean. Many people in & out of home.

4. Equipment in bad condition, dirty.

5. Concerns over child development. Son is restricted to an airconditioned room all summer. Referred to programs for parents &

children / Childrens Bureau6. Loosing materials that were provided. Not filling prescriptions

7. When do you call it quits?!


31/44



LIFE WITHOUT SLEEPLIFE WITHOUT SLEEP

Referral from Sickle Cell ProgramProblems identified:

1. Single Mom states that 2 y.o. Son has symptoms daily.Mostly at night. Not sure of triggers.

2. Son only sleeps 2 hours/ night. Not sure if it is themedications he is on or irritation from his severe eczema.

3. Roaches present in home. ( Dbl. Occupancy)

4. Educated on dust mite reduction. Removed large stuffed

animal from room. Dust mite pillow protector provided.5. Mom stressed from his care. No one will help her care

for him because of his of his lack of sleep and he getsinto things in the home when Mom falls asleep.


32/44



NONNON--COMPLIANT TEENCOMPLIANT TEEN

Referral from Neighborhood ClinicProblems identified:

1. Freshman HS student. Filled quick relief meds 10Xs &controller 2 Xs in 6 months

2. Admits she does not take her controller meds. Shedoesnt like the taste & she forgets

3. Discussed the damage to her lungs with long standinginflammation

4. Running out of Medicaid. Trying to re- instate.5. Committed to keep appointments

6. Provided Spanish materials for Mother


33/44



NEED FOR INTERVENTIONNEED FOR INTERVENTION

Self referralProblems identified:1. 10 y.o. Son with severe asthma, Mother lost job 2nd to

repeated calls from work to pick Son up at school with

asthma symptoms

2. No food in home. Ran out of food stamp support, notransportation

3. Referred to appropriate DHO for basic needs resources.

Social Worker intervened

4. Presently goes to school daily to give Son his asthmatreatment


34/44


ContinuedContinued

5. Needed direction in job search. Inquired about a job ather sons school/ may be aide position available in thenear future. Continues to seek employment/ hassubmitted several applications.

6. Son had sleep study, cab was involved in accident on theway home. Needed direction to report incident.

7. Walmart card given for household goods , toiletries, andeye drops for her son. Bus vouchers also provided for

transportation.E

ncouraged to go to Trustees office toobtain assistance with her utility bill and school clothesfor her Son.


35/44


ContinuedContinued5. Paid all but $7 of her electric bill obtaining $ by

doing odd jobs. Needed direction in contactingthe power company so that her electricity

wasnt turned off in 2 days. Need for utilityassistance.

6. Son doing much better. No furtherhospitalizations since initial asthma referral.

7. Continued visits to support ongoing needs offamily.


36/44


Closing the GapsClosing the Gaps

Home

WorkSchool

HCP Office

Hospital discharge follow up


37/44


38/44


RewardsRewards Improvement of

symptoms is often

directly related tothe degree clientsfollowenvironmentalrecommendations

Greatly affected bythe partnershipwith the educator.

Buildingpartnerships with

clients & theirfamilies ensuringthat support ,consistent

messages, &coordinated careare provided.


39/44


RESULTSRESULTS CONTROLLED

ASTHMA, FEWER

SICK DAYS, &BETTERFUNCTIONALLIVES OF

CLIENTS.


40/44


Numbers served each yearNumbers served each year2006

Total referrals = 72

Unable to reach=14 Common referrals to

other services wereasthma educator,indoor air specialist &public health nurse.


41/44


Related StrategiesRelated Strategies

Marketing plan

Word of mouth

Alliance members & sponsors

World Asthma Day

Annual golf outing and fundraiser

Community outreach engagements

.


42/44


Related StrategiesRelated Strategies

Budget

Administered by the Marion County Health

Department Donations of management items

Use of all profits back to the community viaroach baits/ gel, dust mite pillow protectors,

equipment needed to administer medications


43/44


Final CommentFinal CommentA unique way to join forces with

clinics, physician offices &

managed care organizations thathave implemented asthma-management programs. Sharing

our strategies and success.

FOR MORE INFO...

Asthma Alliance of Indianapolis

#317-221-2473 www.asthmaindy.org


44/44


Thank you for your time & attention.

Any questions?

To learn more about becoming a member orsponsor of the Asthma Alliance log onto

our website or give us a call. We arealways looking to expand our coalition tohelp benefit those with asthma in ourcommunity.

Documents

Asthma Case Management