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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?