Implementing Interventions in Diverse Communities: The Asthma Partnership Of New York Pediatric Pulmonary Center Meeting March 1-3, 2007 Arlington, Virginia New York State Department of Health

“Despite some improvements in awareness, care and management, asthma still remains an epidemic in New York state with significant public health and financial. Disparities among high and low income groups and variation in care processes, quality and cost of care persist. More system level activity is necessary to accelerate and spread improvements for all New Yorkers.” New York State Asthma Plan New York’s Call to Action

Objectives Describe the Burden of Asthma In New York Define the role of the Asthma Partnership of New York Highlight New York’s strategies to improve asthma outcomes

BRFSS Prevalence of Asthma Among Adults by Survey Year, New York State & Nationwide

National Asthma Survey – NY 2003

The total cost of asthma hospitalizations has increased 44%, from $322 million in 1993 to $465 million in The top 20% of asthma hospitalizations consumed ~ 55% of the total cost for asthma hospitalizations. The average cost per asthma hospitalization increased 106% from $5,656 in 1993 to $11,634 in This occurred despite the average length of stay for asthma decreasing 24% from 4.9 days to 3.7 days during the same time period.

Use of Appropriate Medications for Children with Asthma, Trends by Payer 5-17 Years: Commercial, Medicaid 5-18 Years: Child Health Plus Source: QARR data

Use of Appropriate Medications for Adults with Asthma, Trends by Payer Source: QARR data

New York State Asthma Report Card – Modified HEDIS Asthma Measures* MODIFIED HEDIS MEASURESTATEWIDE AVERAGE CHILDREN (5-17) STATEWIDE AVERAGE ADULTS (18-56) 1 or More Controller Scripts in 2004**69.8%70.1% 3 or More Controller Scripts in %55.0% 5 or More Controller Scripts in %43.9% *Cohort comprised of enrollees in HMOS and PHSPs who qualified for the denominator of the 2005 HEDIS Measure, ‘Use of Appropriate Medications for People with Asthma.’ **Standard 2005 HEDIS Measure.

NY Asthma BCAP Overall 2004 and 2005 Audit Results

What will it take to spread improvements and reach New York’s diverse communities? Change will not happen on the scale needed unless there is collaboration and alignment of priorities across stakeholder groups. There must be some awareness that the stakeholders are more likely to achieve the goal by working together than individually. “Americans are a peculiar people. If in a local community a citizen becomes aware of a human need that is not met…suddenly a committee comes into existence…and a new community function is established. It is like watching a miracle.” de Tocqueville, 1840

Definition of Terms - NY Partner: an associate or organization who works with other partners, including the NYSDOH, toward a common goal Partnership: a cooperative relationship between Partners who agree to share responsibility for achieving the goal of reducing the burden of asthma Coalition: An organized group of partners within a specific region who work together to achieve a shared goal through a population based sustainable systems approach and some awareness that they are more likely to meet their goal by working together than individually. State Asthma Program: Implementation of coordinated asthma activities based on the New York State Asthma Plan and led by NYSDOH with statewide partners

Who are NY’s Partners? Statewide Partnership (advisory, and implementation role) Regional Coalitions (advocacy, implementation role) Local/Project Specific Partners (advisory, implementation, sponsor role)

Statewide Partnership NYSDOH Partners Center for Community Health Center for Environmental Health Child Health Plus Department of Environmental Conservation Information Systems and Health Statistics Group Office of Health Systems Management Office of Managed Care Office of Medicaid Management Office of Science and Public Health Office of Rural Health Public Affairs Group Wadsworth Center for Labs and Research External Partners American Lung Association Healthcare Association of New York State Community Health Centers Association of NY Pediatric, IM, Family Practice Professional Societies Medical Society of the State of New York Health Plan Association of New York State State Education Department New York State Nurses Association NYS Association of School Nurses Pharmacy Society of the State of New York NYS Regional Asthma Coalitions Role: Shape, align, implement and monitor New York’s action to reduce the burden of asthma

NYS Regional Asthma Coalitions Coalition Partners Approximately 100 partners per coalition such as: Health Care professionals/organizations Insurers Local Health Departments Schools/daycares Community groups/organizations (ALA) Pharmacists Faith based organizations Housing Environmental organizations Businesses Media Others Role: Control asthma through a regional, population based, sustainable systems approach.

Local or Specific Project Partners Best Clinical and Administrative Practices (BCAP): Improving Asthma Outcomes in NYS ( ) Project Partners: NYSDOH Asthma Program NYSDOH Office of Managed Care Center For Health Care Strategies (CHCS) Island Peer Review Organization (IPRO) 13 Medicaid Managed Care Plans Providers Regional coalitions Role: Translate the Asthma Guideline into practice, coordinate interventions and share information among partners

NYSDOH Guidance Team SurveillanceHealth CareCommunity Environment and Occupational Health NYSDOH Leadership Team Statewide Partnership How are all these partners connected?

Moving New York Forward: “ Re-Visioning Asthma” Partners National Initiative for Children’s Healthcare Quality (NICHQ): Boston/Seattle MacColl Institute for Chronic Illness Improvement (Dr. Ed Wagner, Mike Hindmarsh) Broad Representation across DOH and NYCDOH&MH, including Executive Level buy in and support) Statewide Partners: professional societies, specialists, health plans, advocacy organizations, ALA, regional coalition reps, patients/parents etc. Role Expert in system change and improving asthma care among children Expert in population based chronic care improvement and aligning system change aims at multiple levels in the health system and community systems. Expert in Public Health, Medicaid, Managed care, Epidemiology, Environmental and Occupational Health Expert in clinical, advocacy, regional issues, patient/community experience

July 2005 new strategic planning began Reviewed burden of asthma in NYS Emerging new evidence Result… “Framework for Improving Asthma Outcomes in NYS” New York State Asthma Plan

1.Seamless, evidence- based, patient/family centered asthma care exists for all New Yorkers with asthma. 2.Disparities in asthma diagnosis, treatment and outcomes are eliminated. 3."Asthma-Friendly" communities exist in New York. 4.Policy makers, health care providers and consumers have an increased understanding of asthma and treat and manage asthma effectively. 5.A Statewide Public/Private Collaboration exists to shape, implement and monitor New York’s action which will improve asthma outcomes in New York. NYSAP Goals

Prioritizing Strategies strategies (based on framework) 3 face to face meetings and 2 surveys Each strategy rated based on a two by two matrix  high or low impact – the degree to which this strategy is supported by evidence and would improve health related outcomes and quality of life and reduce symptom burden, preventable hospitalizations and deaths;  high or low feasibility of implementation – the degree to which the necessary resources, partners and political will are available and can be conducted in the real world.

Goal 1: Seamless evidence-based patient/family centered asthma care Update NYS Asthma Consensus Guideline pending NAEPP updates Develop Asthma Guideline for patients Develop and establish the “NYS Center For Innovation” Develop and implement a model benefit package for that support good asthma care

Goal 2: Eliminate disparities in asthma diagnosis, treatment, and outcomes Develop, implement and spread a multi- modal asthma home environmental intervention through a collaboration with NYS Healthy Neighborhoods Program, Health Plans and Providers in both urban and rural communities Pilot and expand an asthma quality improvement collaborative within School Based Health Centers located in neighborhoods with high asthma morbidity

Goal 3: Create asthma-friendly communities in NYS Develop and implement a comprehensive NYS School Asthma Management Policy Implement tailored environmental trigger reduction interventions in identified high risk elementary schools Create and promote the NYS Asthma Coalition Learning Network among state funded regional asthma coalitions in order to identify and spread best practices

Goal 4: Enhance awareness among policy makers, providers, and consumers Maintain and expand asthma surveillance Produce and disseminate NYS asthma surveillance information Provide technical assistance for monitoring and evaluation of asthma interventions

Goal 5: Foster a statewide public / private collaboration to monitor asthma outcomes Refine and expand the: Asthma Partnership of New York Asthma Partnership of New York actively works together to set priorities, monitor plan implementation and results

Thank You! Pat Waniewski, RN, MS Asthma Coordinator, NYSDOH Phone: (518) New York State Department of Health Asthma Web page: