Health Disparities: Residents and Schools Partnering to Optimize Asthma Care Pediatric Academic Societies April 29 th, 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 County Source: San Mateo Childhood Asthma Coalition

Ravenswood City School District (RCSD) 12 schools Kindergarten-8 th 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 MEDICAL SYSTEM FINANCIAL RESOURCES COMMUNITY ENVIRONMENT

EDUCATION MEDICAL SYSTEM FINANCIAL RESOURCES COMMUNITY ENVIRONMENT

Community Asthma Task Force Community Leaders  Organizations  School District Nurse  Health Care Providers

EDUCATION MEDICAL SYSTEM FINANCIAL RESOURCES 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 MEDICAL SYSTEM FINANCIAL RESOURCES COMMUNITY ENVIRONMENT

Education Teachers  190 Teachers/Staff  11/12 Schools Parents and Kids  Empowerment Residents  Developed & Led Trainings

EDUCATION MEDICAL SYSTEM FINANCIAL RESOURCES COMMUNITY ENVIRONMENT

Environment Home Visitor Program  Home visitors trained in asthma management  Assess indoor air quality & asthma triggers School Air Quality Assessment

EDUCATION MEDICAL SYSTEM FINANCIAL RESOURCES COMMUNITY ENVIRONMENT

Financial Resources Individual  Covered Medications  Durable Medical Equipment Systems  Funding for Asthma Coordinator

Bridge From Medical System to Community Resources: Asthma Coordinator EDUCATION MEDICAL SYSTEM FINANCIAL RESOURCES COMMUNITY ENVIRONMENT

495 PEDIATRIC ASTHMATICS IDENTIFIED BeforeNow Med Auth Forms0142 Action Plans087 MDIs at School165 Asthma Classes Attended 0126 Parents 21 Students Asthma Case Manager 01 Asthma Cards0300+ Home Visits012

Ongoing Project Measured Outcomes  ER 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 ,  Residents chose aspects of their involvement  Community 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?