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SE Minnesota Beacon Program Working Together to Improve Health Care Program Partners: Agilex Technologies; Dodge County & Public Health Department; Fillmore County & Public Health Department; Freeborn County Board & Public Health Department; Goodhue County Board & Public Health Department; Houston County Board & Public Health Department; Mayo Clinic; Mayo Health System [Albert Lea Medical Center, Austin Medical Center, Cannon Falls Medical Center, Cannon Valley Clinic, Fairmont Medical Center, Lake City Medical Center, Owatonna Clinic]; Minnesota Department of Health; Minnesota Counties Computer Cooperative; Mower County Board & Public Health Department; Olmsted County Board & Public Health Department; Olmsted Medical Center& Clinics; Prairie Island Health Services & Prairie Island Clinic; Rochester Veterans Affairs Community-based Outpatient Clinic; Rice County Board & Public Health Department; SE MN Public School Districts; SE MN School Nurse Association; Stratis Health; Steele County Board & Public Health Department; Wabasha County Board & Public Health Department; Winona County Board & Public Health Department; Winona Health Services Pediatric Asthma – “Cocoon of Care” Erin Knoebel, M.D., Barbara Yawn, M.D., Terrance Donnal, M.D., Deborah McWilliams, M.D., Linda Williams, M.D., Daniel Jensen, MPH, Marty Alemán, MA, PHN, Shaylene Baumbach, James Naessens, Sc.D., Lacey Hart, MBA, PMP®, Jason Egginton, MPH, Lauren Textor, BA, Christa Frazier, Erin Martin  2011 Mayo Foundation for Medical Education and Research Background: More than 20 million Americans have asthma, including an estimated 6.3 million children under the age of 18. This chronic, but manageable, disease affects 1 in 14 school-aged children (1). Among Minnesota children with asthma, more than half had an asthma attack in the past year (2). In Rochester, Minnesota, asthma is estimated to occur in 12% of school-aged children (3). Asthma is the leading cause of school absenteeism due to chronic illness. Over 14 million school days are missed due to asthma each year (4). School staff, families, and healthcare professionals play an important role in helping students with asthma manage their disease at school. Program: Funded by the U.S. Department of Health and Human Services, through the Office of the National Coordinator for Health Information Technology, the Southeast Minnesota Beacon project connects school nurses, county public health nurses, and local clinics and hospitals so that treatment – especially for chronic problems such as childhood asthma — does not happen in isolation. Stage One Objectives: The asthma project includes outreach to schools, families, and health professionals to encourage participation in managing students’ asthma at school. The project will assist schools in Southeast Minnesota with the implementation of an effective asthma management program. Stage Two Objectives: The asthma project will enable the asthma management program with technologies for improved access, efficiencies, confidential student tracking and direct communication lines with health professionals. Our focus is on good communication among health professionals, school staff, and families through ongoing exchange of information, agreement on goals and strategies, and a sharing of responsibilities. Why is This Important to Schools?: The health of our students will strongly influence whether they attend school and are successful learners. Our Beacon project will address the issue of asthma management of children in the school setting. School nurses play a major role in asthma screening, education, and care coordination. For more information on the SE Minnesota Beacon program and the Asthma Project visit: www.semnbeacon.org Background & Objectives Methods: From February 3 to May 24, 2011, fourteen (14) focus group discussions were held throughout SE Minnesota to gather an understanding of current beliefs, behaviors, and attitudes about asthma action plans (AAP) from: school professionals, parents of children with asthma, and health care professionals, n=103). Trained facilitators used a pre-formulated questioning route developed by asthma experts in sessions that lasted approximately 60 minutes. All discussions were audio-recorded and transcribed. Analysis: All transcripts were independently hand coded and software coded (NVivo 9, QSR International, 2010) by qualitative analysts. Coders then met to discuss themes and arrive at consensus and categorical semantic agreement on multiple occasions. Electronic codes were then reconciled to reflect the agreed-upon framework and overarching themes. Summary reports were used to inform stakeholders and to develop “uses cases,”— potential ways AAP were likely to be used and flow through a system where a school is the locus of action. Community Input: Focus Groups There were four overarching themes that emerged from the 14 focus groups among various stakeholders: Communication: There are various communication dyads (eg, parent school, physician school) and modes (eg, email, fax) where information can be lost or misconstrued. A shared portal and/or assurance that the right people have information and proper documentation is crucial. Asthma Control Continuum: Each child is different and changing. The AAP should reflect each child’s triggers and current status as clearly as possible and that information should be disseminated to everyone who comes in contact with the child. Policies and Protocol: There is a fair amount of confusion on the part of most stakeholders about “who is allowed to do what, when” and “who is in charge of what, when.” Few wanted to violate privacy or carry out an AAP not approved by parents and physicians. Self-Reliance: By the time children reach adolescence, it was felt they should be trained and approved for self-administer, self-carry of asthma medication. Back-up inhalers and other support measures should still be in place, however, particularly as adolescents participate in after-hours co-curricular programs like sports. Results from Focus Groups A major effort of the Beacon in SE Minnesota is to use information technology to create a communication system for coordinating and improving care. Technology specifications created by the Olmsted County Asthma Action Plan Task Force Data Base pilot program –Resources to scale the infrastructure into the Beacon region Widespread implementation of a technology solution will take time –the magnitude of issues –proposed technology solutions –a strong emphasis on protecting the confidentiality and best interests of patients The pilot approach aims to generalize the technology approach through targeted school participation and lessons learned Technology Pilots 11 Counties – 47 School Districts Map Courtesy of the Minnesota Department of Education: http://education.state.mn.us/MDE/Data/Maps/School_District_Locations/index.html Using our experience with uni-directional sharing of AAP with schools and the community’s expertise in community based participatory work, we will design and develop a program to provide the child with asthma a “cocoon of care” at school, in organized activities and home, based on the healthcare home’s generated asthma action plan. SE Minnesota Beacon Impact 1. Minnesota Behavioral Risk Factor Surveillance System, 2006. 2. National Survey of Children’s Health, 2003 http://nschdata.org/Content/Default.aspx 3. Yawn BP, Wollan P, Kurland MJ, Scanlon P. A longitudinal study of the prevalence of asthma in a community population of school age children. J Pediatrics 2002;140(5):576-581. 4. Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd S. Surveillance for Asthma-United States, 1980-1999. MMWR March 29, 2002; 51 (No.SS-1):1-13. 5. Minnesota Department of Health Asthma Program http://www.health.state.mn.us/asthma References The asthma project has developed toolkit resources to share with all school districts within the eleven counties. This kit is meant to be used as a guide for interested schools to use to increase communication efforts among health professionals, school staff, and families. The toolkit contains example asthma action plans (AAP), consent forms, communication forms, workflow examples, and educational materials (5) for school nurses, coaches, teachers, and students. The toolkit can be found online at: www.semnbeacon.org. Asthma Action Plan Toolkit Outreach to all 47 districts; schools provided with various venues to participate in the SE MN Beacon program Measures % patients age 5-18 w/asthma  % w/documented action plan  % w/influenza vaccine  preventative care utilization  appropriate med usage  inpatient/ED utilization  acute attacks in school  school absenteeism In Numbers 2,000 students with AAP in 2012 8,000 students with AAP in 2013 In March of 2011, an online survey was sent via email link to 249 asthma care professionals at Mayo Clinic Rochester; 106 responded, (Response rate=42.6%). Most endorsed* asthma action plans (AAP) as evidence-based and leading to improved outcomes (74.3%) Almost all supported* evaluation and measurement of school- based outcomes, e.g. fewer missed days (89.1%) Most want to hear from the school** when a child is missing class because of his/her asthma (93.2%) Almost all*** are willing to review and sign an AAP, with over a quarter willing to spend as much time as it takes to make and AAP (83.1%; 27.4%) *agree+strongly agree ** moderately helpful + helpful + very helpful *** willing to create, to review/sign, or take all time needed Health Professionals’ Survey