National Environmental Leadership Award in Asthma Management
The U.S. Environmental Protection Agency (EPA) is committed to improving the lives of people with asthma by integrating sound science into effective public health programs. In partnership with other federal agencies and nonprofit organizations, EPA delivers a national, multi-faceted education and outreach initiative to increase public awareness and action to manage environmental asthma triggers as part of comprehensive asthma management. An important component of this initiative is the recognition of exemplary programs and community leaders so that they may serve as national models and mentors for community asthma care improvement. The National Environmental Leadership Award in Asthma Management celebrates the outstanding programs and leaders who are improving the lives of people with asthma by delivering strong environmental asthma management as part of their comprehensive asthma care services.
Read about the 2014 winners: Peach State Health Plan, Atlanta, Georgia; Tufts Medical Center, Boston, Massachusetts; Multnomah County Health Department, Portland Oregon.
2014 Award Winners
- Health Plan Winner
- Health Care Provider Winner
- Communities in Action Winner
Peach State Health Plan
Peach State Health Plan in Atlanta, Georgia, is a statewide Medicaid managed care organization that delivers a customized asthma program for teenagers. The Plan is part of the Centene Corporation, an integrated health enterprise that delivers Medicaid services in 19 states. Peach State Health Plan has a targeted asthma improvement program focused on their teen members with asthma because almost 20 percent of teens in the Plan have an asthma diagnosis (13,159 members with asthma out of 66,138 members ages 13–19.) Peach State’s innovative program has successfully engaged teens with asthma—a notoriously hard group to engage—and has demonstrated success in improving teens’ ability to understand their asthma, improve their asthma, and address the environmental and social factors that can make asthma worse.
Peach State’s Asthma Team seeks to reduce teens’ asthma healthcare utilization, improve their asthma status (i.e., functional severity), ensure appropriate medication regimens per NIH EPR-3 Asthma Program Guidelines and promote self-management. They pursue these goals by facilitating relationships between teens, caregivers, primary care physicians and medical homes, providing access to specialists, delivering tailored education and addressing social issues, such as environmental exposures at home and school.
The Plan delivers stratified asthma management services, including health coaches and environmental, medical and social interventions in clinic, at home and at school. The Asthma Team includes health plan case managers, medical directors, pharmacists, a disease manager/ health coach and respiratory health coaches, who serve as the primary contact for teens, their families, the care team and partners.
Teens with an asthma diagnosis in the Plan’s information system are stratified into three intervention groups—low, moderate and high risk—based on a multi-stage and validated initial health assessment. Sixty percent (60%) are in the low-risk intervention group and receive education materials by mail. The moderate group receives telephonic and mail outreach and can receive home visits if appropriate. The high-risk group, which includes about 700 members per year, receives telephonic and mail outreach and in-home visits. Peach State uses an innovative and award-winning incentive program, CentAccount, to motivate teens (and others) to take preventive care actions. For example, when a healthy activity, such as a preventive well visit, is completed, members receive money on a debit card they can use to purchase healthy items. This has encouraged teens with asthma to get well visits, thus helping to identify previously undiagnosed teens with asthma. In fact, teenage members in the asthma program have increased their attendance at regular wellness visits by more than 500% compared to a control group. This increased and proactive interaction with primary care providers at scheduled visits has helped teens with asthma to stay healthy and to stay ahead of their asthma rather than having them interact with their providers only after a serious asthma attack.
All teen members in Peach State’s asthma program receive award winning, age-appropriate educational materials, including the multilingual and multimedia, “Off the Chain—It’s All About Asthma” and “On Target with Your Asthma.” These materials promote understanding of asthma, environmental triggers and appropriate medication use. Members in the low-risk group receive education by mail and can also receive peak flow meters, spacers, and masks as indicated.
Members in the moderate-risk group receive mailed education materials and telephonic counseling by health coaches to identify medical, environmental and social needs and to provide asthma education and self-management support. During calls, coaches collect self-reported asthma symptom data, review individualized treatment plans and self-management guides, and discuss environmental triggers; they also teach teens signs and symptoms that merit rapid intervention. The health coaches communicate back to the medical home and cooperating community organizations, such as schools and churches.
High-risk members receive everything the moderate group receives—education, barrier assessment, coordination of care and additional support—and in-home visits by a licensed Respiratory Care Practitioner. Home visits include disease education, medication counseling and an environmental assessment, which, according to Peach State, occurs in “the ideal setting to… assess all of the factors that impact the severity of the patient’s condition…and [to facilitate] patient specific education.” During visits, health coaches conduct spirometry screening and pulse oximetry, measure vital signs, review medications, demonstrate how to use spacers and peak flow meters, and discuss barriers to effective asthma control. During home visits, teens also receive counseling from a respiratory therapist about environmental factors in the home environment and their impact on asthma to take advantage of the ‘teachable moment’ that a home visit provides. The home visit team also identifies environmental factors in the home that may be contributing to the members’ asthma and reviews in detail the teen-focused asthma education materials that address allergens and irritants.
In addition to the tailored interventions stratified by risk, Peach State’s Asthma Team also bolsters clinical providers’ abilities to care for teen asthma patients. The Asthma Team functions as an extension of the physician’s practice by reinforcing the individual asthma management plan and providing up-to-the minute documentation on functional status, barriers and recommendations for future treatment based on the assessment.
Using clinical and financial data (i.e., medical and pharmacy claims), the Plan was able to model the health improvements and cost savings generated by the teen-focused asthma program. Compared to a control group, teens in the program had nine percent fewer respiratory-related unplanned healthcare utilization incidences and a shorter average length of stay when unplanned hospitalizations did occur. They were more likely to visit their primary care physicians as planned and to receive recommended flu vaccines, a critical self-management step as people with asthma are at increased risk of severe disease and complications from the flu because influenza can cause further inflammation of the airways and lungs. Peak flow meter use and controller medication use both improved at higher rates for program participants compared to a control group, while rescue inhaler use declined, indicating better overall asthma medication management and compliance. Peach State estimates the program saves approximately $320 per member per month. Recognizing the importance of environmental management of asthma, particularly for its Medicaid population, and the impact on the quality of care and patient outcomes that their program is achieving, Peach State Health Plan, Centene and Nurtur intend to continue funding the asthma disease management program.
Tufts Medical Center
Tufts Medical Center (Tufts MC) is a not-for-profit academic medical center that provides health care to patients both locally in the City of Boston, Massachusetts, and regionally in surrounding communities. For the past eight years, Tufts MC’s Department of Community Health Improvement Programs (CHIP) has operated the Asthma Prevention and Management Initiative (APMI) to serve a primarily immigrant, non- or limited-English speaking and densely populated Chinatown community. APMI is the only local asthma management program that focuses on and prioritizes Asian speaking families and features program components in the hospital, schools and community.
Tufts Medical Center established the APMI in 2006, in partnership with Chinatown school principals. Asthma prevalence had increased from 15 to 20 percent at the local elementary school that year (compared to a 10 percent prevalence in Boston as a whole) and Tufts MC’s bilingual pediatric providers saw a spike in asthma-related urgent care visits. In response, the CHIP team set out to inform the community in places where people live, work, and gather - at day cares, elementary and secondary schools and community agencies - and educate patients and families during home visits to children with poorly controlled asthma.
In 2006, CHIP secured a Health Disparities Grant from Blue Cross Blue Shield Foundation and used the funding to initiate and sustain APMI for three years. Additional grant support from a local community development fund, The Chinatown Trust Fund, and the Department of Housing and Urban Development through the Boston Public Health Commission (BPHC), facilitated APMI’s expansion to include home visits and to serve more families over time. In partnership with local elementary and secondary school principals, school nurses, Tufts MC administrators and physician champions, the CHIP director established APMI and hired its first program manager in 2006 and a bilingual Community Health Worker (CHW) in 2011. Based on a detailed assessment, conducted with input from parents with limited English skills, teachers and clinical providers, APMI developed targeted solutions for Chinatown’s asthma improvement needs.
APMI developed multilingual, multimedia asthma education and self-empowerment materials that are distributed in the clinic, at schools, during home visits and in the community. In partnership with the local schools, APMI created asthma education classes and an asthma education program for local day care and community center staff, and began the development of an asthma registry connected to Tufts MC’s electronic medical record system. In addition, APMI convened care providers from across the pediatric continuum - emergency, inpatient and outpatient departments, as well as local schools - to develop standardized messaging, materials and procedures to ensure children with asthma and their families hear consistent asthma care messages everywhere they receive care.
APMI also promotes prevention of asthma and improved asthma management across local neighborhoods by providing all students diagnosed with asthma, whose parents consent to their involvement, with education programs at local elementary and middle schools. APMI promotes community awareness and management of asthma, particularly how to recognize environmental triggers, by educating local parents and day care, preschool and elementary school staff in Chinatown.
Children with poorly controlled asthma who are referred to the Asthma Prevention and Management Initiative by their primary care physicians or identified by APMI staff from data in the asthma registry, receive asthma action plans and tailored and culturally and linguistically competent environmental home visits and supplies, provided by the Boston Public Health Commission. APMI currently serves more than 100 families per year through the home visit program, which includes environmental assessments, medication review, review of asthma action plans and disease education for children and their families.
APMI’s home visit program is part of the broader Boston Asthma Home Visit Collaborative (BAHVC). APMI draws on and contributes to the city-wide standardized approach to in-home asthma care. Where appropriate, APMI’s Community Health Worker and other home visitors make referrals to Boston’s Breathe Easy at Home program - an extension of the BAHVC - for housing inspection and advocacy on behalf of tenants, and refer patients to other services to reduce environmental and social stressors, as appropriate.
To complete the circle of care and ensure communication, home visitors fill out a Home Visit Progress Note and submit it to referring clinicians after each home visit. The note also is incorporated in Tufts Medical Center's ambulatory electronic medical record and listed as a patient encounter, thus enabling clinicians to review home visit findings and reinforce CHW and home visitor interventions with patients during clinical visits. As part of the BAHVC program, APMI home visitors also share de-identified home visit information with the BPHC.
APMI tracks its progress and impact in the schools, clinic and community. After four years of delivering asthma education in schools, absences for students with asthma decreased by one day, while absences for the general elementary student population decreased by only 0.2 days. Efforts to improve clinician adherence to National Institutes of Health EPR-3 Guidelines for Asthma Care also showed impressive results. Chart review data indicate that 35 percent more children, with two or more asthma-related urgent care visits within an eight-week period, now receive appropriate controller medication prescriptions than before the clinical quality improvement effort began. For children with poorly controlled asthma, APMI can demonstrate statistically significant improvements in the home environment (i.e. reduction in the presence of triggers) and asthma outcomes (i.e. improved ACT scores, decreased hospital admissions and increased use of asthma action plans) from the first to the follow-up visit, which occurs six months later.
A partnership with BPHC’s Asthma program since its inception has aided APMI’s sustainability. With BPHC’s encouragement and the Department of Housing and Urban Development award, APMI was able to initiate its home visiting program, which Tufts MC continues to fund. APMI also is active in advocacy efforts in Massachusetts, supporting reimbursement for asthma education and home visits by third-party payers. APMI has strong data to support this case; Outcomes data from 2009-2013 show that receiving home visits decreased urgent care visits by 21 percent and inpatient admissions by six percent, saving the health care system nearly $50,000 in avoided costs.
Multnomah County Health Department
Multnomah County Health Department partners with organizations at the national, state and local levels to deliver a multi-component healthy homes program across Portland and Multnomah County, Oregon.
The Healthy Homes Program developed as a result of a community assessment which was guided by the efforts of a community-based environmental health coalition. The coalition was comprised of a network of 45 community-based organizations, local agencies and public officials and was instrumental in developing and implementing a community-based environmental health assessment to identify community environmental health concerns. The goals were to identify environmental health issues, prioritize issues, develop action plans and evaluate the progress to address selected issues.
The assessment data and results became the impetus for developing the Healthy Homes Asthma program and focusing on improving indoor air quality and reducing asthma triggers in the homes of low income families with children with asthma. The Multnomah County Environmental Health Services (MCEHS) sponsored the Healthy Homes Coalition, which emerged from the Summit with a goal to address environmental factors that affect asthma and other health conditions by prioritizing substandard housing and housing codes.
The work of the coalition resulted in the successful submission of a grant to the Department of Housing and Urban Development (HUD) Healthy Homes program in 2005. With HUD funding, MCEHS began delivering in-home nursing case management, environmental assessments, behavioral interventions and supplies to reduce asthma triggers for low-income families of children with asthma. In addition to direct care services, the program also focused on policy development, housing code enforcement, integration with clinical providers, and connections to remediation and community support resources.
MCEHS initially developed the Healthy Homes Program for low-income children with asthma who received primary care at county health department clinics. In 2009, MCEHS developed an Asthma Inspection and Referral (AIR) program, a one-time home inspection program for any child with asthma, regardless of income. AIR augmented the more in-depth Healthy Homes program, which targeted low income and less controlled children with asthma. Over time, the Healthy Homes Program broadened its services, developing the Community Asthma Inspection and Referral (CAIR) program funded by a HUD Demonstration Grant, to deliver home assessments to an even broader group of children with asthma and other environmentally related health conditions. Referrals to the Multnomah County Asthma programs now come from clinic providers and other community organizations throughout Multnomah County. Through a web based referral system the programs were able to accept referrals from community medical providers, community based organizations and other partners through-out the county. MCEHS and its growing group of partners continued to expand the services and reach of the Healthy Homes to include Healthy Homes, AIR, and CAIR. Working in collaboration with other community partners such as the City of Portland, they seek to address asthma at the individual, family, organizational, community and public policy levels to improve outcomes for all children in the county.
MCEHS’ Healthy Homes program is available to low-income families and prioritizes children with uncontrolled asthma who have had recent ER visits, or who are prescribed inhaled corticosteroids. Healthy Homes positions a Community Health Nurse (CHN) as the child’s case manager and a Community Health Worker (CHW) to help manage the home environment. Together, they conduct approximately seven home visits and provide ongoing telephone support. CHNs receive referrals, review cases and consult with providers. During home visits, CHNs focus on assessing asthma severity and control, reviewing medication, and developing individualized asthma care plans. CHWs work with families on environmental assessments and interventions. Both CHWs and CHNs link families to support resources; CHNs link to medical services and consult with the medical team and pharmacy, while CHWs connect families to remediation and other services.
Over approximately six months, Healthy Homes program CHWs provide customized assistance in implementing the Family Action Plan. Assistance consists of in-home and telephone support, education ,behavioral interventions, skill-building demonstrations and providing supplies, such as green cleaning kits, vacuum cleaners with HEPA filters, allergen-free bedding encasements, door mats, bed frames and linens. In addition, families may be given basic maintenance items such as batteries for smoke detectors, furnace filters or new smoke detectors. Client assistance items average $336 per family.
With the expansion of the initiative to add CAIR, providers and social service agencies began to use a Web-based system for referrals, charting, and reporting. In AIR an Environmental Health Specialist (EHS), performs a single environmental assessment. If appropriate, he might refer clients directly into Healthy Homes or CAIR. CAIR program staff included two CHWs who served as case managers. They conducted environmental assessments, basic interventions, addressed behaviors and make referrals. Physical and structural remediation concerns were referred to the EHS who was able to leverage services for home repair. Uncontrolled health issues were referred to the CAIR CHN.
The Healthy Homes program has collected outcomes data since 2005, and the CAIR program has collected data since its inception in 2010. Both Healthy Homes and CAIR programs tracked environmental assessment scores, asthma control test (ACT) scores and ER visits.
The Healthy Homes program has demonstrated a 2.5 times reduction in the use of ER and significant reduction in hospitalizations for children with asthma who have completed the program. In addition, the Healthy Homes intervention is associated with a statistically significant reduction in the number of environmental observations of asthma triggers in both Healthy Homes and CAIR. Finally, 75 percent of Healthy Homes’ clients showed improved ACT scores over a six month period. Based on a 2008 evaluation conducted in partnership with Care Oregon, the managed care plan that served 99 percent of Healthy Homes’ participants at the time of the evaluation, the program resulted in almost $350,000 in savings from avoided health care utilization (i.e., avoided hospitalizations and ED visits).
To sustain the program, MCEHS advocated for direct reimbursement from the State of Oregon. In 2010 MCEHS negotiated with Oregon Department of Medical Assistance Programs and Center for Medicaid Services, CMS to develop Healthy Homes targeted case management, allowing for Medicaid reimbursement. In addition, the Healthy Homes Coalition continues to seek to embed environmental solutions for asthma in the housing code, improve substandard housing and advocate for tenants.
Read Gina McCarthy's Blog: "Getting the Right Asthma Care to People Who Need it Most: Recognizing Community Asthma Leaders" May 29, 2013
2013 Award Winners
Health Care Provider Winners
- Greenville Health System's Asthma Action Team, Greenville, SC
- Parkview Health System, Fort Wayne, IN
Communities in Action Winner
Greenville Health System's Asthma Action Team, Greenville, SC
The Center for Pediatric Medicine (CPM) Asthma Action Team (AAT) within the Greenville Health System Children's Hospital is the major clinical provider of outpatient care for children with limited health care access in Greenville, South Carolina. A diverse community, Greenville is South Carolina's most populous county and asthma/bronchitis is the leading cause of hospitalization for children under 18 in the area. Ninety percent of the population served at CPM receives Medicaid funding.
The AAT is a multidisciplinary, multilingual, family-centered program within CPM that was formed in 2008 to address increasing asthma prevalence, increasing pediatric emergency department (ED) visits and hospitalizations and ED recidivism for asthma, and growing asthma disparities in greater Greenville. The AAT is staffed by pediatricians, certified asthma educators, respiratory therapists, case managers, nurses, social workers, translators, an electronic medical record (EMR) technician, and community home visitors. Residents training in pediatrics, internal medicine, family practice and third and fourth year medical students also rotate through the AAT clinic where they learn an evidence-based approach to asthma care according to the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma.
The program strives to ensure that patients and families receive consistent asthma education and support services in clinics, homes, schools and daycares, including support for environmental asthma control, in order to promote effective self-management and avoid emergency health care utilization. The AAT coordinates with payers, local schools, community-based organizations and others to identify patients in need and to provide case management for children and adolescents with hard to control asthma. Case management includes asthma education, home visits, office visit coordination and school visits with a certified asthma educator from CPM serving as the case manager.
All AAT patients receive personalized pictorial asthma action plans written in their primary language which AAT staff review and update at every patient interaction and share with providers across the Greenville Health System (GHS) network and with school and daycare providers. The action plans are stored in the patients' EMR and on a web-based platform where clinical providers and educators working across both inpatient and outpatient settings can access and update them. The AAT also maintains a registry and alert system to help manage 4,338 pediatric patients with asthma, to track their asthma outcomes in real time, to stratify patients for care and to ensure high quality and appropriate care is consistently delivered.
The AAT focuses on delivering comprehensive and guidelines-based clinical and environmental care everywhere people with asthma spend time. The team is acutely aware of the social, economic and cultural factors that affect pediatric asthma outcomes for the diverse community GHS serves. To help children with asthma and their family's access to appropriate clinical care and avoid emergency health care use, CPM offers extended evening and weekend hours, same day service to children experiencing asthma exacerbations, and an after-hours telephone triage line. The AAT also partners extensively to provide education, diagnostics, in-home services and social supports for environmental interventions in the community. Partners include the Family Connection of South Carolina's Project Breathe Easy (PBE), the South Carolina Asthma Alliance, the Greenville Pediatric Asthma Community Collaborative, the Greenville County Schools and many others. This network of partners allows the AAT to provide personalized environmental counseling in the clinic, environmental home visits and asthma education that includes environmental counseling in the community, and at school and day care sites.
Perhaps the strongest evidence of the AAT's impact is the fact that at the same time that the population of children with asthma in the CPM system grew by an annual rate of 63 percent, rates of ED visits for asthma declined. Data from the AAT's partnership with PBE — which applies only to AAT clients who receive referrals to PBE — demonstrate a 71 percent decrease in urgent health care utilization, a 21 percent decrease in unscheduled clinical care visits, a 51 percent decrease in missed school days, and a 41 percent decrease in missed work days for parents post intervention.
Parkview Health System, Fort Wayne, IN
Parkview Health System is a nonprofit health care provider that delivers care to more than 875,000 people in a five county area in northeast Indiana. Parkview's community consists of urban, suburban and rural populations that have seen increasing asthma prevalence over the past 15 years. In response to rising asthma rates, data indicating that asthma is a major health concern and a frequent cause for emergency health care services, particularly among low-income communities served by Parkview, and input from community partners, the hospital developed a comprehensive Asthma Education and Management Program in 2004.
Parkview's Asthma Education and Management Program identifies children and adults with asthma in order to improve their ability to self-manage by providing support services, resources and age-appropriate education. The program is run by the hospital's Integrated Community Nursing Program and relies on Parkview's partnerships with local school districts and social service agencies to enroll patients and deliver Program services. Parkview also partners with the Fort Wayne-Allen County Department of Health and Indiana State Department of Health (ISDH) to provide environmental home visits and to evaluate the Asthma Education and Management Program's impact. With its partners, Parkview reaches people each year with asthma education, including school nurses, teachers, coaches, bus drivers and other school staff. Parkview also works with the County's Healthy Homes Program to provide environmental home visits and in-home asthma/allergy education.
The second program component is the Emergency Department (ED) Asthma Call Back Program, which began in 2009, and serves over 1200 individuals on an annual basis. The Call Back Program equips people who have visited the ED for asthma care with the knowledge and tools they need to manage their asthma and avoid future ED visits. All patients who visit the ED for asthma-related illnesses receive calls from an asthma educator after they are discharged to discuss asthma control, and access to and use of appropriate medications. Where indicated, nurses can order home visits to provide environmental asthma trigger assessment and mitigation. Home visitors typically provide supplies, including bedding encasements, HEPA vacuums and green cleaning supplies at no-cost, and provide asthma education. Qualified patients who cannot afford their asthma medications or do not have a medical home are enrolled in Parkview's Medication Assistance Program and referred to a physician in the Parkview system, a Federally Qualified Health Clinic, or a free clinic.
Through its partnership with ISDH, Parkview has access to evaluation data that demonstrate the impact of its asthma program. Surveillance data show improved asthma outcomes over time in counties served by Parkview as compared to demographically similar counties within the state. ISDH's evaluation of the ED Call Back Program found that it is effective at reducing ED readmissions: ED recidivism dropped to 15.04 percent in the intervention group compared to 21.95 percent in the control group. The ED Asthma Call Back Program also demonstrated impact on school and work attendance and quality of life with nearly 59 percent of participants reporting they had missed zero school or work days since involvement in the program. The program has also demonstrated a positive impact on increasing access to medical homes and controller medication with 11.2 percent of participants acting on physician referrals and 16.4 percent receiving prescription support services. Finally, Parkview's own data demonstrate a reduction in inpatient visits for asthma over time and reduced average costs per patient encounter. Parkview has been able to demonstrate a steadily improving return on investment (ROI) from the ED Asthma Call Back Program — from $20 saved for every $1 invested in the baseline year to $23.75 saved per dollar invested in 2012. This ROI data helped Parkview's leadership decide to expand the ED Asthma Call Back Program to all six campuses within the health system.
North East Independent School District, San Antonio, TX
The North East Independent School District (NEISD) is a large urban district that serves 67,000 students, including more than 8,000 with asthma. In 2006, NEISD hired a Registered Respiratory Therapist/Certified Asthma Educator (RRT/AE-C ) to launch an asthma management program to improve students' asthma control and school attendance in order to positively contribute to the district's academic performance.
NEISD's investment in the Asthma Awareness Education Program (AAEP) reflects its leadership's recognition that asthma control is fundamental to student achievement.
The AAEP provides education, disease management tools, and other supports to help school nurses identify and monitor students with asthma, and improve communication between schools and clinical staff. NEISD also provides case management services for children with hard to control asthma, including RT/AE-C-led home visits, personalized counseling and coordination with asthma specialists. The Asthma Blow Out (ABO) is the AAEP's community engagement component, which is delivered in areas with the largest disparities in asthma outcomes. The ABO brings RT/AE-Cs and physician partners to local schools where they provide disease management strategies and medication counseling, provide access to flu vaccines and provide age-appropriate asthma education to students, parents and others. To decrease healthcare barriers where indicated NEISD provides bus transportation to and from the schools, free meals, English-Spanish translation services and offers academic incentives for students to attend the ABO events.
The AAEP addresses environmental asthma triggers in schools through training for custodial staff, monthly meetings with facilities staff, training for principals and teachers, an asthma management component in the high school's Healthy Lifestyles course, an air quality health alert policy to ensure the campus community knows when unhealthy outdoor air conditions occur and regular monitoring of asthma symptoms and possible environmental exposures in schools. The AAEP also promotes environmental asthma management at home.
In the six and a half years since the program's launch, the AAEP has reduced asthma symptoms in school as measured by declines in rescue/reliever medication use — for example, inhaler use declined by 50 percent during the first six weeks of school from the first year to the next and when targeted campus environmental strategies took place; and reduced emergency medical service transports during the school day from 80 transports per year to 24 transports per year. The AAEP has delivered asthma education to every district campus, by reaching every physical education teacher, nurse and campus administrator. ABO survey results also demonstrate improved student and parent understanding of appropriate asthma management strategies — 95 percent of parent attendees surveyed said they would recommend the ABO program to a friend. And the district has seen yearly attendance averages increase from 95.3 percent to 96.1 percent since the AAEP's inception, including significant increases during flu season. NEISD has achieved state-recognition as a Recognized District for its academic performance four years in a row. There is widespread agreement that the AAEP-led environmental improvements and involvement in student health contributed to improved student performance and the district's academic accomplishments.
2012 Award Winners
- Health Plan
- Health Care Provider
- Community in Action
L.A. Care Health Plan
On a monthly basis, LA Cares About Asthma® identifies health plan members with asthma and provides them with a variety of educational materials and tools to help them take control and manage their disease. To be inclusive to its community's needs, the program ensures that linguistically and culturally appropriate materials are available for all potential enrollees.
LA Cares About Asthma® also partners with several community-based organizations to expand its reach and depth to serve individuals most in-need. An in-home visitation program with Long Beach Alliance for Children with Asthma in the Los Angeles South Bay area and specialist referrals with Harbor-UCLA Medical foundation Inc., throughout Los Angeles County offered to high-risk members with asthma are just two examples of such successful partnerships.
Thanks to these efforts, LA Cares About Asthma® achieved a member satisfaction of 97.6 percent, which exceeded their 2011 goal. In particular, members reported great satisfaction with the program materials and felt the materials educated them on how to control their asthma.
Health Care Provider
Mission Children's Hospital
RADMP confronts these issues at the root of the problem — taking the clinical approach to asthma management and control into non-clinical settings, such as homes, schools and other care facilities in outlying areas. The program addresses social determinants of health, medical and environmental management, education on asthma and environmental triggers, and comprehensive care through an ever-expanding network of invested stakeholders and agencies.
In order to reach minority and low-literacy populations, RADMP utilizes population specific outreach materials and interpretive services. For low-income families, the program offers access through Mission's Medication Assistance Program for asthma medications. Home remediation to eliminate environmental exposures is provided through RADMP's strong network of community partners.
In 2008, the program was recognized as one of the state's top three asthma disease management programs. In 2009, RADMP received a two-year demonstration project grant from the National Heart, Lung, and Blood Institute (NHLBI), as part of the National Asthma Control Initiative. Since 2009, RADMP activities have contributed to reducing asthma-related emergency room visits by 94 percent and hospitalizations by 95 percent, equaling a total savings of more than $800,000. In addition, the average number of school days missed by children in the program decreased from 17 to nine, indicating an increased quality of life. Statistically significant improvements were made in clinical measures including lung spirometry and eosinophilic inflammation.
Community in Action
Connecticut Children's Medical Center
The community needed a cost effective asthma management program to assist busy primary care clinicians in diagnosing asthma and effectively treating patients. The result was the creation of the Easy Breathing© program.
Easy Breathing© — originally housed within the Connecticut Children's Medical Center — focuses on five elements of care: diagnosing asthma, determining asthma severity, prescribing therapy appropriate for the asthma severity, developing a written Asthma Treatment Plan that is understood by the family, and assessing asthma control.
The program then utilizes a database to track its outcomes, including environmental exposures, interventions and feedback for clinicians. The database is also used for research and reporting purposes, and it provides clinicians with information regarding the demographics of their patient population, environmental exposures and asthma severities for all children enrolled in the program.
An essential element of the program is the Easy Breathing© Survey, which is administered in the physician's office when the patient comes for an office visit. The survey helps parents identify environmental exposures in the home that are potentially problematic for a child with asthma. The results of the survey are then immediately discussed with the patient and are used as a starting point for education regarding avoidance and elimination of harmful environmental conditions, such as smoking in the home.
Today more than 106,000 children across the state have been enrolled in the Easy Breathing© program — more than 28,000 of which have asthma. This success is due in large part to extensive community partnerships between clinicians, parents, hospitals, clinics, schools, foundations, lung associations, housing authorities and pharmaceutical industry representatives that have been a cornerstone of the program from its inception.
Easy Breathing© has been tremendously successful and has lead to significant increases in the use of written treatment plans, decreases in hospitalization rates and emergency department visits for asthma, and increased usage of inhaled corticosteroids. The program is now being implemented throughout Connecticut and in nine other states.
Michigan Department of Community Health
Therefore, in 2000, MDCH brought together more than 125 asthma experts to develop the first statewide plan to address asthma in communities bearing the highest burden. This successful collaboration lead to the creation of the Asthma Prevention and Control Program (APCP).
The APCP, which provides expertise and long-term guidance for asthma quality improvement activities, has aided in the development and impact of many successful community-based asthma management programs across the state, such as Managing Asthma Through Case-management in Homes (MATCH). This program utilizes a combination of home, school and work visits; asthma action plans; and Medicaid reimbursement to provide long-term interventions and care for individuals with asthma. MATCH participants reported significantly fewer emergency room visits and hospitalizations, and had significantly shorter lengths of stay, if hospitalized due to asthma.
Recognizing the success of the program, APCP helped to replicate this model in other communities, and as a result, has more than doubled the number of people served by MATCH. Surveillance data and input from strategic partners have been key components to this success and are used to continuously measure both the state's and community's needs and to ensure that any changes in asthma burden result in adjusted programming.
Between 2000 and 2007, APCP's efforts have contributed to a 24 percent reduction in the asthma mortality rate in Michigan, preventing an estimated 182 deaths. Similarly, pediatric asthma hospitalization rates in the state decreased by 28 percent between 2000 and 2009. In addition, children enrolled in Michigan Medicaid programs exhibited a 41 percent decrease in asthma hospitalizations between 2005 and 2009.
2011 Award Winners
- Centene Corporation Nurtu MHS
- South Bronx Asthma Partnership
- New York State Department of Health, Center for Environmental Health, Healthy Neighborhoods Program
Centene Corporation® Managed Health Services, Nurtur®
(St. Louis, Missouri and Indianapolis, Indiana)
Medical records, pharmacy records and claims data are scanned by predictive modeling software to identify patients that meet these criteria, who are then referred to the Asthma Team. A case manager follows up with each patient to assess their level of need and recommends an appropriate asthma intervention. Educational materials for children and adults, trigger identification training, goal-setting exercises, home visits and barrier assessments are just some of the many tools used as a part of this holistic asthma care process. The patient's treatment plan is also updated by the Asthma Team and sent to the physician for review. Continuous monitoring and evaluation are integral to this program, and results from 2007 to 2009 indicate an incredible 17.3 percent decrease in emergency department visits for child participants and a 9.4 percent decrease for adult participants. In addition, visits to primary physicians for children and adults were up by 11.1 percent and 16.4 percent, respectively, indicating improved preventive care.
South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center
(Bronx, New York)
Early on, program staff members recognized that to improve asthma outcomes, they must not only improve provider knowledge and communication, but also strengthen the existing health system in which providers practice. As a result, the program conducts provider training sessions that translate asthma management recommendations into quality clinical practice to ensure that patients receive comprehensive asthma services across the care continuum. Furthermore, the program engages Medicaid to provide reimbursement incentives for provider participation in asthma education.
As the lead organization of the South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center also partners with a variety of environmental agencies and community organizations to create tailored environmental interventions that address both indoor and outdoor asthma triggers. Program partners provide building walk-throughs, designate asthma-friendly zones at schools, and provide pest management assistance and air-sampling. In addition, the program distributes culturally appropriate and literacy-sensitive educational materials throughout the hospital and the community to promote patient self-management and encourage healthy behaviors in homes.
This multi-faceted approach to asthma care has resulted in tremendous success. Since 2003, Bronx-Lebanon Hospital Center has shown a 42 percent decrease in asthma-related hospitalizations, as well as a decrease in the length of stay of asthma-related hospitalizations. This equates to an annual average cost savings of about $431 per child. In addition, the National Asthma Control Initiative recently named the Bronx Lebanon partnership as a clinical champion in recognition of their efforts in promoting the Expert Panel Report 3 — Guidelines for the Diagnosis and Management of Asthma.
New York State Department of Health, Center for Environmental Health, Healthy Neighborhoods Program
(Troy, New York)
This program relies on an extensive network of grant-funded, local health department partners and emphasizes home environmental management as an enhancement to case management and clinical care. Local health departments initially identify target areas in the community for intervention and develop work plans to meet the specific needs of that area. These health departments are also encouraged to leverage local resources and infrastructure to ensure that the services delivered are meaningful and effective.
During home visits, field staff members assess a wide variety of healthy homes issues, including tobacco control, fire safety, lead poisoning prevention, indoor air quality, asthma control, injury prevention and more. Following the assessment, residents are provided with products, referrals and education to help remediate any potential hazards identified during the assessment. A quarter of homes receive a three-to-six month follow-up visit to reassess conditions. Any new or ongoing problems identified during the revisit are addressed.
This program has had incredible success for residents with asthma, with marked improvements in environmental triggers, including a 14% reduction in environmental tobacco smoke exposure and improved pest control in at least 44% of homes with pest problems. There have also been significant improvements in participants' knowledge about asthma triggers and significant decreases in the number of days with worsening asthma and in the number of work or school days missed due to asthma.
- Community Asthma Initiative, Children’s Hospital Boston
- Neighborhood Health Plan of Massachusetts
- Sinai Urban Health Institute
- WIN for Asthma
- Woodhull Medical and Mental Health Center
Community Asthma Initiative, Children's Hospital Boston
- Contact: Susan Sommer, email@example.com (617) 355-5592
- Website: www.childrenshospital.org/cai
Neighborhood Health Plan of Massachusetts
Sinai Urban Health Institute
- Contact: DeShuna Dickens, firstname.lastname@example.org (773) 257-2685
WIN for Asthma
- Contact: Patricia Peretz email@example.com (212) 305-4065
Woodhull Medical and Mental Health Center
- Contact: Desire La Tempa, firstname.lastname@example.org (718) 963-7916
- Bethlehem Partnership for a Healthy Community – The Asthma Initiative
- Boston Medical Center/Boston Public Health Commission
- California Department of Public Health/Center for Chronic Disease Prevention and Health Promotion
- Genesee County Asthma Network
- Seton Asthma Center
Bethlehem Partnership for a Healthy Community – The Asthma Initiative
- Contact: Mary Mittl, BSN, Asthma Program Coordinator, email@example.com
Boston Medical Center/Boston Public Health Commission
- Contacts: Megan Sandel, MD, MPH, Pediatrician, firstname.lastname@example.org, Margaret Reid, Director of Asthma and Diabetes Programs, Boston Public Health Commission, email@example.com
- Website: www.cityofboston.gov/isd/housing/bmc
California Department of Public Health/Center for Chronic Disease Prevention and Health Promotion
- Contacts: Sarah Campbell Hicks, Director, California Breathing, Sara.Hicks@cdph.ca.gov, David Nunez, MD, Chief, California Asthma Public Health Initiative, firstname.lastname@example.org
- Website: www.cdph.ca.gov/HealthInfo/discond/Pages/Asthma.aspx
Genesee County Asthma Network
Seton Asthma Center
- Contact: Kenna Griffith, Respirator Case Manager, email@example.com
- Website: www.dellchildrens.net/services_and_programs/asthma_program/seton_asthma_center
- The Asthma Network of West Michigan (ANWM)
- The Monroe Plan for Medical Care
- The University of Michigan Health System Asthma Quality Improvement Steering Committee
The Asthma Network of West Michigan (ANWM)
- Contact: Karen Myerson, Program Manager, firstname.lastname@example.org
- Website: www.asthmanetworkwm.org
The Monroe Plan for Medical Care
- Contact: Deborah Peartree, Director Health Care Quality Management, email@example.com
- Website: www.monroeplan.com
The University of Michigan Health System Asthma Quality Improvement Steering Committee
Priority Health, Grand Rapids, Michigan
MaineHealth AH! Program, Portland, Maine
- Health Plan: Blue Cross of California, State Sponsored Business Unit
- Health Care Provider: Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC)
Blue Cross of California, State Sponsored Business Unit
"I’m extremely honored by our award from the EPA and proud of our growing partnership with them. The EPA is one of the premier organizations in our country that is fighting for higher standards for clean air, a cause that SSB celebrates. SSB looks forward to an ongoing relationship that is rooted in our common goal to create a healthier world for our members and their communities."
John Monahan, President of Blue Cross of California State Sponsored Business (SSB).
- Contact: Margot Miglins, Ph.D. Margot.Miglins@wellpoint.com Clinical Research Manager, State
Phone: (805) 384-7476
- Website: https://www.anthem.com/ca
- Download the overview (PDF) (1 page, 720 K, about PDF)
- Contact: Stephen J. Teach, M.D. M.P.H, firstname.lastname@example.org Medical Director and Principal Investigator
Phone: (202) 884-5134
- Website: www.impact-dc.org
- Download the overview (PDF) (1 page, 705 K)
- Health Plan: Optima Health Plan
- Health Care Provider: Children's Mercy Hospitals and Clinics
- Honorable Mentions
- Health Plan - Neighborhood Health Plan of Rhode Island
- Health Care Provider - Connecticut Children’s Medical Center Easy Breathing Community Initiative
- Contact: Janice Sabol email@example.com, Program Coordinator-Asthma Disease Management
- Website: www.optimahealth.com/optimahealth
- Download the case study (PDF) (5 pp, 242 K, about PDF)
Children's Mercy Hospitals and Clinics
"We were very honored to win this award on behalf of Children’s Mercy Hospital and Family Health Partners. Receiving this award empowered us to continue the great work we were doing and take it to the next level. Our health plan received an additional state contract because of our success and award winning management of asthma and indoor environments.
Our goal is to take what we learned from our hard work on effective asthma management with families and apply this knowledge to building effective asthma management for the entire community. The more we can improve awareness education in our community, the healthier our community will be for all children."
Kevin Kennedy, Program Manager, Environmental Health Program,
Children’s Mercy Hospitals and Clinics
- Contact: Candace L Ramos firstname.lastname@example.org, BHS, RRT, AE-C, Education Coordinator - Asthma Program
- Phone: (816) 559-9346
- Website: www.childrensmercy.org/
- Download the case study (PDF) (5 pp, 304 K)
2005 Honorable Mentions
Neighborhood Health Plan of Rhode Island
Founded in 1993, Neighborhood Health Plan of Rhode Island (NHPRI) is the leading provider of health insurance to low income and minority children and families in the state, serving nearly 75,000 Medicaid members. NHPRI’s asthma program has one simple goal: to enable members with persistent asthma to live normal, healthy lives. To achieve their goal, NHPRI developed a multi-faceted education and outreach program to address environmental management of asthma, with educational modules tailored to the needs of providers, asthma patients and their families. NHPRI gave providers clinical practice guidelines; continuing medical education credits for learning about environmental asthma management; and incentives for referring patients to the home visit component of NHPRI’s asthma management program. NHPRI also offers a range of services for patients. The services vary depending on the patient’s asthma severity. Patients diagnosed with severe persistent asthma and who have been hospitalized or visited an emergency room automatically receive an initial call or home visit from an Asthma Case Manager and ongoing interactions to educate the patient and family about comprehensive asthma management. NHPRI developed a more specialized home visit program called “Beating Asthma,” for patients with persistent asthma living within three high-need communities. To reach those patients, NHPRI trained bilingual and bicultural Asthma Advocates to conduct home visits that combine education about medical management with an assessment of environmental asthma triggers found in the home and information on controlling them. Patients and families that participate in the “Beating Asthma” program, receive a calling card, peak flow meter, a written, personalized Asthma Action Plan, allergy-free mattress and pillow covers, and a supermarket gift card. NHPRI’s preliminary results indicate that participants in the “Beating Asthma” program have experienced a reduction in emergency department visits, use of rescue medications, and unscheduled outpatient visits. NHPRI’s approach targets healthcare providers and asthma patients to ensure that each group receives the information it most needs to reduce the burden of asthma for Rhode Island families.
- Contact: Beth Ann Marootian email@example.com, MPH, Director of Quality Management
- Phone: (401) 459-6148
- Website: www.nhpri.org
Connecticut Children’s Medical Center Easy Breathing Community Initiative
The Easy Breathing Program improved asthma care by educating primary care clinicians about disease management standards and the importance of environmental asthma management. The program was launched in 1998 to serve a poor, urban community in Connecticut where approximately 85% of the children served were Medicaid and SCHIP-eligible. The Easy Breathing Program has been so successful and well-documented that, over time, it has been replicated by healthcare providers and clinics throughout Connecticut and across the country. Easy Breathing focuses on training healthcare providers in the appropriate use of pharmacologic therapies, environmental management, and culturally appropriate patient outreach. Providers receive asthma management education in phases – starting with guidance on recognizing asthma, followed by tips on successfully managing it. As providers moved through the phases of learning, they requested additional information and outreach materials that they could use with their patients. Easy Breathing provided culturally appropriate materials for providers to use to educate patients from all backgrounds and language communities. Easy Breathing coached providers on identifying a patient’s asthma severity, skin testing patients to identify allergens that trigger each patient’s asthma, and developing personalized asthma treatment plans with patients and their caretakers that include guides on using appropriate medications and following environmental asthma management techniques. In collaboration with the Hartford Pediatric Asthma Coalition, Easy Breathing developed a standardized home environmental assessment tool to survey home environments and make recommendations to families living with asthma on how to reduce environmental asthma triggers. To date, over 55,000 children in Connecticut have been enrolled in Easy Breathing and participants have shown a significant decline in hospitalizations, emergency department visits, and an increase in the appropriate use of medications.