CDC ranked Nebraska #1 in asthma deaths in 2009, with higher prevalence and disparate trigger exposure. This project connects at-risk children to medical home and in-home education through a case management network of school nurses, daycare directors, emergency department and family advocates.
Goal 1: 50% of children rescued by the Asthma Safety Net will have decreased trigger exposure after in-home visits. Objective 1: Establish the Asthma Safety Net through the creation of a collaborative network with 14 community partners by August 2013. Objective 2: Connect all the elements of asthma care by web-based case management in 5 referral sites by December 2013. Goal 2: 75% of children served by the Asthma Safety Net will initiate asthma action plans and 50% of children with in-home education will exhibit improved self-efficacy in asthma care. Objective 1: Coordinate asthma care, including 20 annual community referrals for families at risk-January 2014; initiated January 2015; completed March 2018. Goal 3: Urgent care visits (emergency room) for asthma will decrease by 10% and breathing emergencies during sports and recess will decrease by 10%. Objective 1: Construct NIH guidelines-patterned asthma diagnosis and treatment education for 56 healthcare provider students; asthma management education for 848 nurses, respiratory therapists, teachers, coaches and athletic trainers 2015-2018. Goal 4: School absences for children in the Asthma Safety Net will decrease by 20%. Objective 1: Utilize vigilant surveillance to establish a baseline, evaluate performance for evidence-based programming, and publish addendums every 3 years-2015-2018. Goal 5: Ten percent of RT's, school nurses, and healthcare providers statewide will be apprised of current asthma care guidelines. Objective 1: Design a template to illustrate the use of Respiratory Therapists for in-home asthma assessment/education, and dissemination of training and programming statewide through telehealth, educating healthcare providers on current asthma treatment guidelines-completed March 2018.
The Asthma Safety Net is a new component to an existing grass-roots initiative, illustrated by a community model of care coordination, created by a multidisciplinary, visionary leadership group launched by an AAP physician in 1998. The Community Asthma Education Initiative (CAEI) has a successful track record in the implementation of patient and provider asthma programming through physician, nurse and respiratory therapy education, on-site asthma management clinics, engagement of pharmacists as asthma allies, asthma surveillance and asthma public education outreach. CAEI will spearhead case management for asthmatic children and youth, guiding case managers from 5 agencies, AAP physicians, CAEI staff to secure a medical home and coordinate in-home asthma assessment/education. Programming for healthcare providers and students completes the circle of care. Outcomes are compiled, analyzed and disseminated by CAEI and a project template is shared with healthcare providers via the Nebraska Statewide Telehealth Network.
Collaborative partners for referral and case management: hospital emergency departments, Lincoln public/private school nurses, Community Action Partnership, daycare directors/Head Start, Complete Children's Health (Dr. Steve Russell, AAP), Lincoln Medical Education Partnership, and Center for People in Need. Program consultants include: University of Nebraska Pesticide Safety Education, State of Nebraska Maternal and Child Health, Environmental Health Hazards and Indoor Air Division.
Outcomes are measured by improved asthma trigger exposure, care self-efficacy, action plan completion, urgent care visits, breathing emergencies, all assessed during asthma home visits and in collaboration with public health departments, public schools and three partner hospitals. Data is stored on web-based case management software that links agencies and is HIPPA compliant. A baseline report was published in 2003 with updates every 3 years for dissemination.
Great success in community collaboration to establish the Asthma Safety Net network. Project is ahead of schedule for site assessments and home visits; project augmentation completed utilizing cellular-supported tablets for on-site case management documentation. Expectations have been exceeded for marketing asthma management edification for providers and ancillary staff.