On the Front Lines of Asthma Treatment
“Now that I am in the asthma program, I can have more fun at school. I understand my asthma better and don’t worry about it as much,” said Talia Powell. Powell, with the support of her mother, Taneise Jones, participates in a new asthma program, Kansas City Teams Up for Asthma Control (KC TUAC), at her school that helps her better understand her disease.
Poorly controlled asthma reduces the quality of life for children and dramatically drives up the total cost of their care. According to the Mayo Clinic, the disease is also the leading cause of emergency department visits, hospitalizations, and missed school days. With more than 10 million children affected, pediatric asthma is the most common childhood chronic disease in the country, according to the Centers for Disease Control and Prevention. In Missouri alone, the number of children diagnosed with the disease exceeds 150,000, 14.8 percent of whom reside in the Kansas City metro area.
To help combat the disease, the greater Kansas City’s area Aligning Forces for Quality (AF4Q) Alliance, led by the Kansas City Quality Improvement Consortium (KCQIC), has teamed up with Asthma Ready Communities (ARC) of the University of Missouri Health Systems to conduct a community project, KC TUAC.
KC TUAC builds on the Asthma Ready® Program (ARP) in cooperation with the Missouri School Boards’ Association. The program provides free, evidence-based, multimedia asthma education to children and school nurses. Parents are encouraged to participate in the effort and are offered incentives, including complimentary educational materials and a $20 gift card for completing a booklet and evaluation form.
School nurses who were asked to complete a survey and provide feedback on how students benefited from KC TUAC indicated:
“The education provided in the video really helped my students have a better understanding of their asthma and the proper management.”
“Some of the parents appear to be taking meds and the condition more seriously.”
“I was able to work closely with a student who otherwise would have no intervention, significantly improved his understanding of asthma, improved his inhaler technique, and fostered independence and ownership of his asthma.”
The program is targeted toward all 5-to-12- year-old children suffering from persistent asthma as defined by the Healthcare Effectiveness Data and Information Set. Three area school districts piloted KC TUAC. Twenty-four students in these districts obtained parental consent for the program. KC TUAC has since expanded from its pilot to include 30 rural and urban schools.
“Now that I am in the asthma program, I can have more fun at school. I understand my asthma better and don’t worry about it as much.”
Paul Foreman, MS, MA, PhD, project director, Asthma Ready® Communities, indicated there are many interventions that could work, but it takes a collaborative model to sustain the efforts over time. “We all need to keep our eyes on the children,” he said. Fostering a community approach, KC TUAC is also targeted toward area pediatric primary care providers (PCPs). The PCPs are identified by school enrollment forms provided by parents and from parents themselves. If the child does not have a PCP, a referral is provided to the parents.
Complimentary asthma education is provided to a designated office representative. The certified Asthma Educator in each office can bill health plans for 15 and 30 education sessions.
KC TUAC program effectiveness for school nurses and students participating in the pilot was assessed through pre- and post-evaluation school visits. A total of 82 students, ages 5-11, were evaluated. A 15 percent increase in forced expiratory volume in one second (FEV1) was noted for participants. Through collaboration with the Missouri School Board Association and the Office of Social and Economic Data Analysis, further criteria are undergoing evaluation, including asthma knowledge increase among students, school absenteeism, academic achievement growth, pharmacy fill rates, and ED and hospital visits.
KC TUAC is the first of its kind in the country where students report to school nurses, who connect directly with PCPs. The collaborative effort is already improving the lives of children in the affected communities. Eighty-seven percent of school nurses and 93 percent of parents recommend TUAC. Positive preliminary findings have prompted further expansion and development of protocols to improve pediatric asthma control through KC TUAC.