Vol. 16 •Issue 8 • Page 30
Role Models for Asthma Care
The Environmental Protection Agency recognizes programs aimed at asthma triggers.
Maine conjures images of fresh lobster, L.L. Bean, and arctic winters. But for people with asthma, this northern haven also produces wheezing, coughing, and painful breathing.
Nicknamed “the tailpipe of the Midwest,” Maine has one of the highest asthma rates in the U.S. Pollution breezing in via the Westerly winds, high smoking rates, and homes built air-tight to trap in the heat can seriously aggravate breathing problems for people with asthma.
One health care provider decided it needed an aggressive approach to educating the state’s breathless population. MaineHealth, a system of hospitals physicians, long-term care agencies, and home care agencies created the AH! (Asthma Health) program in 1998. A decade later, the AH! program is getting national attention for its innovative asthma care.
The Environmental Protection Agency awarded MaineHealth the National Environmental Leadership Award in Asthma Management. The honor, given out each May, goes to one health care provider and one health plan. Michigan-based Priority Health received the health plan award.
A panel of asthma experts judges dozens of applicants each year on how well their asthma management programs follow the best practices established by the EPA and reduce asthma triggers in the environment. (See Sidebar on page 32.)
When Tracey Mitchell, RRT, AE-C, was a student at Youngstown (Ohio) State University in the late 1980s, environmental management wasn’t the focus of asthma care. The curriculum, instead, concentrated on medical management.
“Many respiratory therapists don’t know a lot about the environmental component of asthma, and they aren’t comfortable teaching patients about that,” said Mitchell, now an EPA scientist.
The EPA hopes to offset this lack of knowledge by spotlighting shining examples of asthma care. The award winners are role models for the 500 asthma management programs the agency has identified across the U.S., which range from start-ups to statewide programs such as MaineHealth and Priority Health.
With their emphasis on reducing environmental triggers, Priority Health and MaineHealth saved hundreds of thousands of dollars in health care costs and significantly reduced emergency room visits among asthma patients by 26 percent and 61 percent, respectively. They accomplished this by tackling asthma education on three fronts: patients of all ages and income levels, health care providers, and communities at large.
“Asthma is a disease of self-management,” said Mary Cooley, manager of case and disease management at Priority Health. “If you educate members properly, they can ramp up or down their medications based on their symptoms or their peak flow readings.”
Such a sweeping approach requires manpower and money. These organizations pulled it off by connecting with other non-profit groups throughout their states.
“In attending the National Asthma Forum where we received the EPA award, one of the things that stood out to me was that we are quite comprehensive,” said Donna Levi, the AH! program manager. “The other programs that I heard about were community organizations focusing in one direction because of resources.”
MaineHealth collaborated with HomeHealth Visiting Nurses of Southern Maine to provide at-home counseling for high-risk patients. The City of Portland’s Health and Human Services Department helped translate educational handouts into the most commonly spoken languages by immigrants: Spanish, French, Khmer, Somali, and Vietnamese. They also offer a telephone hotline for Spanish and Somali-speaking patients.
The Maine Lung Association is helping the health system develop an educational program about workplace asthma triggers. As part of the initiative, asthma educators will deliver public service broadcasts on local access television, Levi said.
MaineHealth estimates 90,675 patients with asthma live in its coverage area in southern, central, and western Maine. This figure includes 27,156 children.
Priority Health allied with the Asthma Network of Western Michigan (ANWM) to educate its 19,000 subscribers with asthma. Patients identified with low- or moderate-risk asthma receive twice-yearly mailers in English or Spanish with information about clinical care, asthma action plans, triggers, and medications.
Those designated as high-risk asthma patients receive asthma counseling by phone from ANWM caseworkers, who check in with patients anywhere from weekly to quarterly to talk about their goals, problems, and medical needs.
ANWM social workers meet with Medicaid patients in their homes. Medicaid represents 10 percent of Priority Health’s patient population, but they make up 80 percent of referrals into the high-risk asthma program.
“Many times, this particular population faces so many other psychosocial issues that asthma is not their main priority,” Cooley said. “Their main priority might be food, clothing, or shelter.”
Urban housing tends to have higher incidences of cockroaches and faulty heating and cooling systems, which lead to mold growth, she added. Social workers work closely with landlords, food banks, schools and pest control services to reduce these triggers.
Keeping it consistent
One of the primary goals of each organization is to ensure hospitals, clinics, and physician practices use consistent, evidence-based guidelines when treating asthma patients
MaineHealth established an asthma advisory group to develop clinical procedures in keeping with federal standards for asthma care, Levi said. The hospital system also offers three-day workshops each year on chronic diseases, including asthma. Asthma educators keep clinicians updated on medications and devices and regularly train new hospital employees.
Like MaineHealth, Priority Health offers staff training. The insurer also implemented a physician incentive plan, in which doctors are paid each month if they adhere to Priority Health’s asthma management guidelines.
Since the EPA award, Levi and Cooley have been fielding calls from health care providers and insurers across the country, asking how to start their own asthma management programs. Among the most frequently asked questions: How can my program secure financial stability?
Mastering the sales pitch is key, Cooley said. It’s crucial for non-profits drumming up support for an asthma program to track data on how well they improve patients’ quality of life and reduce medical costs. She can recite statistics easily on the organization’s return on investment, emergency room visits, and long-term savings.
“My most driving message, quite frankly, is to capture outcomes,” Cooley said. “If you’re going to knock on my door, saying, we want to partner with you to provide a service that is needed in your community, I’ll say, prove to me you can do this.”
Mitchell, of the EPA, agreed that money — and how to obtain it — is a key issue for asthma management programs. By drawing attention to successful programs such as MaineHealth and Priority Health, other programs will be able to find a funding approach that works for them, she said.
“It really takes a lot of players to get asthma under control in communities across the country,” Mitchell said. “It is happening widely across the country. But we still have a long way to go.”
The competition for the 2008 National Environmental Leadership Award in Asthma Management opens in October. Applications will be accepted through late January.
Lauren Meade is assistant editor of ADVANCE. She can be reached at [email protected].
Keys to Asthma Management
The U.S. Environmental Protection Agency expanded its asthma management protocols in 2005 on the heals of the Asthma Health Outcomes Project, a nationwide examination of 223 asthma programs conducted by the University of Michigan School of Public Health with funding from the EPA.
Based on the interviews, researchers identified five components to a successful asthma management program:
These are some of the criteria asthma management programs must follow to win the EPA’s National Environmental Leadership Award in Asthma Management.
In addition to the contest, the EPA is promoting its best practices via guidebooks that include case studies of successful programs. Organizers from asthma management programs also can link into the EPA’s online network, Communities in Action for Asthma Friendly Environments, to receive information about other programs, seek mentors, and attend Webinars featuring PowerPoint presentations and audio recordings. For more information, visit www.asthmacommunitynetwork.org.