Last updated: May 2020

Author: Asthma Program, Vermont Department of Health

The Asthma Program has aligned this performance measure with a CDC Performance Measure required of the last five-year cooperative agreement, September 2014 to October 2019, entitled Comprehensive Asthma Control Through Evidence-based Strategies and Public Health—Health Care Collaboration. CDC’s National Asthma Control Program has funded state health departments to administer asthma control programs since 1999. The Asthma Program is tasked with carrying out five infrastructure strategies (leadership, partnerships, surveillance, communication and evaluation) to support home- and school-based services strategies as well as health systems strategies aimed at promoting public health – health care collaboration.

The purpose of this measure is to monitor and improve the efforts of state asthma programs in promoting system-level changes to create a continuum of asthma services across the health care facility, school, home and community settings.  It counts the number of health care organizations influenced by the state asthma program to implement an asthma quality improvement process to improve systems and services.  These opportunities have in part been identified through working with the Asthma Advisory Panel. The Asthma Program hosts a quarterly Asthma Advisory Panel. This panel invites key partners throughout the state including physicians, school nurses, industrial hygienists, housing partners, asthma educators, community health workers, hospital administrators and other governmental partners. Topics for the meeting come from the panel members themselves. The Asthma Program gains a state wide collaborative that is engaged in current asthma research, advocates for Asthma program work through the state, and an expert panel that validates and informs products the Asthma Program creates.

Working with Accountable Care Organizations, the Vermont Asthma Program works to encourage broad, strategic thinking about the place for specialized asthma programming and support in health care.  Efforts have included exploring common performance measures to drive adoption of prevention, counseling and other provider interventions to promote tobacco cessation, prevent hospitalization, and ensure proper medication use.  The Asthma Program has supported the expansion of Asthma education in home and clinic settings to improve asthma self-management and control, including policy development and support for payment reforms to cover these tested interventions.

Earlier program initiatives to enhance quality improvement in asthma care included the following:

M.A.P.L.E. asthma hospital discharge plan: Following a pilot of the M.A.P.L.E. Plan at the Rutland Regional Medical Center (RRMC), the RRMC planning team developed and implemented a protocol that ensures patient contact and care following discharge from the hospital or emergency room. M.A.P.L.E. is tailored for VT hospitals to implement the patient education components of the National Institutes of Health (NIH) Guidelines for the Diagnosis and Management of Asthma. This tool is intended to serve as a provider script and as a form of patient-specific educational materials.  In the past year, the MAPLE Plan (as its anacronym evolved) was expanded to the Springfield Medical Center (SMC).  At RRMC, the MAPLE Plan is being integrated within the more expansive hospital's call back system, with efforts to ensure specialized asthma education for those with a recent asthma related emergeny department visit or hospitalization.

Easy Breathing: The Easy Breathing Program has been implemented in 3 pediatric practices in Burlington, VT, as an evidence-based asthma management tool that aids providers in diagnosing and improving asthma control among their patient registry. To date, over 400 children have been screened. Screening rates are at 100% within these practices among all patient visits, and the project’s physician champion, Dr. Jill Rinehart, also the Vice President of the Vermont Chapter of the American Academy of Pediatrics, has been making presentations to peers to recruit other primary care practices.

The Program also worked with Vermont Children’s Health Improvement Project (VCHIP) based at UVMC, to launch a quality improvement initiative designed to increase the use of Asthma Action Plans.

• Environmental Health is a partner that works with the Vermont Asthma Program on school based environment assessments.
• Vermont Department of Labor is a partner that works on the worksite wellness program.
• OneTouch is a partner that works with the Vermont Asthma Program on linking individuals to education and environmental remediation based on home visits. Other partners in the OneTouch program include Healthy Homes and Weatherization.
• Maternal and Child Health is a division in the Department of Health that works with the Vermont Asthma Program on increasing coordination at schools and among school nurses to address absenteeism and asthma education for school nurses/students, including training school nurses in selected supervisory unions throughout the state on asthma self-management.
• Blueprint for Health is a partner that works with the Vermont Asthma Program on educating community health teams on asthma education and tools available to improve self-management, including Asthma Action Plans and Healthier Living Workshops that support improving asthma management.
• Rutland Regional Medical Center is a partner that works with the Vermont Asthma Program on home visiting programs, the MAPLE hospital discharge protocol and community education.
• DVHA is a partner that works with the Vermont Asthma Program on reducing the burden of asthma among Medicaid-insured including exploring reimbursement for community-based education.
• Vermont Department of Health Offices of Local Health are partners that work with the Vermont Asthma Program to disseminate asthma action plans and reach local communities
• Asthma Advisory Panel is a partner that works with the Vermont Asthma Program on developing strategic goals and relationships.
• Asthma Regional Council is a partner that works with the Vermont Asthma Program on facilitating meetings between the different New England Asthma Programs
• Northeast American Lung Association is a partner that works with the Vermont Asthma Program on supplying education materials to asthma educators within the state.
• University of Vermont: Pediatrics is a partner that works with the Vermont Asthma Program on expanding access and delivery of supplementary asthma self-management education to those with uncontrolled asthma and severe persistent asthma to prevent asthma-related emergency department visits and hospitalizations.
• Vermont Chronic Care Initiative is a partner that will work with the asthma program on incorporating asthma education into their case management home visiting programs
• Vermont One Care is a partner that works with the Vermont Asthma Program at improving care for pediatric and adult populations by hosting a learning collaborative and facilitating quality improvement projects among participating providers and practices in guideline care.
• Hark Website Design, Branding & Communication is a partner that works with Vermont Asthma Program creating a digital media plan with the goal of increasing awareness of secondhand smoke exposures, increasing referrals to 802Quits, promoting importance of flu shots and asthma action plans, and reducing exposures to asthma triggers in homes and schools.

The Program looks at validated and evidenced based quality improvement processes which are defined as: a system that seeks to improve the provision of services with an emphasis on future outcomes such as:

• Health outcomes: asthma control, quality of life, school/work absenteeism

• Utilization outcomes: urgent/emergency room visits, hospitalizations

• Cost outcomes: savings to the HCO attributed to changes in QOC

September 2015 - December 2016 : The Easy Breathing Program will be actively shopped to pediatric practices around the state and funding will be available to all practices that are interested in participating in the initiative.

May 2016- December 2016: The Asthma Program and Evaluator will continue to evaluate the outcomes and process measures of the MAPLE plan that will be live in two different hospitals throughout the state. They will continue to engage the quality improvement divisions in these discussions in an effort to make this program sustainable and tell the story of hopeful cost savings and reduced hospital utilization.