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.