Vermont Department of Health - Asthma Program

# program participants attending at least 60% of sessions of guidelines-based intensive asthma self-management education

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Story Behind the Curve

Last updated: May 2020

Author: Asthma Program, Vermont Department of Health

The Asthma Program has decided to align this performance measure with one of the one’s that is CDC is requesting. CDC’s National Asthma Control Program has funded state health departments to administer asthma control programs since 1999. The most recent five-year cooperative agreement, which began in September 2014, is titled Comprehensive Asthma Control Through Evidence-based Strategies and Public Health—Health Care Collaboration

The Vermont Asthma Program is tasked with carrying out 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 document the success of the program and their partners in enrolling people with asthma in intensive self-management education and in sustaining their participation through at least 60% of the planned sessions (of between 2 and 5 sessions on average).  This cut-off point has been show to consistently achieve improvements in asthma control. Self management education includes the key educational messages listed in the National Asthma Education and Prevention Program guidelines (Section 3, Component 2 page 124), including basic knowledge of asthma, symptoms and signs of worsening asthma, medications, triggers and asthma management.  Sessions also involve a return demonstration of basic asthma knowledge and skills, including proper device use; they are also tailored as much as possible to an individual’s needs and circumstances. 

There are several ways the program is doing this – one way is leveraging the established Rutland Pediatric Home Visiting Program by asking its champions to serve as trainers for interested health systems. The other way is through leveraging other already existing home visiting programs and adding value through introducing specific elements adapted from the Rutland model. For example, the MAPLE Plan call back follow-up care and education system has been expanded from RRMC to the Springfield Medical System (SMC). Furthermore, the intensive self-management education through home visiting has also been transferred to Springfield Medical Center. Since 2017, RRMC has piloted and is now expanding delivery of intensive self-management education to patients in various settings, with greatest success in clinic settings. University of Vermont Medical: Pediatrics (UVMMC) is working to also expand delivery of intensive self-management education in various settings, currently emphasizing clinic and remote to home settings.  Open Airways for Schools Program was created by the American Lung Association and has been rolled out to supervisory unions to provide self-management education to students 8-11 years of age. Interested school nurses and other educators are trained and certified in this evidence based curriculum that has been shown to improve outcomes among students, namely improving asthma control, reducing missed days of school, improving student knowledge and proper use of medications and devices, identification and avoidance of asthma triggers, and reduced emergency visits and hospitalizations. The Asthma Program continues to collect data from both RRMC and UVMMC on their self-management education programs that target high burden populations. 

The targets have been adjusted to reflect combined actual targets of each of these programs. Note that these targets have been consistently exceeded with increasing margins year after year.

Why Is This Important?
Partners
  • 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.
  • Springfield Health Center is a partner that works with the Vermont Asthma Program on community education, clinical integration of asthma educators into practice, the MAPLE hospital discharge protocol and potential home visiting 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 bridging the gaps in caregivers (allowing nurses to have access to electronic health records).
  • HARK is a partner that works with Vermont Asthma Program to create 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.
What Works

In 2007, the National Asthma Education and Prevention Program (NAEPP), coordinated by the National Heart, Lung, and Blood Institute (NHLBI), released its third set of clinical practice guidelines for asthma. The Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma (EPR-3) reflects the latest scientific advances in asthma drawn from a systematic review of the published medical literature by an NAEPP-convened expert panel. It describes a range of generally accepted best-practice approaches for making clinical decisions about asthma care.The program has continued to strengthen efforts to promote self-management education, which has worked well among patients and educators.

Action Plan

The program will continue to support the efforts detailed above in Open Airways for Schools and the Rutland Pediatric Home Visiting Project. The Program hopes to support a robust home visiting initiative to the Burlington Region in 2016-2017.

  • The program will seek to enroll ten more schools into the Open Airways for School Program between September 2016 and Spring of 2017. The Program will work with the American Lung Association to implement this across the state and in areas where burden is high.
  • The Program will continue to support the Rutland Home Visiting Project throughout the fall of 2016.
  • The Program will leverage existing programs and agencies in the Burlington area to replicate the home visiting project that is active in Rutland in the fall of 2016.
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