Reduce the burden of respiratory diseases

Asthma hospitalization rate per 10,000 Vermonters age 5-64

3.12015

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Story Behind the Curve

                                                                                                      Last Updated: February 2023

Author: Asthma Program, Vermont Department of Health


There has been a downward trend in the rates of hospitalization for asthma among those 5-64 years of age.  In 2014, the VT rate was 3.1 per 10,000 and lower than the Healthy Vermonter goal of 4.2 hospitalizations per 10,000 people. Having achieved that target, it was reset to 3.0%! The VT rate has been less than half of the U. S. rate when comparing the most recent U.S. data available (3.8 vs. 10.5 in 2010).

The reason for the decreasing rate of hospitalizations for asthma is unclear, the decrease may be due to a program of comprehensive asthma control efforts being initiated in 2009 with support of a CDC grant. The Vermont Asthma Program began to expand efforts to promote national asthma best practices, including supporting regional hospitals with high asthma prevalence to provide home visiting for environmental trigger identification and elimination of those things that can exacerbate asthma and provide intensive asthma self-management education (AS-ME) to persistent uncontrolled or high-risk patients – with special emphasis on pediatric populations. These partners also worked to develop clinical protocols to improve asthma-related hospital discharge protocols to reduce readmissions. The second 5-year CDC grant cycle started in 2014 allowing spread to additional regional hospitals of best practices shown to work, with new elements focusing on a learning collaborative of health care providers implementing asthma best practices and monitoring outcomes in patient care.

Another reason for the decrease over time could be from the myriad of initiatives hospitals and federal programs are employing to reduce hospitalizationrelated costs. It does appear that the decreases are being sustained overtime.  

The Vermont rate has consistently been less than the U.S. Healthy People 2020 target of 8.2 per 10,000 when it comes to hospitalizations for asthma in the 5-64 age group.  The hospitalization rate for Vermonters aged 5-64 has reached an all time low at 3.1 per 10,000 in 2014 and remained at that level in 2015. 

NOTE: The rates in this scorecard include hospitalizations of Vermont residents that took place in Vermont and neighboring states.  The nearest hospital for many Vermont residents is out-of-state. The approach of the Vermont Asthma Program therefore has been to report full data including Vermont residents treated in adjacent states.  Due to changes in data collection and processing technologies, updated data from NY and NH has been delayed and so the most recent data available for this indicator is from 2016.  This indicator will be updated when more recent data is available.

Why Is This Important?

Hospitalizations for children are serious and disruptive. Hospitalizations can be costly to the family, and disrupt home routines. Effective management includes control of exposure to factors that trigger exacerbations including exposure to secondhand smoke, improved pharmacological management, regular visits with the child’s medical home, and patient education and support.1

In the United States in 2010, an estimated 18.7 million adults, or 8.0% of the adult U.S population and 6.8 million children or 9.3 % of child U.S. population had asthma. In the United States in 2010, there were approximately 439,000 inpatient discharges with asthma as a first diagnosis. These inpatient stays for asthma averaged 3.6 days in duration. Although inpatient hospitalization for asthma is less frequently used than emergency care and pharmaceutical services, its cost is substantially higher. In the U.S. there were 1.8 million total ED visits with Asthma as primary diagnosis in 2011.2

Hospitalizations due to asthma could be reduced if asthma is managed according to established guidelines. Effective management includes control of exposure to factors that trigger exacerbations, adequate pharmacological management, continual monitoring of the disease, and patient education in asthma care.3

  1. CDC/National Center for Health Statistics. Last updated May, 2015. http://www.cdc.gov/nchs/fastats/asthma.htm
  2. Rutland Regional Medical Center. http://www.rrmc.org/about/vermont-blueprint-for-he...
  3. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: US Department of Health and Human
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 has worked 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 organization made up of a cross-section of experts in diverse fields and organizations 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 Child Health Improvement Project is a partner that has worked with the Vermont Asthma Program on implementing a learning collaborative to reinforce and expand asthma guideline care bast practice standards among health care providers.
  • Vermont Chronic Care Initiative is a partner that has worked 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.
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) that reflected the latest scientific advances in asthma drawn from a systematic review of the published medical literature by an NAEPP-convened expert panel. It continues to describe a range of generally accepted best-practice approaches for making clinical decisions about asthma care.

Asking providers to implement the clinical practice guidelines for asthma and educating people with asthma on how to manage and control their asthma will result in lower hospital readmissions. In most cases people should not have to go to the hospital if they have properly controlled and managed asthma.

The Program supported the Rutland Regional Medical Center in their efforts to improve asthma management in the region, in particular through their evidence-informed Pediatric in home visiting program supported through the Blueprint Community Health Team. Pediatric in-home education and trigger reduction is effective at lowering hospital readmissions. People can self refer to this program or can be referred by a provider, and it is targeted to serve those with uncontrolled asthma. By seeking to reduce uncontrolled asthma, outlined below, the Program’s goal is to reduce the impact uncontrolled asthma has on the healthcare system and the hospitalization rates.

  • 1 or More Unscheduled Visits for Emergency or Urgent Care
  • 2 or More a Year Frequent Primary Care Office Visits for Asthma Symptoms
  • 1 or More In-Patient Asthma Related Admissions
  • 2 or More Refills of Rescue Inhalers
  • Exceeds 2 or More Missed Days of School or Other Activities Related to Asthma
Strategy

A declining rate of hospitalizations may indicate that the Health Department’s Asthma Program’s focus on promoting the new asthma national guidelines of care, supporting best practice reinforcement and expansion through learning collaboratives, piloting and expanding home visiting for asthma trigger identification and elimination, and providing resources to improve Vermonters’ self-management is working to keep their asthma under control.

The Vermont Asthma Program engages with lung health experts, partners, insurers, healthcare providers, hospitals, and schools to improve asthma control. Efforts focus on providing asthma self-management education in schools, clinics, and community settings, promoting use of Asthma Action Plans and proper use of spacers and inhalers, and assisting people to quit smoking and avoid tobacco smoke. Priorities include supporting in-home asthma education among populations with highest burden. The Asthma Program promotes other protective measures including receiving the annual flu shot, using clean burning stoves, and minimizing exposures to common triggers.

The Asthma Program is working with other New England state programs through the Asthma Regional Council to explore if there is a provider training program that all states could collaborate. Additionally, the Program organizes an Asthma Learning Collaborative each year to provide guideline care education for quality improvement practices in areas with higher hospitalization and/or emergency room visits due to asthma. The Vermont Asthma Program also works to disseminate Asthma Action Plans which are a validated tool for educating patients on how to manage asthma. The Program supported clinical partners to develop and expand use of the M.A.P.L.E Plan in Rutland and Springfield – a protocol aimed to help lower rates of hospitalization and readmission by forming plans for asthma management post hospital discharge. The Vermont Asthma Program also continued to support the Rutland Pediatric in home visiting program and efforts to expand those services in other high burden areas, including the  Springfield area. The Program implemented the Easy Breathing initiative that contributes to diagnosing asthma sooner. The Asthma Program worked with the Vermont Chronic Conditions Initiative (VCCI) to develop/educate their case managers with the goal that the case managers administer an asthma control test, provide key messaging and supports to improve medication adherence. Lastly, the Asthma Program worked with schools to train school nurses on asthma self-management and proper medication use so that school nurses can pass that knowledge onto those students who have missed school due to asthma.

Notes on Methodology

Data is updated as it becomes available, and timing varies by data source. For more information about this indicator and other Vermont asthma data, click here.

This indicator is age-adjusted to the 2000 U.S. standard population. In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont are age adjusted. In cases where age adjustment was noted as being part of the statistical analysis, the estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000. For more detailed information on age adjustment visit /www.cdc.gov/nchs/data/statnt/statnt20.pdf.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy