All asthma is local Dr Stephen Teach Childrens National Medical Center IMPACT DC What are the specific geographic characteristics and considerations for asthma in your state What are the particular disparities and challenges that apply to your target population ID: 1038231
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1. Southeast Regional Asthma Disparities Overview
2. “All asthma is local” Dr. Stephen Teach, Children's National Medical Center (IMPACT DC)
3. What are the specific geographic characteristics and considerations for asthma in your state?What are the particular disparities and challenges that apply to your target population ?What state and local resources and assets are available to successfully address asthma disparities in your work?Questions to Run On
4. Karen Farrington, Asthma Program Manager, Division of Community Health Promotion Bureau of Chronic Disease PreventionFlorida Department of HealthSoutheast Regional Asthma Disparities Overview
5. Florida Asthma ProgramSoutheast Regional Asthma Summit & Healthy Homes Environmental Exposures SymposiumAtlanta, GAMay 17-18, 2016
6. Health Disparities Related to AsthmaLarge disparities related to race/ethnicity, gender, age, and income exist when reviewing the most severe outcomes of asthma in FloridaSubstantial disparities can be seen in the rates of emergency department visits and hospitalizations – indications of poorly controlled asthma
7. Risk FactorsEnvironmental pollutantsExposure to secondhand smokeFamily historyToxic stressExercise InducedFloridians with asthma are also more likely to: be obese, have diabetes, COPD, or heart disease, and smoke than Floridians who do not have asthma
8. Population-Based SurveysFlorida Youth Tobacco Survey (FYTS)Behavioral Risk Factor Surveillance System (BRFSS)
9. DefinitionsLifetime Asthma Adolescent: Respond “yes” to the question “Has a doctor or nurse ever told you that you have asthma?”Adult: Respond “yes” to the question “Has a doctor, nurse, or other health professional EVER told you that you had asthma?”Current AsthmaRespond “yes” to lifetime asthma and “yes” to the question “Do you still have asthma?”
10. Definitions (continued)Current Asthma AttackRespond “yes” to the question “During the past 12 months, did you have an asthma attack?”Asthma ED / Urgent Care VisitReports one or more visits to the question “During the past 12 months, how many times did you go to an emergency room or urgent care center because of your asthma?”
11. Adult Report Key Findings: PrevalenceCurrent asthma first captured in 2012
12. Adult Report Key Findings: Prevalence
13. Adult Report Key Findings: PrevalenceNH=Non-Hispanic
14. Adult Report Key Findings: Prevalence
15. Adult Report Key Findings: PrevalenceNH=Non-Hispanic
16. Adult Report Key Findings: Prevalence
17. Adult Report Key Findings: Prevalence
18. Adult Report Key Findings: PrevalenceNH=Non-Hispanic
19. Adult Report Key Findings: Prevalence
20. Mandatory Reported Health InformationAgency for Health Care Administration (AHCA) Emergency Department (ED) Discharge Data
21. ED Discharge Data The following slides present data for ED discharges with asthma (ICD-9 Code 493) listed as the primary diagnosis
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23. 23Number of Florida Asthma ED Visits by Payer, AHCA 2010 – 2014
24. Adult Report Key Findings: Prevalence
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28. Florida Asthma Program Overview
29. Florida Asthma Program Organizational Overview
30. Florida Asthma ProgramInfrastructure StrategiesSupporting the Florida Asthma CoalitionCommunication campaignsOngoing surveillance and evaluation
31. Florida Asthma ProgramService StrategiesAsthma-Friendly SchoolsTraining, Education, and Promotion Asthma Home Visiting ProgramPilot Program between Florida Department of Health Miami- Dade and Nicklaus Children’s Hospital
32. Florida Asthma ProgramHealth Systems StrategiesLearning and Action NetworksMedicaid Managed Care Plans and Federally Qualified Health CentersCommunity Health Worker (CHW) Asthma Home Visiting Curriculum Development
33. Florida Asthma Coalition33Established in 2009Launched the Asthma-Friendly Child Care Center and Asthma-Friendly School RecognitionsDeveloping recognitions, including home-visiting referrals and/or coverage, forHealth InsurersHospitalsPrimary Care Providers
34. Asthma-Friendly Schools34Tiered recognition opportunityEmphasis on Title 1 SchoolsBronzeDesignating an Asthma Champion and TeamEducating staffEnsuring immediate access to medications per statuteProviding student-centered asthma management supportDisplaying posters in high-traffic areasSigning up for AirNow.gov alerts and planning for indoor activities on days with poor air quality
35. Asthma-Friendly Schools35SilverProviding student self-management educationProviding parent and caretaker educationGoldMaintaining a healthy school environmentImplementing an indoor air quality program Recommend Environmental Protection Agency’s (EPA) Tools for SchoolsPlatinumEstablishing a school policy to ensure all criteria are metEstablishing a district-wide comprehensive tobacco-free schools policy
36. Asthma Home Visiting Program36Based on previous Healthy Homes projectThree home visits Environmental specialist and health educator teamEPA’s Asthma Home Environment ChecklistTailored asthma self-management educationThree month (phone) and six month (provider) follow-up and parent survey
37. Learning and Action Networks37Florida Asthma and Tobacco Cessation Learning and Action Networks (FATC LANs) Improving delivery of and reimbursement for comprehensive asthma control Fostering communication and cooperation Medicaid Managed Medical Assistance Plans Federally Qualified Health Centers
38. FATC LANs38Three virtual learning sessions for each FATC LAN and monthly action period webinarsTopics will include Quality improvementTeam based careCoverage and reimbursementHealth system linkages Tobacco cessation
39. CHW Asthma Home Visiting Curriculum39Being developed by Miami-Dade College of MedicineOptional component of the Florida CHW Certification TopicsLesson #1: Asthma BasicsLesson #2: Asthma Triggers Lesson #3: MedicationsLesson #4: Asthma Outside the HomeLesson #5: AllergiesLesson # 6: Home Visit Guidelines
40. Contact Info40Karen Farrington Asthma Program Manager Florida Department of Health (850) 245-4444 x 2976karen.farrington@flhealth.gov
41. Francesca Lopez, MSPH, AE-C, Program Manager Georgia Asthma Control ProgramGeorgia Department of HealthSoutheast Regional Asthma Disparities Overview
42. 2016 Southeast HUD Regional Asthma SummitBuilding Public Health Capacity to Deliver SME and Healthy Homes InterventionsGeorgia Asthma Control ProgramFrancesca Lopez, MSPH, AE-CMay 17, 2017
43. Comprehensive Asthma Control Through Evidence-based Strategies and Public Health—Health Care CollaborationDPH Asthma Funding Georgia one of 23 states awarded federal cooperative agreementGeorgia’s new 5-year Cooperative Agreement from CDC, started on Sept 1, 2014Total of approximate $3M over 5 yearsFunding increase from $300k per year to $599k per year (no state funds
44. The Georgia Asthma Control Program (GACP)Mission: To improve asthma control and reduce its burden in Georgia by a focused commitment to policy and environmental change, education, and an integrated care delivery system.
45. Coordinated federal action plan to reduce racial and ethnic asthma disparities2013-2018 Strategic plan for addressing asthma in georgiaThe Road Maps
46. 2013-2018 Strategic PlanEnvironmental Work GroupGoal 1: Decrease exposure to environmental triggers for people with asthma.Family Support Work GroupGoal 2: Promote/support self management in children ages 0-17 diagnosed with asthma and their families.Health Care Delivery SystemsGoal 3: Increase access to asthma services and resources.Goal 4: Promote and increase implementation of National Asthma Education and Prevention Program (NAEPP) guidelines in standards of care for the diagnosis, treatment, and management of asthma.Goal 5: Improve coverage and reimbursement rates for comprehensive asthma care.Goal 6: Improve asthma health information exchange.Schools and Childcare SettingsGoal 7: Reduce the negative impact of asthma on the development and academic success of Georgia children.Goal 8: Improve the integration of care management between health care providers and schools/childcare settings.
47. GACP: Enhancing Georgia’s CapacityEngage strategic partners to develop sustainable strategies and expand reach of comprehensive asthma control services.Address State’s surveillance and evaluation capacity for tracking asthma morbidity and mortality and evaluating program effectiveness. Increase the proportion of people with current asthma that report they have received asthma self-management education.Increase the proportion of people with asthma who receive appropriate asthma care according to the National Asthma Education and Prevention Program Guidelines.
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49. * BRFSS weighting methodology changed in 2011 *
50. Note: We did not have data for 2011
51. Rate of Hospitalization, by Age, Georgia
52. ER Visit Rates by Age, Georgia
53. Hospitalizations & ER Visit Rates among Georgia’s Children
54. Asthma: A DPH PriorityDecrease hospitalizations of children with asthma in the 0-9 range.Increase access for persons with asthma to evidence-based care.Increase the number of providers that offer and payors (including Medicaid) that cover in-home asthma education and interventions by certified asthma educatorsIncrease the number of children with an asthma action planAchieve a 1:4 ratio of rescue to controller prescriptions statewideIncrease the percentage of persons with asthma who receive the seasonal flu vaccineIncrease the number of early care settings and school districts with asthma-friendly policies.
55. PROGRAM THEORYThree strategies to achieve this (all are required)InfrastructureServices Health systemsComprehensive services InfrastructureInfrastructure
56. Step-Wise Approach: Complementary Evidence-Based InterventionsComprehensive Asthma Control ServicesCDC Grantee Meeting 1/13/15
57. Our Approach
58. InterventionBased on a systematic review of the literature CDC and the Community Preventive Services Task Force recommends home-based multi-trigger, multicomponent interventions with an environmental focus for children with asthma aim to reduce exposure to multiple indoor asthma triggers.
59. Purpose To identify children with poorly controlled asthma in DPH’s Maternal and Child Health Children’s Medical Services (CMS) Program for participation in a program aimed at increasing the number of children receiving guidelines-base care for the diagnosis, treatment, and management of asthma.DescriptionGACP and Georgia Healthy Homes Program will provide: Healthy Homes Essentials training course to increase district capacity and number of certified healthy homes specialist Becoming an Asthma Educator and Care Manager training course to increase district capacity among District Health Promotion Coordinators, CMS nurses and partners to deliver asthma self-management education to children with asthma and their families DPH District CMS Nurse will provide - Self-management education for children with asthma and their caregivers Asthma care coordination with primary care providers, specialty providers, Healthy Homes specialist, and schools District Environmental Health-Healthy Homes Specialist will provide – Healthy Homes education for caregivers In-home trigger reduction activities Healthy Homes assessment and recommendationsMay include provision of mattress/pillow case covers, HVAC filters, pest baits, etc. Partner Involvement DPH Maternal and Child Health Section Children’s Medical Services, DPH Environmental Health – Healthy Homes Program, Public Health Districts, Local Provider Practices, Community PartnersIntended Outcomes Reduce the emergency room and hospitalization rate among program participantsIncrease the prescription ratio of controller medications to relievers by 3:1 Increase the number of primary care setting using spirometry for the diagnosis of asthma Increase the number of children receiving seasonal influenza vaccination Develop return on investment for comprehensive asthma care Cross DPH Multicomponent, Multi-Trigger Intervention for Asthma
60. Building Public Health CapacityDrive a mutual understanding of:Primary Goals of Asthma Self Management EducationHealthy Home PrinciplesBuild Subject Matter Expertise To:Deliver customized in-home asthma trigger assessments to promote self efficacy among caregivers to identify/eliminate triggers and maintain a healthy home environmentDeliver asthma education to promote self efficacy in asthma management among care givers and patients
61. Healthy Homes Visits for AsthmaEducation Goals:Educate asthma caregiver certain housing conditions can impact health outcomes such as asthma and respiratory illnesses, lead poisoning, and injuriesBuild self efficacy around caregivers ability to recognize, eliminate/control potential Asthma triggers and/or hazardous conditionsIntervention Goals:Identify asthma triggers present in the home via customized assessmentIdentify source or cause of triggersProvide recommendation and action plan for trigger elimination/controlProvide technical assistance on how to address triggersProvide moderate intervention suppliesIntervention Outcomes:Elimination and/or control of asthma triggers contributing to exacerbationsImproved asthma controlImproved caregiver ability to maintain an asthma friendly home environment
62. Want More Info?Georgia Department of Public HealthAsthma Control Program Visit us at http://dph.georgia.gov/asthma dph-asthmaprogram@dph.ga.gov Funded by a Cooperative Agreement from the Centers for Disease Control and Prevention. 5U59EH000520-08