asthma case management
TRANSCRIPT
-
8/8/2019 Asthma Case Management
1/44
Asthma Alliance of Indianapolis 1
Asthma Case Management:Asthma Case Management:
A Unique Asthma Referral ServiceA Unique Asthma Referral Service
Presented by Robin Costley, CRT
Asthma Educator
Marion County Health Department
Asthma Alliance of Indianapolis
-
8/8/2019 Asthma Case Management
2/44
Asthma Alliance of Indianapolis 2
Who is theWho is the
Asthma Alliance of Indianapolis?Asthma Alliance of Indianapolis? Formed in 1997
3 year grant from NHLBI Multi disciplinary approach to
asthma education, prevention, &treatment
Developed as a result of acomprehensive health assessment
-
8/8/2019 Asthma Case Management
3/44
Asthma Alliance of Indianapolis 3
Mission Statement:
The mission of the Asthma Alliance ofIndianapolis is to arm individuals
affected by asthma with the knowledgeand skills to improve health & qualityof life.
-
8/8/2019 Asthma Case Management
4/44
Asthma Alliance of Indianapolis 4
Coalition GoalsCoalition Goals
Decrease # of emergency room visits forasthma
Decrease school absenteeism & missed work
days due to asthmaIncrease the use of NHLBI guidelines amonghealthcare professionals
Plan, conduct, & evaluate educationcampaign on the impact of the environmentand asthma management
-
8/8/2019 Asthma Case Management
5/44
Asthma Alliance of Indianapolis 5
Coalition ServicesCoalition Services
Education programs targeting school staff,students, parents
Advocating for public policies that aid inincreasing the quality of life for those affectedby asthma
Partnering with other community groups to
increase public awareness of asthma
UniqueAsthma Referral Service
-
8/8/2019 Asthma Case Management
6/44
Asthma Alliance of Indianapolis 6
Asthma a Key Health ProblemAsthma a Key Health Problem 51,000 adults & 25,000 children
are diagnosed with asthma inIndiana
Affects 22.2 Million Americans, 5million are children
Estimated 12.8 million lostschool days & 14.5 million lost
work days Top 10 of prevalent conditions
causing limitation of activity &costs US $19.7 billion inhealthcare costs.
-
8/8/2019 Asthma Case Management
7/44
Asthma Alliance of Indianapolis 7
Top Chronic Health ConditionsTop Chronic Health Conditions
in Indiana Schoolsin Indiana Schools
Surveys were receivedfrom 35 schoolcorporations, ranging
in size from 496-32,000students.
Two private schoolsincluded representing
1,112Making a combined total
of 255,818 students.0
2000
4000
6000
8000
10000
12000
14000
Type IDiabetesType IIDiabetesAsthma
Seizures
Allergies
-
8/8/2019 Asthma Case Management
8/44
Asthma Alliance of Indianapolis 8
Five Key Elements of ProgramEffective Care for People with Asthma
1.
Tailored EnvironmentalInterventions
In-home assessments
School and workplaceassessments
Environmental triggereducation and remediation
Indoor Air Specialist
-
8/8/2019 Asthma Case Management
9/44
Asthma Alliance of Indianapolis 9
2.
Integrated Health Care Services Unique asthma referral service
Home visit database with environmental outcomes
School health coordinator database to trackschools and participants.
Contract to carry asthma medications at school
-
8/8/2019 Asthma Case Management
10/44
Asthma Alliance of Indianapolis 10
3.
High-Performing Collaborations & Partnerships Annual World Asthma Day poster contest
Head Start
Corporate sponsors Neighborhood clinics
-
8/8/2019 Asthma Case Management
11/44
Asthma Alliance of Indianapolis 11
4.
Committed Program Champions County health department administers AAI
Governance Board
Website sponsor
Serves as consultant
-
8/8/2019 Asthma Case Management
12/44
Asthma Alliance of Indianapolis 12
5.
Strong Community TiesLocal university respiratory therapy program
Tailored community outreach activities
Education and resource binder to local libraries
School workshops
-
8/8/2019 Asthma Case Management
13/44
Asthma Alliance of Indianapolis 13
Goals of Asthma ManagementGoals of Asthma Management Maintain normal activity
levels ( including exercise)
Maintain (near) normallung function
Prevent chronic &troublesome symptomssuch as coughing,
shortness of breath atnight, early morning, orafter exertion.
Avoid adverse effects fromasthma medications.
-
8/8/2019 Asthma Case Management
14/44
Asthma Alliance of Indianapolis 14
COMPONENTS ofCOMPONENTS of
ASTHMA MANAGEMENTASTHMA MANAGEMENT
1. Objective measure of lung function toassess & monitor
2. Environmental Control efforts to reduce
or eliminate exposure to allergens,irritants & other triggers that induceairway inflammation & precipitate acuteasthma episodes.
3. Pharmacologic therapy to prevent,reverse, & control airway inflammation &
obstruction.4. Education to help clients prepare & follow
their daily mgt. plan and their plan fordealing with symptoms.
-
8/8/2019 Asthma Case Management
15/44
Asthma Alliance of Indianapolis 15
Asthma Referral ServiceAsthma Referral Service To provide an extension of resources
and free services to residents in
Marion County with a diagnosis ofasthma or allergies
Integration of health care services
Improve & coordinate care Initiated in 2001
To instill healthy habits for life
-
8/8/2019 Asthma Case Management
16/44
Asthma Alliance of Indianapolis 16
Common ReferralsCommon ReferralsPublic
Health
Nurse
Indoor
Air
Specialist
Asthma
Educator
Social
Worker
Insurance
CoverageSpecialist
SmokingCessation
Specialist
Other
Identifiedresources
-
8/8/2019 Asthma Case Management
17/44
Asthma Alliance of Indianapolis 17
Development of theDevelopment of the
Asthma Referral SystemAsthma Referral System Took a strong stand in the benefits of
managing the indoor environment vs.
prescribing medications as the firstline of defense.
Found most clients in need of
additional services and referralsoutside of asthma education
-
8/8/2019 Asthma Case Management
18/44
Asthma Alliance of Indianapolis 18
Where Do Referrals Come From?Where Do Referrals Come From?
Hospitals
MCHD Programs
Schools
Self referrals Head Start Centers
Other daycares
HCP offices
Neighborhood clinics
Health Centers
-
8/8/2019 Asthma Case Management
19/44
Asthma Alliance of Indianapolis 19
Reporting InformationReporting Information Parent or Guardian Primary Care Physician
Allergy/ Asthma Specialist
Source of referral
Health Insurance Portability & Accountability Act of1996 (HIPAA)
Acknowledgement of receipt of notice of privacypractice
Authorization for release of information
-
8/8/2019 Asthma Case Management
20/44
Asthma Alliance of Indianapolis 20
Barriers & ChallengesBarriers & Challenges
Transient clients Family not ready to initiate education and
management
Other STUFF is priority
Not an earlyintervention Too many caretakers
New asthma guidelines
Addictions Language barriers
Cultural behaviors
-
8/8/2019 Asthma Case Management
21/44
Asthma Alliance of Indianapolis 21
Services Noted Outside ofServices Noted Outside of
Asthma CareAsthma Care Medical equipment & providers
Education & Information
Support
Resources
Disease management Crisis management
Life care planning
-
8/8/2019 Asthma Case Management
22/44
Asthma Alliance of Indianapolis 22
Services continuedServices continued Pharmaceutical companies
Rx for Indiana
Rodent control
Family services
Child development services
Sources to obtain needed managementitems
Dietician
-
8/8/2019 Asthma Case Management
23/44
Asthma Alliance of Indianapolis 23
Real Life ExampleReal Life Example
OLDER ADULT ARTISTOLDER ADULT ARTIST
Referral from neighborhood clinicProblems identified:
1. Second Hand Smoke in apartment complex
2. Dust no upholstered furniture, washes bedding 1X/Wk,dust mite protectors in place. Home appeared clean but
cluttered with books, papers, etc.3. Paint supplies- works with acrylic paints & cleaning
solutions. Feels like this may be contributing to herexacerbations
4. Suggested mask, consulted Indoor Air Specialist forrecommendation. Sent her a listing of local distributorsfor an appropriate mask.
-
8/8/2019 Asthma Case Management
24/44
Asthma Alliance of Indianapolis 24
Real Life ExampleReal Life Example
DESPERATE CAREGIVERDESPERATE CAREGIVER
Self Referral- Grandmother, Great Grandmother, 2 smallGrandchildren, and 1 teenage Daughter
Problems identified:
1. Deplorable living conditions ;
Standing water in all of the bedrooms, closets,with visible mold throughout the house.
2. Windows not placed properly. Heat at 95 degreesin winter to overcome cold temperatures in the
home. Bugs in home, fly paper placed in allrooms.
3. Toilet not seated properly with human wastecoming up on the floor with each use.
-
8/8/2019 Asthma Case Management
25/44
Asthma Alliance of Indianapolis 25
Real Life ExampleReal Life Example
MULTIPLE ISSUESMULTIPLE ISSUES
Referral from Head Start-Mother, 2 children with asthma, 4 childrentotal, unemployed father.1. Father not involved with care, playing video games at each visit.
Also smokes.
2. Mother not able to hold job due to childrens uncontrolled asthma.
3. Home very cluttered and dirty. Dirty dishes & food laying about.Cockroaches visible all over.
4. Vacuum is broken.
5. Pet cat
6. Plumbing and ceiling leaks. Mold & mildew developed.
7. Landlord & client sited
8. 3 ER visits in 5 months
-
8/8/2019 Asthma Case Management
26/44
Asthma Alliance of Indianapolis 26
Real Life ExampleReal Life Example
CHILD WITH AUTISMCHILD WITH AUTISM
MOTHER DISABLEDMOTHER DISABLEDSelf Referral
Problems identified:
1. Single Mother desperate for help. Has CP with a
severe speech impediment.2. Two sons; a 6 y.o. with asthma & newly
diagnosed autism, & a 10 y.o.
3. No medical home- numerous medications that
she didnt know what to do with4. Collaborated with school nurse to develop a
more effective management plan for the schoolenvironment.
-
8/8/2019 Asthma Case Management
27/44
Asthma Alliance of Indianapolis 27
AUTISM Case continuedAUTISM Case continued
Services utilized:
1. About Special Kids (ASK)
2. Inadequate equipment-DME donated portable
neb.3. Provided neb machine for
before school care.
4. Staff education at school
and before care.5. Allergy testing finally
completed with new MD.
-
8/8/2019 Asthma Case Management
28/44
Asthma Alliance of Indianapolis 28
Real Life ExampleReal Life Example
CHILD WITH LEARNING DISABILITYCHILD WITH LEARNING DISABILITY
Referral from SchoolProblems identified:
1. Mother not comfortable letting son carry his inhaler. Previouseducation & instruction have failed to improve his technique.
2. Son was instructed in the home with Mother present using a
picture format containing pictures for each step to take his inhalerwith spacer.
3. Follow up phone call 3 months later revealed that Son had a flare-up since the instruction & is doing a great job with his inhaler &spacer. He now takes his rescue medicine with him and feelscomfortable using it.
4. Mother doing a great job of managing sons asthma & was alreadyeducated on common triggers & has already taken measure toreduce them in the home.
-
8/8/2019 Asthma Case Management
29/44
Asthma Alliance of Indianapolis 29
Real Life ExampleReal Life Example
CHILD WITH DOWNS SYNDROMECHILD WITH DOWNS SYNDROME
Referral from co- workerProblems identified:
1. Child currently on ventilator due to severe asthma exacerbation.Parents wanted home environmental assessment before she wasdischarged from the hospital.
2. Concern over carpets. Have a HEPA vacuum but family structure isso hectic that they do not vacuum regularly.
3. Questions regarding furnace filters. Consulted Indoor AirSpecialist for recommendations on most effective filters available.Also suggested running fan continuously versus automatic so that
it continually filters the air.4. For furnace humidifiers it was suggested that they have a humidity
gage to keep it no more than 40% humidity level. Stressedimportance of keeping unit clean.
-
8/8/2019 Asthma Case Management
30/44
Asthma Alliance of Indianapolis 30
Real Life ExampleReal Life Example
MULTIPLE FAMILY MEMBERS LIVINGMULTIPLE FAMILY MEMBERS LIVING
AT RESIDENCEAT RESIDENCEReferral from Health Clinic
Problems identified:
1. Non compliant with medications. Son 7 y.o. ,3 y.o. & 2 y.o.daughters with severe asthma.
2. Very transient3. Home not kept clean. Many people in & out of home.
4. Equipment in bad condition, dirty.
5. Concerns over child development. Son is restricted to an airconditioned room all summer. Referred to programs for parents &
children / Childrens Bureau6. Loosing materials that were provided. Not filling prescriptions
7. When do you call it quits?!
-
8/8/2019 Asthma Case Management
31/44
Asthma Alliance of Indianapolis 31
Real Life ExampleReal Life Example
LIFE WITHOUT SLEEPLIFE WITHOUT SLEEP
Referral from Sickle Cell ProgramProblems identified:
1. Single Mom states that 2 y.o. Son has symptoms daily.Mostly at night. Not sure of triggers.
2. Son only sleeps 2 hours/ night. Not sure if it is themedications he is on or irritation from his severe eczema.
3. Roaches present in home. ( Dbl. Occupancy)
4. Educated on dust mite reduction. Removed large stuffed
animal from room. Dust mite pillow protector provided.5. Mom stressed from his care. No one will help her care
for him because of his of his lack of sleep and he getsinto things in the home when Mom falls asleep.
-
8/8/2019 Asthma Case Management
32/44
Asthma Alliance of Indianapolis 32
Real Life ExampleReal Life Example
NONNON--COMPLIANT TEENCOMPLIANT TEEN
Referral from Neighborhood ClinicProblems identified:
1. Freshman HS student. Filled quick relief meds 10Xs &controller 2 Xs in 6 months
2. Admits she does not take her controller meds. Shedoesnt like the taste & she forgets
3. Discussed the damage to her lungs with long standinginflammation
4. Running out of Medicaid. Trying to re- instate.5. Committed to keep appointments
6. Provided Spanish materials for Mother
-
8/8/2019 Asthma Case Management
33/44
Asthma Alliance of Indianapolis 33
Real Life ExampleReal Life Example
NEED FOR INTERVENTIONNEED FOR INTERVENTION
Self referralProblems identified:1. 10 y.o. Son with severe asthma, Mother lost job 2nd to
repeated calls from work to pick Son up at school with
asthma symptoms
2. No food in home. Ran out of food stamp support, notransportation
3. Referred to appropriate DHO for basic needs resources.
Social Worker intervened
4. Presently goes to school daily to give Son his asthmatreatment
-
8/8/2019 Asthma Case Management
34/44
Asthma Alliance of Indianapolis 34
ContinuedContinued
5. Needed direction in job search. Inquired about a job ather sons school/ may be aide position available in thenear future. Continues to seek employment/ hassubmitted several applications.
6. Son had sleep study, cab was involved in accident on theway home. Needed direction to report incident.
7. Walmart card given for household goods , toiletries, andeye drops for her son. Bus vouchers also provided for
transportation.E
ncouraged to go to Trustees office toobtain assistance with her utility bill and school clothesfor her Son.
-
8/8/2019 Asthma Case Management
35/44
Asthma Alliance of Indianapolis 35
ContinuedContinued5. Paid all but $7 of her electric bill obtaining $ by
doing odd jobs. Needed direction in contactingthe power company so that her electricity
wasnt turned off in 2 days. Need for utilityassistance.
6. Son doing much better. No furtherhospitalizations since initial asthma referral.
7. Continued visits to support ongoing needs offamily.
-
8/8/2019 Asthma Case Management
36/44
Asthma Alliance of Indianapolis 36
Closing the GapsClosing the Gaps
Home
WorkSchool
HCP Office
Hospital discharge follow up
-
8/8/2019 Asthma Case Management
37/44
-
8/8/2019 Asthma Case Management
38/44
Asthma Alliance of Indianapolis 38
RewardsRewards Improvement of
symptoms is often
directly related tothe degree clientsfollowenvironmentalrecommendations
Greatly affected bythe partnershipwith the educator.
Buildingpartnerships with
clients & theirfamilies ensuringthat support ,consistent
messages, &coordinated careare provided.
-
8/8/2019 Asthma Case Management
39/44
Asthma Alliance of Indianapolis 39
RESULTSRESULTS CONTROLLED
ASTHMA, FEWER
SICK DAYS, &BETTERFUNCTIONALLIVES OF
CLIENTS.
-
8/8/2019 Asthma Case Management
40/44
Asthma Alliance of Indianapolis 40
Numbers served each yearNumbers served each year2006
Total referrals = 72
Unable to reach=14 Common referrals to
other services wereasthma educator,indoor air specialist &public health nurse.
-
8/8/2019 Asthma Case Management
41/44
Asthma Alliance of Indianapolis 41
Related StrategiesRelated Strategies
Marketing plan
Word of mouth
Alliance members & sponsors
World Asthma Day
Annual golf outing and fundraiser
Community outreach engagements
.
-
8/8/2019 Asthma Case Management
42/44
Asthma Alliance of Indianapolis 42
Related StrategiesRelated Strategies
Budget
Administered by the Marion County Health
Department Donations of management items
Use of all profits back to the community viaroach baits/ gel, dust mite pillow protectors,
equipment needed to administer medications
-
8/8/2019 Asthma Case Management
43/44
Asthma Alliance of Indianapolis 43
Final CommentFinal CommentA unique way to join forces with
clinics, physician offices &
managed care organizations thathave implemented asthma-management programs. Sharing
our strategies and success.
FOR MORE INFO...
Asthma Alliance of Indianapolis
#317-221-2473 www.asthmaindy.org
-
8/8/2019 Asthma Case Management
44/44
Asthma Alliance of Indianapolis 44
Thank you for your time & attention.
Any questions?
To learn more about becoming a member orsponsor of the Asthma Alliance log onto
our website or give us a call. We arealways looking to expand our coalition tohelp benefit those with asthma in ourcommunity.