Promote Institutional Change for Sustainability
Integrating the Easy Breathing curriculum into established education pathways has been one critical component to fostering program sustainability. In 2010, the American Board of Pediatrics approved Easy Breathing as a quality improvement program for Maintenance Certification, Part IV for re-certification of pediatricians. Currently, 30 pediatricians are enrolled or have completed the certification process using the Easy Breathing program.
Easy Breathing also recently partnered with Connecticut’s sole Medicaid vendor, to increase the enrollment of underserved children into the program and provide a disease management follow up for children with asthma.
Easy Breathing continues to offer educational enhancements such as Took Kits and training for clinical staff, Continuing Medical Education credit for physicians and asthma education materials for patients. Easy Breathing is also committed to keeping up with the cutting edge of technology. Therefore, the program currently works with several electronic medical records (EMR) companies to integrate the program into their EMRs, which will further help to sustain the program and promote wide scale dissemination
Easy Breathing was created in 1998 by Physician Champion Michelle M. Cloutier, M.D., a pediatric pulmonologist in Hartford, Connecticut. The goal was to improve diagnosis and guidelines-based care for children with asthma in the Hartford area, a community with some of the highest asthma rates in the state (approximately 30% of Hartford residents have asthma). The Easy Breathing Program provides clinicians with standardized tools that translate the National Asthma Education and Prevention Program’s (NAEPP) National Guidelines for the Diagnosis and Management of Asthma (EPR-3) into a useable format; even for doctors that typically deal with 250 diseases and have less than 10 minutes with a patient in a typical office visit. The program was initially funded with a private grant and was implemented in six urban clinics in Hartford, Connecticut. Funding and expansion has continued to grow with the program over the last 14 years, which is now conducted throughout the state of Connecticut and is funded by the State.
In 1998, a staggering 41% of children in Hartford were diagnosed with asthma and only 38% of those children were receiving care consistent with the NAEPP’s National Guidelines, including treatment with anti-inflammatory medications.
The program focuses on four elements of care: diagnosing asthma, determining asthma severity, prescribing therapy appropriate for the asthma severity and developing a written asthma treatment plan that is given to the family.
Prior to the start of the program in 1997, only 5% of children diagnosed with asthma in Hartford received a Written Treatment Plan. Today, 90% of children enrolled in the program with asthma receive Written Treatment. Furthermore, the majority of Hartford area residents live in pre-1950 homes with extensive overcrowding and pest infestation. Therefore, the program’s Written Asthma Treatment Plans include asthma triggers on the back of the plans with pictures and check boxes to promote discussion between the clinician and family regarding personal triggers and written instructions for avoiding and/or eliminating harmful exposures. The program’s goals were to improve asthma diagnosis and reduce ED visits, hospitalizations, and outpatient visits in underserved minority children.
Easy Breathing was initially housed within the Connecticut Children’s Medical Center in Hartford and served only patients seen within that facility. Two years later, a grant from the Agency for Healthcare Research and Quality (AHRQ) enabled the program to grow to include private practices in the greater Hartford area. Approximately 50% of all Medicaid funded children in Connecticut are cared for in private practice settings; therefore, expansion of the program into the private sector was an important step. In 2002, using funds from the Tobacco and Health Trust Fund, the program expanded to include five new communities. In 2007, the program underwent another significant expansion to include communities across the state of Connecticut with funds from the Department of Social Services and the Tobacco and Health Trust Fund. The program remained headquartered at the Connecticut Children’s Medical Center. Today, more than 105,000 children are enrolled in the program, more than 26,000 of whom have asthma, and nearly 340 clinicians and 100 practices participate statewide.
Easy Breathing also recently partnered with Community Health Network of Connecticut, the state’s sole Medicaid vendor, to increase the enrollment of underserved children into the program and provide disease management by telephone for children with asthma.
EDUCATE AND SUPPORT CLINICAL CARE TEAMS
Regional coordinators provide comprehensive asthma education to medical staff members at participating practices. They also receive an Asthma Tool Kit with demonstration devices and instructional aides. In 2011, CME credit was approved for training on the Easy Breathing program.
TAILORED ENVIRONMENTAL INTERVENTIONS - MAKE ENVIRONMENTAL MANAGEMENT A REALITY AT HOME
In a unique partnership arrangement, the Easy Breathing program served as the foundation for the U.S. Department of Housing and Urban Development (HUD) -sponsored Healthy Homes program in Hartford and the Genetics of Asthma in Latino Children project funded by the National Institutes of Health (NIH). In these programs, home visits were made either by trained members of the community or by health researchers, to conduct structural assessments of the home and measure allergen levels in collected dust samples. Remediation for families with children with asthma were provided as part of the HUD grant and were coupled with improved asthma management, family education and environmental control.
Evaluate Program Implementation
An integral component of the Easy Breathing program is tailored environmental interventions – and specifically the Easy Breathing Survey. The survey is used to identify environmental exposures in the home that may be problematic for children with asthma. Easy Breathing collects survey information, provider assessments, treatment plans, and follow-up details from communities each quarter, which is entered into a comprehensive database containing information about each patient that has participated in the program. This database is continually used for research and reporting purposes and provides clinicians with demographic information for the communities they serve, environmental exposure risks and asthma severities for all children enrolled in the program. It is also used to provide feedback to clinical care sites on how closely their treatment plans adhere to national guidelines, and guidance on follow-up treatment plans for patients with asthma. Recently, the database was used to develop a flu shot registry and to implement targeted smoking cessation and prevention programs.
The Easy Breathing database has supported three cohort studies over the lifetime of the program. The first, measuring the reduction of medical service utilization for program participants, found a 35% decrease in hospitalizations – which was sustained for three years, and a 27% decrease in emergency department (ED) visits for children with asthma. The second study, measuring the effectiveness of the program in private practices, found a 47% increase in corticosteroid prescription and use, a 56% reduction in outpatient visits and a 91% decrease in ED visits for patients of clinicians who completed the Easy Breathing training. The third study examined the effectiveness of the program in communities where it was led by local program coordinators and champions. That study found similar significant decreases in ED visits and hospitalizations resulting from the program.