2012

In the mid-90s, the Michigan Department of Community Health (MDCH) recognized asthma as a growing health problem, especially among low-income children and populations with economic, race and access disparities. As MDCH geared up to increase asthma awareness in these disproportionately affected communities, it quickly determined that a coordinated effort would ultimately have the greatest impact on health outcomes.

Therefore, in 2000, MDCH brought together more than 125 asthma experts to develop the first statewide plan to address asthma in communities bearing the highest burden. This successful collaboration lead to the creation of the Asthma Prevention and Control Program (APCP). 

The APCP, which provides expertise and long-term guidance for asthma quality improvement activities, has aided in the development and impact of many successful community-based asthma management programs across the state, such as Managing Asthma Through Case-management in Homes (MATCH). This program utilizes a combination of home, school and work visits; asthma action plans; and Medicaid reimbursement to provide long-term interventions and care for individuals with asthma. MATCH participants reported significantly fewer emergency room visits and hospitalizations, and had significantly shorter lengths of stay, if hospitalized due to asthma.

Recognizing the success of the program, APCP helped to replicate this model in other communities, and as a result, has more than doubled the number of people served by MATCH. Surveillance data and input from strategic partners have been key components to this success and are used to continuously measure both the state’s and community’s needs and to ensure that any changes in asthma burden result in adjusted programming.

Between 2000 and 2007, APCP’s efforts have contributed to a 24 percent reduction in the asthma mortality rate in Michigan, preventing an estimated 182 deaths. Similarly, pediatric asthma hospitalization rates in the state decreased by 28 percent between 2000 and 2009. In addition, children enrolled in Michigan Medicaid programs exhibited a 41 percent decrease in asthma hospitalizations between 2005 and 2009. 

Mission Children’s Hospital serves the 21 most rural and isolated counties in North Carolina. This area’s  diverse minority population faces some of the greatest health disparities in the state, and further, the majorty of Mission Children’s Hopsital patients are uninsured or underinsured. Pediatric asthma, unsurprisingly, is one of these disparate health concerns.

Through an innovative and bold approach designed to meet the unique needs of this population and to impact minority children suffering from asthma in a significant way, Mission  Hospital developed the Regional Asthma Disease Management Program (RADMP). 

RADMP confronts these issues at the root of the problem — taking the clinical approach to asthma management and control into non-clinical settings, such as homes, schools and other care facilities in outlying areas. The program addresses social determinants of health, medical and environmental management, education on asthma and environmental triggers, and comprehensive care through an ever-expanding network of invested stakeholders and agencies.

In order to reach minority and low-literacy populations, RADMP utilizes population specific outreach materials and interpretive services. For low-income families, the program offers access through Mission’s Medication Assistance Program for asthma medications. Home remediation to eliminate environmental exposures is provided through RADMP’s strong network of community partners.

In 2008, the program was recognized as one of the state’s top three asthma disease management programs. In 2009, RADMP received a two-year demonstration project grant from the National Heart, Lung, and Blood Institute (NHLBI), as part of the National Asthma Control Initiative. Since 2009, RADMP activities have contributed to reducing asthma-related emergency room visits by 94 percent and hospitalizations by 95 percent, equaling a total savings of more than $800,000. In addition, the average number of school days missed by children in the program decreased from 17 to nine, indicating an increased quality of life. Statistically significant improvements were made in clinical measures including lung spirometry and eosinophilic inflammation.

L.A. Care Health Plan established the comprehensive disease management program LA Cares About Asthma® in 2003. L.A. Care selected asthma as a disease management focus because of the large number of members with asthma enrolled in L.A. Care and the success of programs like these in helping patients with chronic illness improve their health status over the course of the disease. LA Cares About Asthma ® is a collaborative program designed to improve member self-management through education, empowerment, monitoring and member input and communication.

On a monthly basis, LA Cares About Asthma® identifies health plan members with asthma and provides them with a variety of educational materials and tools to help them take control and manage their disease. To be inclusive to its community’s needs, the program ensures that linguistically and culturally appropriate materials are available for all potential enrollees.

LA Cares About Asthma® also partners with several community-based organizations to expand its reach and depth to serve individuals most in-need. An in-home visitation program with Long Beach Alliance for Children with Asthma in the Los Angeles South Bay area and specialist referrals with Harbor-UCLA Medical Foundation Inc., throughout Los Angeles County offered to high-risk members with asthma are just two examples of such successful partnerships.

Thanks to these efforts, LA Cares About Asthma® achieved a member satisfaction of 97.6 percent, which exceeded their 2011 goal. In particular, members reported great satisfaction with the program materials and felt the materials educated them on how to control their asthma.

In 1998, the city of Hartford, Connecticut had a growing population of low-income minority citizens with asthma. Only one-third of children with persistent asthma in this community were being treated with appropriate anti-inflammatory medication, and most of these children lived in old housing where pest infestation and overcrowding were common problems.

The community needed a cost effective asthma management program to assist busy primary care clinicians in diagnosing asthma and effectively treating patients. The result was the creation of the Easy Breathing© program.

Easy Breathing© — originally housed within the Connecticut Children’s Medical Center — focuses on five elements of care: diagnosing asthma, determining asthma severity, prescribing therapy appropriate for the asthma severity, developing a written Asthma Treatment Plan that is understood by the family, and assessing asthma control.

The program then utilizes a database to track its outcomes, including environmental exposures, interventions and feedback for clinicians. The database is also used for research and reporting purposes, and it provides clinicians with information regarding the demographics of their patient population, environmental exposures and asthma severities for all children enrolled in the program.  

An essential element of the program is the Easy Breathing© Survey, which is administered in the physician’s office when the patient comes for an office visit. The survey helps parents identify environmental exposures in the home that are potentially problematic for a child with asthma. The results of the survey are then immediately discussed with the patient and are used as a starting point for education regarding avoidance and elimination of harmful environmental conditions, such as smoking in the home.   

Today more than 106,000 children across the state have been enrolled in the Easy Breathing© program — more than 28,000 of which have asthma. This success is due in large part to extensive community partnerships between clinicians, parents, hospitals, clinics, schools, foundations, lung associations, housing authorities and pharmaceutical industry representatives that have been a cornerstone of the program from its inception.

Easy Breathing© has been tremendously successful and has lead to significant increases in the use of written treatment plans, decreases in hospitalization rates and emergency department visits for asthma, and increased usage of inhaled corticosteroids. The program is now being implemented throughout Connecticut and in nine other states.