Asthma Program Manager

Asthma remains the most common chronic condition of childhood. Strong evidence has linked exposure to allergens and other triggers commonly found in homes to allergen sensitization and asthma incidence and morbidity. A growing body of evidence has demonstrated that a home visit strategy that includes an environmental component that addresses multiple triggers through multiple interventions is effective. Such home visits reduce exposure to triggers, decrease symptoms and urgent health-care use, and increase quality of life. To make home visits widely available will require health-care payor reimbursement, government and health plan funding, training and certification of home visitors, and active referrals from health-care providers. However, a strategy based solely on education and behavior change is limited, because it cannot adequately reduce exposures due to adverse housing conditions. Therefore, approaches that address substandard housing are needed. These include remediation of existing housing and construction of new asthma-friendly homes. Most studies of remediation have made relatively narrow and focused improvements, such as insulation, heating, or ventilation. Outcomes have been mixed. Studies of new asthma-friendly homes are in their infancy, with promising pilot data. Further investigation is needed to establish the effectiveness of improving housing. A final strategy is improving housing quality through policy change, such as implementation of healthy housing guidelines for new construction, enhancement and increased enforcement of housing codes, and assuring smoke-free multi-unit homes. The combina tion of home visits, improved housing construction, and policy change has great potential for reducing the global burden of asthma.

Regarding composition of the teams, one critical difference between two types of teams will be the perspectives of the stakeholders. For the Strategic Evaluation Planning Team: · The stakeholders you engage should be the people who “think big picture” and are able to contribute in a meaningful way to discuss why a state asthma program is needed. · This team may include representatives of key partner and constituent groups, and members of this group may be involved with crafting the state plan and making decisions regarding the overall approach to addressing asthma in your state. · The primary product of the work conducted by this team is the Strategic Evaluation Plan as well as any updates to this plan. For the Individual Evaluation Planning Teams: · Include people directly engaged with the process/activity/product that is the focus of the evaluation. This team should be chosen to reflect the specific program knowledge, skills, and experience necessary to design a specific evaluation. · This team may, but does not need, to include one or more members of your strategic evaluation planning team. · These stakeholders should include those directly involved in operations or day-to-day administration and may also include recipients of the service or product. It is important to have one or more individuals on this team who are in the position to make enhancements or improvements, if indicated by the evaluation findings. · The primary product of this team is an Individual Evaluation Plan that refines and builds upon the general information provided in the evaluation profiles included in the Strategic Evaluation Plan. Some individuals on the evaluation planning team may also participate in implementing parts of the evaluation (e.g., collecting data, analyzing data, interpreting and sharing findings). As the evaluator, you will manage the feedback loop between the strategic evaluation plan and the individual evaluation plans. You will oversee how the strategic evaluation plan is implemented via the individual evaluation plans as well as how information from the individual evaluation planning process and the findings from those evaluations are used to revise the strategic evaluation plan. For example, based on their perspectives and information needs, the individual evaluation teams may try to steer the evaluation in a direction that would not meet the longer-term needs identified by the strategic planning group. In this instance, you may have to work with both teams to reconcile their visions for the evaluation. Similarly, the individual evaluations may identify new big-picture evaluation questions that the strategic evaluation planning team should consider. Providing frequent updates to all of your evaluation stakeholders, particularly those on the planning teams, will ensure that others can help you in your role as evaluation facilitator and negotiator. These updates need not always be formal or detailed; they merely need to keep stakeholders who are contributing their time and expertise “in the loop”. Updates also serve as an opportunity to acknowledge and thank participants for their contributions.

School-based health centers (SBHCs) have steadily increased in numbers across the United States over the last 3 decades.

The most recent SBHC census, conducted in 2004 to 2005 by the National Assembly of School Based Health Care, identified more than 1709 SBHC programs in the United States.  This shift in the delivery of health care for children is premised on the assumption that access to health services in school increases access to health care and improves health status among children, especially for those children whose access to care is otherwise limited.  Health status is often measured by health-related quality of life (HRQOL), which attempts to tap the current health perception of individuals.  HRQOL has been demonstrated in both social scientific and clinical research to predict future health status, health care utilization and costs, and even mortality.

For example, a study linking the 1992 Medicare Current Beneficiary Survey with the 1993 Medicare Continuous History Survey found that a person’s response to a selfrated health question accurately predicted that individual’s respective use of health care services over the next year.  Only a few studies, however, have examined the connection between HRQOL and health care utilization and health care cost savings among children.  The link between HRQOL and utilization among Canadian adolescents was examined by Vingilis et al. with a single measure of perceived general health status that asked children to rank their answer on a 5-point scale from excellent to poor.  They found that reductions in perceived health over time were associated with increases in physician services and declines in dental care. This anomaly in usage across service providers may reflect differences between preventive dental care (representing the majority of dental services), which is not covered by publicly funded Canadian Medicare, and insured, curative health services.