NEISD Asthma Awareness Education Programe3alliance.org/wp-content/uploads/2017/10/Asthma... · Asthma Management: A priority for Schools In the US, more than 7 million children have

NEISD Asthma Awareness Education Program

North East Independent School District:• A large urban school district in San Antonio, Texas • 66,770 students (pre K-12) ; 8800 employees• 67 traditional campuses, 14 Magnet Programs • Registered Nurse (RN) for every campus. • More than 8,000 students with Asthma (12% of student population) • 1 Registered Respiratory Therapist (RRT), Certified as Asthma Educator (AE-C)

• Program created in 2006 utilizing a 4 component approach to Asthma Disease Management (NHLBI EPR 3)

Asthma Management: A priority for Schools

In the US, more than 7 million children have

asthma.

Of the absences caused by chronic conditions,

asthma is one of the biggest contributors, causing 10.5 million missed school days

annually.

In a classroom of thirty,3 students are likely to

have asthma. Asthma management in schools can be addressed through a

two-pronged approach: • Creating a comprehensive asthma management plan

• Establishing an environmental assessment plan

The added plus: Student performance and teacher and staff productivity can be improved by managing the environmental quality of school facilities.

NEISD asthma Prevalence Rate12% 18%

AsthmaControl

A normal, active life

AsthmaDevelopment

AsthmaSymptoms

Genetics

Environment“Inducers”:

dust mites, cat dander,cockroaches, mold,

ETS

Environment

"Our genes may load the gun, but the environment pulls the trigger." — Ellen Silbergeld, Ph.D.

EnvironmentReduction of Triggers

and Co-morbid conditions(allergy, reflux, obesity)

Costs: • Loss of instruction time

(to clinic for med)• Loss of focus in

classroom• Loss of attendance• EMS calls • Death

MedicationNHLBI guidelines,

adherence and technique

Asthma is….Asthma Management…

allergens

allergens

allergens

allergens

irritants

irritants

irritants

irritants

infection

infection

situation 1 situation 2( allergy induced )

situation 3( infection induced )

situation 4(goal)

infl

amm

atio

n / s

ympt

om d

evel

opm

ent

Impact of Asthma Triggers

Symptom ThresholdCumulative Effect of Asthma Triggers

allergens irritants infection

Symptom Threshold metSymptoms develop (PRN usage needed)

No symptoms seen, yet inflammation

exists

Threshold met Threshold met

Environmental Impact on Health of Students Asthma/Allergy

Exposure reduction measures taken, infection does not provoke symptoms

Diane Rhodes RRT AE-C

BOLD GOAL: program is focused on creating healthy learning environments forall students, including reducing asthma triggers, through comprehensive indoor airquality and asthma management.

Healthy Children Learn Better

VALUE PROPO$ITION: Asthma Program

In the first year and for an input cost of $63,000, the program will reduce the number annual average school days missed by students with asthma from 8 to 7. This cumulative effect of a one day reductionin absenteeism by over 8000 asthma students will generate $267,552 in state revenue for North East Independent School District. Within 5 years we will change the culture, reduce absenteeism due to asthma by 50% generating $1 million in revenue gains each year, and will decrease the amount of lost academic instruction time due to asthma symptoms; ensuring studentswith asthma may achieve their full academic potential.

Costs of doing

nothing

• Webinars/Podcasts to admin• Staff development

Symptom threshold• Parent activities: PTA, ABO

•Student/Staff Activities-Asthma Obstacle Course

• Curriculum: Asthma and Environmental Quality

• AIMS Asthma: Incentivizing Management Skills

•Walkthroughs: Remove triggers from school environments

• Indoor environment quality best practices• TfS Six Technical Solutions• Tips for Healthy Learning

Environment • Symptom threshold

• Standardized Environmental Assessment• Facility scores feedback

•Emergency Nebulizer Policy

• Asthma Action Plans (ALL meds)

• NHLBI EPR 3 guidelines/ 6 priority messages Logic Model

• Health Check √ data•PRN usage tracking• Inspiratory flow assessment• Self-Carry Timeline

curriculum• Referral mechanism

• School District impact: Funding/Performance

•Quality of Life Surveys• Raise parent expectations• Staff disease awareness• Recruit champions (custodial,

nurses, PE staff, administrators )• Data, data, data• Return on investment

Awareness Medication & Tools

EducationEnvironment EducationEnvironment

Medication & ToolsAwareness

Asthma ControlAssess culture; reduce

environmental risks:Identify gaps; provide disease management strategies to stakeholdersto improve quality of life:

Provide tools/resources to reduce health care barriers:

Bring an understanding of prevalence and assess needs to improve processes district wide: O r g a n i z e

Stakeholders: students, parents, staff, community

C o m m u n I c a t e

NEISD Asthma Awareness Education ProgramDASHBOARD

Quality of Life SurveyAwareness Component: Bring an understanding of prevalence and assess needs to improve processes district wide

Target Population: students with asthma (6000)

Input: 1 FTE (Asthma Educator), NEISD research department staff member (3 hours)

Activities: plan QOL asthma survey, assess students QOL, familyburden/barriers (handout or online), evaluate results

Outputs: identified campus outliers and at risk populations:absenteeism, % of uncontrolled asthma, ER visits, limited activity, visits to clinic (classroom interruption)

Outcomes: Communicate results, campus/admin buy-in, policy changes, new policies, staff education on asthma triggers, asthma letter (welcome packet), Tips for Teachers

Impact: targeted outreach asthma education to community and bringing healthcare providers to NEISD families, increase asthma awareness, attendance, control symptoms, and increase student performance

Target Population: students with asthma with no medication or not responding to personal medication in clinic (8000)

Inputs: compressor/campus –capital outlay ($2000), supplies and albuterol (1.49/treatment) as needed

Activities: assess EMS calls/transports data, organize policy to close health care gaps (HS, MAC),

Outputs: provide an albuterol treatment for students who meet criteria, provide earlier intervention to reverse/minimize symptoms

Outcomes: decreased EMS calls, decreased EMS transports, decrease risk of death due to asthma, improve continuity of care with primary asthma physician

Impact: parents see NEISD as a partner and establishes a coordinated approach to asthma management, reduces cost of ER visit for parents, increases academic instruction time, attendance and student performance.

EMS calls- Nebulizer protocolMedication Component - Provide tools/resources to reduce health care barriers

Target Population: asthma students with quick-relief medication on campus

Input: 1 FTE AE-C

Activities: Assess nurses data for clinic visits for quick relief inhaler use

Outputs: Nurses to isolate symptom driven (PRN) inhaler use from scheduled symptom inhaler use. Track # PRN use to determine loss of classroom time due to symptoms occurring during the school day/classroom

Outcomes: Identify campus with outliers in PRN usage. Increase IAQinvestigations driven by health of students. Removal of stuffed animals, fragrances, wall-wall carpet, residential animals from classrooms. Communicate IAQ improves health of students and decrease clinic visits, identifying uncontrolled asthma (> PRN use 2 times/week) earlier

Impact: Development of electronic medical record (Healthcheck), Tracking asthma and IAQ symptoms to classroom where symptoms developed. Understanding ‘Reaching’ Symptom Threshold of administrators and staff, Proactive asthma management vs reactive, strategic use of facilities maintenance resources

Comparison of Inhalers/Nebulizers

0100020003000400050006000700080009000

10000

Aug/sept

Inhalers 2006-2007Inhalers 2007-2008Nebulizers 2006-2007Nebulizers 2007-2008

Tracking PRN dataMedication Component - Provide tools/resources to reduce health care barriers

Asthma Obstacle CourseEducation component: Identify gaps; provide disease management strategies to all stakeholders to improve quality of life of those with asthmaTarget Population: all campus staff, students, families

Input: 1 FTE AE-C, grant of $1500 (props)

Activities: plan hands-on asthma awareness education with a strong environmental component.

Outputs: increase # of teachers informed on asthma triggers, ‘experience’ symptoms that follow trigger exposure (set up during school day), and airway changesIncrease # of Families understanding the pathophysiology of asthma, triggers, medication actions (wellness/health fairs)

Outcomes: increase in staff trigger awareness/ IAQ best practices, trigger cause and effect, classroom self-assessment, increase asthma awareness, triggers, & symptoms to general population

Impact: Change in Culture: Asthma friendly classrooms/disease management. Reducing clinic visits and increase classroom instruction time. Teachers conceptualize healthy environments

Principals experiencing AOC

Teacher Self Assessment

of Classroom Environment

Environmental AssessmentsEnvironment component: Assess culture and reduce environmental risks

Target Population: all environmentally sensitive students & staff (asthma, allergy, migraines, chemical sensitivity, etc.)

Input: 1 FTE Indoor Air Quality, 1 FTE AE-C

Activities: campus assessment “Environmental Health” issue (submitted by campus via Electronic work order system), Healthcheck data driven classroom assessments, routine assessment of campus (walkthrough), distribution of Tips for Healthy Learning Environments

Outputs: Track # PRN use to determine origination of possible trigger location (classroom, building), remove triggers, IAQ assessment standards, training of teachers/administrators/custodians, communicate Symptom Threshold philosophy, Pollen count tracking

Outcomes: Identify campus and classrooms with outliers in PRN usage, increase in IAQ investigation requests, communicate IAQ benefits (improve health of students and decrease clinic visits), reduce maintenance costs (ex water intrusion events), end of year clean-out

Impact: Development of electronic Environmental Assessment software application, CHANGED CULTURE, IAQ/Asthma in parent/student manual, facilities staff buy-in, administrator buy-in, additional IAQ staff member, Symptom Threshold understanding

Teacher Tips• Given to teachers who have students with a diagnosis of asthma in their classroom

• Goal is to ensure students with asthma can achieve full academic potential by; Decreasing asthma /allergy symptoms Reduce disruption of classroom instruction timeAlleviate a potential emergency situation

• Proper asthma management involves • Access to MEDICATION • ENVIRONMENTAL trigger reduction

Bold Goals Value Proposition Overview Asthma Friendly Environments & Disease

Management Policies

Capture State Revenue: Potential Revenue Gains

Reduce Loss of Academic Instruction Time

Attendance Funding

Number of asthmatics in

NEISD schools

11.935%

8,361

Average number of school days missed by those with

asthma(CDC)

8

Attendance daily rate by

state

$32.00

Potential revenue

LOST

$2,140,416.00

Benefits possible when asthma/allergy control environmental measures applied:

Return on Investment

Reducing average number of schools days missed of those with asthma by 50%.....

$ 1,070,208.00/yearImproving all asthmatics’ attendance by only ONE day….

$ 267,552.00/year

PRN Inhaler Use = Loss of Academic Instruction Time

Total Academic Time Lost 26 min

Student symptomatic during class,

notifies teacher walks to clinic*

In clinic, nurse assesses

(symptoms, history, etc)

Gives inhaler, (2 puffs 1 min apart)

Wait time for med to work

Reasses student

Variable

Send back to class if symptoms

clear5 minutes 4 minutes

Asthma is an individual disease and responses to medication vary. This example is a best-case scenario in which a student responses appropriately to the first administration of quick relief inhaler and can promptly return to class.

* Buddy system used to escort to clinic

### In many instances, a second dose is required if student symptoms have not completed subsided at time of reassessment. In this case an additional 20 minutes of wait time is required before administration of 2nd dose.

0

20

40

60

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Campus A. Campus B. Campus C. Campus D. Campus E.

PRN

inhaler

usage

Benefits to Campus E Over Next Two MonthsAfter utilizing ‘Tips for Healthy Classroom’ best practices

Aug/Sept

October

November

December

January

February

March

0

20

40

60

80

100

120

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160

180

Campus A. Campus B. Campus C. Campus D. Campus E.

PRN

inhaler

usage

Elementary Campus ComparisonTips for Healthy Classroom Air

(Similar size, area, building age, demographics)Can you indentify which campus was NOT

following best practices?

Aug/Sept

October

November

December

January

IAQ influences PRN Inhaler Use

0

20

40

60

80

100

120

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180

Campus A. Campus B. Campus C. Campus D. Campus E.

PRN

inhaler

usage

Benefits to Campus E Over Next Two MonthsAfter utilizing ‘Tips for Healthy Classroom’ best practices

Aug/Sept

October

November

December

January

February

March

IAQ BEST PRACTICE Reduces PRN Inhaler Use

Reductions in Loss of Academic Instruction Time after IAQ Best Practices Applied

January 176 PRN visits

26 minutes

4576 minutes

February 106 PRN visits

26 minutes

2756minutes

April28 PRN visits

26 minutes

728 minutes

March46 PRN

visits26

minutes1196minutes

76 hours

50 hours

20 hours

12 hours

Bold Goals Value Proposition SummaryNEISD Asthma Awareness Education Program

Initial input cost of $63,000: • Financial Impact:

REDUCTION in annual average school days missedfor 8,000 students with asthma:1 day = $267,552; 50% = $1 Million

• Academic Impact: DECREASE in asthma related clinic visitsREDUCTION in Loss of Academic Instruction Time Reduce barriers for Asthma students: achieve full academic potential

• Human Impact: IMPROVED Quality of Life, Change in Culture

Create an environment conducive to learning for all students

and come to $choolHealthier children learn better…

Diane Rhodes BBA, RRT, AE-C, RCP

North East Independent School District

[email protected]