Modified School-Based Asthma Therapy Targeting Poorly Controlled Asthma

Abstract

SESSION TITLE: Pediatric Pulmonary SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 25, 2016 at 02:45 PM - 04:15 PM PURPOSE: School aged children suffer significant asthma morbidity. School nurses(SNs) are uniquely able to identify children with poor asthma control. School administered controller therapy efficacy has been proven by Halterman Arch Pediatr Adolesc Med. 2011;165(3):262-268. This study describes the growth of a School Based Asthma Therapy(SBAT) program modified to identify enrollees via SN and primary asthma provider referral and evaluates how successfully it identifies poorly controlled asthmatics and reduces disease morbidity. METHODS: The Asthma Quality Improvement program at Nationwide Children’s Hospital (NCH) supports an SBAT program that began in 16 local schools during 2013-2014. SNs, and less often primary asthma providers, refer students with problematic asthma after introducing SBAT to their guardians. Controller therapy is adjusted post discussion with the primary asthma provider, insurance authorization is obtained, inhalers are provided to home and school, then doses are administered at least daily at school. If follow-up evaluations using Asthma Control Test(ACT) scores identify a child in ongoing poor control, asthma providers are alerted and medications adjusted. Numbers of participating schools and students were tracked as markers of program expansion. ACT scores collected prior to starting SBAT were compared to follow-up ACT score results from current enrollees using Mann-Whitney test. Students enrolled for at least one year were evaluated re healthcare utilization. Measured in mean events/student/year±SD, NCH Emergency Department (ED) use, inpatient stays (IP), and Intensive Care Unit (PICU) care for one year prior to enrollment were compared to one year post-enrollment using the Wilcoxon matched-pairs signed rank test. RESULTS: By late March of the 2015-2016 school year, the SBAT program grew to 269 students from 129 schools. Average age at enrollment was 9.2±2.8 years. 92% had Medicaid insurance. Median ACT score pre enrollment were 16 (25-75%ile 13-19, n=230); most recent follow-up ACT scores improved to 22 (25-75%ile 20-24, n=211), p<0.0001. Healthcare utilization fell in the 84 SBAT student participants enrolled ≥ 12 month. Mean ED use decreased from 0.87±1.12 to 0.42±0.97 (p=0.0003). Mean IP visits decreased from 0.42±0.69 to 0.09±0.36, p<0.0001. Mean PICU use fell from 0.30±0.55 to 0.02±0.15, p<0.0001. CONCLUSIONS: Our modified SBAT program, driven by SN and asthma provider referrals, successfully identifies children with poor asthma control, reflected in initial low ACT scores and high healthcare utilization. Its positive reception by local schools is evidenced by its rapid expansion. SBAT improves asthma morbidity, reflected by improving ACT scores, and decreased utilization of ED/IP/PICU resources in the year following initial enrollment. Once children have been enrolled >1 year, subsequent analyses will incorporate the Adjustment for “Natural Declines in Asthma Outcomes (ANDAO)”(Ko, Song, & Clark, 2014) to adjust for lack of a control group. CLINICAL IMPLICATIONS: School nurses and asthma providers appropriately identify children in poor asthma control who can benefit from a school based intervention that improves communication between SNs, providers and parents and increases compliance with controller therapy. DISCLOSURE: The following authors have nothing to disclose: Elizabeth Allen, Courtney Rowe, Jessica Vehr, Myra Weiler, Kimberly Arcoleo, William Long No Product/Research Disclosure Information