Asthma Outcomes Pathway

Lori PalenskyLori PalenskySaint Elizabeth FoundationSaint Elizabeth Foundation

Lincoln, NELincoln, NE9.14.099.14.09

A-S-T-H-M-AA-S-T-H-M-A www.Bing.com says…www.Bing.com says…

AsthmaAsthma is a predisposition to chronic is a predisposition to chronic inflammation of the lungs in which the inflammation of the lungs in which the airways (bronchi) are reversibly airways (bronchi) are reversibly narrowed. Asthma affects 7% of the narrowed. Asthma affects 7% of the population, and 300 million worldwide. population, and 300 million worldwide.

BACKGROUND OF ASTHMABACKGROUND OF ASTHMA

Devastating Devastating chronic diseasechronic disease

Public impact Public impact has increased has increased over the last two over the last two decadesdecades

Qualifies as a Qualifies as a public health public health epidemicepidemic

Nebraska-#2Nebraska-#2

COMMUNITY ASTHMA COMMUNITY ASTHMA EDUCATION INITIATIVEEDUCATION INITIATIVE - - CAEICAEI

CAEI launched in 1998 at Saint Elizabeth CAEI launched in 1998 at Saint Elizabeth Regional Medical Center- Regional Medical Center-

Funding-Funding-

Asthma Coordinator Asthma Coordinator

30 Agencies - 30 Agencies -

CAEI Management CAEI Management of Asthmaof Asthma

1. Healthcare Provider Education Pyramid1. Healthcare Provider Education Pyramid

2. Family Asthma Adventure2. Family Asthma Adventure

3. Pharmacist Intervention3. Pharmacist Intervention

4. Asthma Awareness4. Asthma Awareness

5. Asthma Surveillance5. Asthma Surveillance

Developed to bridge the patient-provider communication gap.

FUNDERS THROUGH FUNDERS THROUGH THE YEARSTHE YEARS

Saint Elizabeth Regional Medical Saint Elizabeth Regional Medical CenterCenter

Pharmaceutical Pharmaceutical EPAEPA Private and Community Based Private and Community Based

OrganizationsOrganizations

ASTHMA ASTHMA OUTCOMES PATHWAYOUTCOMES PATHWAY

Catholic Health Initiative – Catholic Health Initiative –

Mission & Ministry Fund through the Mission & Ministry Fund through the

Saint Elizabeth Foundation Saint Elizabeth Foundation

Asthma Outcomes PathwaysAsthma Outcomes Pathways

1. Task Force formed2. AHRQ Face-to-Face3. Recruit partners-form

liaison with ED Connection

4. Work groups assemble pathway – technical assistance Dr. Redding

5. Define barriers and embed into pathways process

6. Determine outcome measures specific to intervention

7. Finders and connectors trained with referral mechanism

8. Develop return on investment, and create audit system

9. Begin documenting

10. Build system for review and quality assurance

ASTHMA PATHWAYASTHMA PATHWAY

OutreachOutreachIdentify Patients Most at RiskIdentify Patients Most at Risk

AgeAgeCensus Tract NESWCensus Tract NESW

Socioeconomic StatusSocioeconomic StatusRaceRace

NumbersNumbersNo Medical HomeNo Medical Home

AssessmentAssessmentBegin Asthma Action PlanBegin Asthma Action Plan(Intervention/Identification)(Intervention/Identification)

ASTHMA PATHWAY CONTINUEDASTHMA PATHWAY CONTINUED

Intervention Specific-Education & ReferralIntervention Specific-Education & Referral

Barrier Barrier BarrierBarrier Barrier Barrier

ReductionReduction Reduction Reduction ReductionReduction

EnvironmentalEnvironmental Medical HomeMedical Home Medical Medical

ManagementManagementAssessmentAssessment Review Review

OutcomeOutcome OutcomeOutcome OutcomeOutcome

Finalize Asthma Action PlanFinalize Asthma Action Plan

Follow-upFollow-up Short term – OutputsShort term – Outputs

Long term – Clinical methodsLong term – Clinical methods

““Penelope”Penelope” Web-based case managementWeb-based case management

Provides connectivity for Head Start school Provides connectivity for Head Start school nurses and ED case managersnurses and ED case managers

Utilizes customized care algorithmsUtilizes customized care algorithms

Prints vouchers and maintains inventory of fundsPrints vouchers and maintains inventory of funds

Stores data for outcomes and reportingStores data for outcomes and reporting

Case ManagersCase Managers Outcomes Pathways streamlines their workload using Outcomes Pathways streamlines their workload using

algorithms for protocols and readily available algorithms for protocols and readily available vouchers for barrier reductionvouchers for barrier reduction

These “finders” are familiar and trusted by the target These “finders” are familiar and trusted by the target groupgroup

These “finders” are invested in the target groups and These “finders” are invested in the target groups and in connections for barrier reduction in connections for barrier reduction

Penelope connects Head Start, schools and Penelope connects Head Start, schools and Emergency Departments Emergency Departments

How is this How is this improving access?improving access?

• The medical community becomes accountable The medical community becomes accountable to each other – ‘ it takes a village approach’ to each other – ‘ it takes a village approach’

• Bridges the communication gap Bridges the communication gap

• Provides an evidence based programProvides an evidence based program

• A kinder and gentler approach for A kinder and gentler approach for health care with the indigent. health care with the indigent.

Outcomes Reduced duplication of servicesReduced duplication of services Unites at-risk population to evidence based Unites at-risk population to evidence based

interventionintervention Identify and overcome barriers to careIdentify and overcome barriers to care Reduces exacerbation through asthma Reduces exacerbation through asthma

management educationmanagement education Reduced number of sick days at school and workReduced number of sick days at school and work Number of symptom free days increaseNumber of symptom free days increase Decrease recurrent visits in Emergency Decrease recurrent visits in Emergency

DepartmentsDepartments

Asthma Outcomes PathwayAsthma Outcomes PathwayFutureFuture

Continue to add to the number of Outcomes Continue to add to the number of Outcomes Asthma PathwaysAsthma Pathways

Foster and maintain relationships with community Foster and maintain relationships with community partnerspartners

Once the pediatrics population is saturated Once the pediatrics population is saturated develop the second pathway for the elderly develop the second pathway for the elderly populationpopulation

Share and mentor other communities in Share and mentor other communities in Nebraska. Nebraska.

Thank You,for your time.

For more information:

Saint Elizabeth Foundation6900 ‘L’ Street, Suite 100

Lincoln, NE 68510 402.219.7051

LPalensky@stez.org http://www.SaintElizabethOnline

.com