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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
80
100
120
140
160
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
0
20
40
60
80
100
120
140
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
140
160
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