Program reduces asthma visits, admits

The Asthma Management Program at Children's Medical Center in Dallas is a good example of a best practice in education. It received certification from The Joint Commission in 2003 for disease-specific care for pediatric asthma.

Outcome measurements show that the program is working well. As of December 2010, there has been a 77% reduction in the number of asthma-related inpatient admissions, emergency department visits, and unscheduled visits to the primary care physician. Missed school or day care days have been reduced by 76%; the number of days a caregiver missed work due to the child's asthma has been reduced 87%; and there has been an increase of 21% on the Asthma Quality of Life score.

To meet The Joint Commission's requirements for certification, the six-month, outpatient program launched in 2001 follows the education guidelines of the National Heart Lung Blood Institute. ("Guidelines for the Diagnosis and Management of Asthma" used at Children's Medical Center in Dallas can be obtained at www.nhlbi.nih.gov. )

"We help parents and caregivers do a better job of managing their child's asthma by focusing on asthma education and self-management skills," says Robin Brown, RN, BSN, AE/C, program manager.

The bilingual program (English and Spanish) covers common issues associated with the way to manage asthma that includes learning about good asthma control, common triggers and how to mitigate against them, proper use of medications, and signs of an asthma attack and how to respond.

Education takes place bimonthly during telephone conversations with a certified asthma educator and during two home visits by an asthma specialist. At a home visit, the educator is able to observe the child administering the medications and, if the technique is poor, teach the proper way to administer the medicine.

Also while in the home, the educator looks for possible asthma triggers and teaches families how to eliminate them. If a child is allergic to a pet and is symptomatic when around it, the educator suggests the pet is removed from the home, says Brown.  If a family cannot part with the pet, the educator recommends it remain outdoors or at least out of the child's bedroom.

The family is provided with asthma management tools including an asthma action plan, a peak flow meter, a holding chamber, a medication bag to keep all the child's medicines in one place, a pillow encasement to control for dust mites, and various asthma education materials. The action plan helps families take the correct steps in preventing asthma attacks by routinely using controller medications, adding the use of the reliever inhaler when symptoms occur, and seeking medical attention at the appropriate time. A peak flow meter helps families determine a child's lung function and identify a change in symptoms or worsening of symptoms. The holding chamber is a tube in which the inhaler is placed to administer medications correctly.

The bimonthly phone calls from educators are made Monday through Friday during daytime hours, so when families are enrolled they are asked their preference on the time of day to call. The first home visit is done within the first month of the program and can be scheduled in the evenings or on weekends.

The education is geared for a partnership of care, therefore educators will speak with the school nurse, a teacher, a coach, and other caregivers for the child, says Brown.

It is strictly an education program and does not provide any medical management. Assessing and monitoring asthma severity and control is done by the primary healthcare provider. Most patients are referred by a physician, as they are considered high risk because they have had multiple hospitalizations and visits to the emergency department.

Resource

The educational materials used in the Asthma Management Program can be accessed at www.childrens.com. Select "Specialties" and then "Asthma Management Program." The link to the materials is imbedded within a short description of the program within the paragraph on home visits. The educational materials are in English and Spanish and cover such topics as "what is asthma," "asthma medications," and "asthma triggers."