1. Asthma Outcomes Pathway Lori Palensky Saint Elizabeth Foundation Lincoln, NE 9.14.09

2. A-S-T-H-M-A www.Bing.com says… www.Bing.com says… Asthma is a predisposition to chronic inflammation of the lungs in which the airways (bronchi) are reversibly narrowed. Asthma affects 7% of the population, and 300 million worldwide. Asthma is a predisposition to chronic inflammation of the lungs in which the airways (bronchi) are reversibly narrowed. Asthma affects 7% of the population, and 300 million worldwide.

3. BACKGROUND OF ASTHMA Devastating chronic disease Devastating chronic disease Public impact has increased over the last two decades Public impact has increased over the last two decades Qualifies as a public health epidemic Qualifies as a public health epidemic Nebraska-#2 Nebraska-#2

4. COMMUNITY ASTHMA EDUCATION INITIATIVE - CAEI CAEI launched in 1998 at Saint Elizabeth Regional Medical Center- CAEI launched in 1998 at Saint Elizabeth Regional Medical Center- Funding- Funding- Asthma Coordinator Asthma Coordinator 30 Agencies - 30 Agencies -

5. CAEI Management of Asthma 1. Healthcare Provider Education Pyramid 2. Family Asthma Adventure 3. Pharmacist Intervention 4. Asthma Awareness 5. Asthma Surveillance Developed to bridge the patient-provider communication gap.

6. FUNDERS THROUGH THE YEARS Saint Elizabeth Regional Medical Center Saint Elizabeth Regional Medical Center Pharmaceutical Pharmaceutical EPA EPA Private and Community Based Organizations Private and Community Based Organizations

7. ASTHMA OUTCOMES PATHWAY Catholic Health Initiative – Mission & Ministry Fund through the Saint Elizabeth Foundation

8. Asthma Outcomes Pathways 1. Task Force formed 2. AHRQ Face-to-Face 3. 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

9. ASTHMA PATHWAY Outreach Identify Patients Most at Risk Age Census Tract NESW Socioeconomic Status Race Numbers No Medical Home Assessment Begin Asthma Action Plan (Intervention/Identification) ASTHMA PATHWAY Outreach Identify Patients Most at Risk Age Census Tract NESW Socioeconomic Status Race Numbers No Medical Home  Assessment Begin Asthma Action Plan (Intervention/Identification) 

10. ASTHMA PATHWAY CONTINUED Intervention Specific-Education & Referral Barrier Barrier Barrier Reduction Reduction Reduction       EnvironmentalMedical HomeMedical Management Assessment Review       OutcomeOutcomeOutcome Finalize Asthma Action Plan  Follow-up Follow-up Short term – Outputs Short term – Outputs Long term – Clinical methods Long term – Clinical methods

11. “Penelope” Web-based case management Web-based case management Provides connectivity for Head Start school nurses and ED case managers Provides connectivity for Head Start school nurses and ED case managers Utilizes customized care algorithms Utilizes customized care algorithms Prints vouchers and maintains inventory of funds Prints vouchers and maintains inventory of funds Stores data for outcomes and reporting Stores data for outcomes and reporting

13. Case Managers Outcomes Pathways streamlines their workload using algorithms for protocols and readily available vouchers for barrier reduction Outcomes Pathways streamlines their workload using algorithms for protocols and readily available vouchers for barrier reduction These “finders” are familiar and trusted by the target group These “finders” are familiar and trusted by the target group These “finders” are invested in the target groups and in connections for barrier reduction These “finders” are invested in the target groups and in connections for barrier reduction Penelope connects Head Start, schools and Emergency Departments Penelope connects Head Start, schools and Emergency Departments

14. How is this improving access? The medical community becomes accountable to each other – ‘ it takes a village approach’The medical community becomes accountable to each other – ‘ it takes a village approach’ Bridges the communication gapBridges the communication gap Provides an evidence based programProvides an evidence based program A kinder and gentler approach forA kinder and gentler approach for health care with the indigent.

15. Outcomes Reduced duplication of services Reduced duplication of services Unites at-risk population to evidence based intervention Unites at-risk population to evidence based intervention Identify and overcome barriers to care Identify and overcome barriers to care Reduces exacerbation through asthma management education Reduces exacerbation through asthma management education Reduced number of sick days at school and work Reduced number of sick days at school and work Number of symptom free days increase Number of symptom free days increase Decrease recurrent visits in Emergency Departments Decrease recurrent visits in Emergency Departments

16. Asthma Outcomes Pathway Future Continue to add to the number of Outcomes Asthma Pathways Continue to add to the number of Outcomes Asthma Pathways Foster and maintain relationships with community partners Foster and maintain relationships with community partners Once the pediatrics population is saturated develop the second pathway for the elderly population Once the pediatrics population is saturated develop the second pathway for the elderly population Share and mentor other communities in Nebraska. Share and mentor other communities in Nebraska.

17. Thank You, for your time. For more information: Saint Elizabeth Foundation 6900 ‘L’ Street, Suite 100 Lincoln, NE 68510 402.219.7051 LPalensky@stez.org http://www.SaintElizabethOnline.com http://www.SaintElizabethOnline.com