How well are we addressing Asthma Disparities How well are we addressing Asthma Disparities? Demonstration of a Self-Study Toolkit Robin Shrestha-Kuwahara, MPH, Maureen Wilce, MS Centers for Disease Control and Prevention November 12, 2010 AEA, San Antonio, TX National Center for Environmental Health Air Pollution and Respiratory Health Branch

Session Objectives Session Objectives: To present background on development of Asthma Disparities Self-study Toolkit To share cultural competency assessment tool from Toolkit To solicit your ideas on the tool, its usefulness, ways to improve it Small group exercise – 20 minutes Report back – 10 minutes

The Context One of overarching public health goals is to eliminate health disparities Disparities in prevalence, severity, morbidity, and mortality of asthma Asthma disparities have multiple, complex, and interrelated sources Inadequate access to care Substandard quality of care

Asthma – Definition, Risk Factors Asthma: chronic inflammatory disorder of the airways characterized by recurrent episodes of breathlessness and wheezing Risk factors increased by: Hereditary and environmental factors Family history Other genetic factors affect responsiveness to medications Exposure to airborne allergens and other irritants trigger asthma attacks

Burden of Asthma 20 million people in the US currently diagnosed with asthma 12 million experienced an asthma episode in the previous year Annually: 14 million office visits 2 million emergency room visits Half a million hospitalizations 4,000 Americans die from asthma $56 billion spent on asthma (‘07)

Asthma in U.S. Minorities Current asthma prevalence among children Black children slightly higher prevalence than white children, however . . . Emergency department visits are ~3x higher among black children Mortality rates ~4-5x higher Puerto Rican children have highest rates of asthma (19%) Asthma morbidity and mortality among adults Prevalence higher among blacks than among whites, but Mortality is 3x higher among blacks Mortality rate of Puerto Ricans 3x that of non-Latino whites American Indians and Alaska Natives higher prevalence than whites

CDC’s National Asthma Control Program Created in 1999 Supports the goals and objectives of Healthy People 2010 for asthma Based on the 3 public health principles: Surveillance; Interventions; Partnerships Program’s goals: Reduce deaths, hospitalizations, emergency department visits Reduce school /work days missed Reduce limitations on activity due to asthma

Strategies to Reduce Asthma Disparities Target many aspects of asthma care Policies and regulations Operation of the health care system Barriers to care Social/environmental factors Provider-level factors, including communication skills and cultural competence training

Need for Cultural Competence Importance of addressing disparities in health and health care is magnified by the rapidly changing demographics of the nation “Cultural Competence” -- a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations (HRSA) Being respectful of and responsive to diverse patients will facilitate positive health outcomes

Asthma Disparities Logic Model

Asthma Disparities Toolkit 2009-2010 – CDC developing Self-study Asthma Disparities Toolkit Purpose: To guide asthma grantees and their partners in identifying, developing, implementing, and evaluating appropriate interventions to reduce relevant asthma disparities Grounded in the Office of Minority Health’s Strategic Framework and CDC Evaluation Framework 5 units, planning and assessment tools, other resources Integrates the 14 CLAS Standards

14 Culturally and Linguistically Appropriate Service (CLAS) Standards Office of Minority Health’s (OMH) approach to improving cultural and linguistic competency in health care Standards 4, 5, 6, 7 are mandates for all recipients of federal funds Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13 recommended for adoption as mandates Standards 1-3 Culturally competent care Standards 4-7 Language access services Standards 8-14 Organizational supports for cultural competence

The Cultural Competency Assessment Tool for Asthma Programs Purpose: to identify strengths and areas for improvement regarding cultural competency Individual assessment process Diverse staff reflective of communities served Represent wide range of positions Consensus process Staff participate in collective assessment, prioritize areas for improvement, build consensus Develop an action plan – implement and evaluate Disseminate findings

Small Group Exercise – 20 minutes Report Back – 10 minutes Have groups briefly review CC Assessment tool Split groups into “direct service providers” and “state-level administrators” From your group’s “perspective”, brainstorm how you expect each CLAS standard would be manifested Record these indicators on the Worksheet Representative of each group report back

Contact Us! Robin Shrestha-Kuwahara CDC, National Center for Environmental Health Air Pollution and Respiratory Health Branch rbk5@cdc.gov – 770.488.0791 Maureen Wilce muw9@cdc.gov – 770.488.3721