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After Success in 2 States, School-Based Asthma Management Program Goes Nationwide

 

A school-based asthma management program is being rolled out nationwide thanks to a partnership with student healthcare technology firm CareDox. The move could have big implications for kids with asthma — and their attendance records.

The nation’s 6 million children with asthma miss an estimated 14 million days of school each year as a result of the condition. Back in 2012, Children’s Hospital Colorado and the University of Colorado School of Medicine developed a program called “Building Bridges for Asthma Care,” which aimed to help school nurses learn best practices for managing student asthma cases. Since then, the program expanded to 28 elementary schools in Denver, Colorado, and Hartford, Connecticut.

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This month, school electronic health record (EHR) company CareDox said it plans to make the program available to the more than 7,100 schools where CareDox’s services are already in use.

Stanley Szefler, M.D., director of the Pediatric Asthma Research Program at Children’s Hospital Colorado and the CU School of Medicine, told MedTech Boston that the status quo for school asthma management is lacking.

“We consistently find that, in setting up our program for a school that is new to the program, most students have very poor technique with inhaled asthma medications, and they do not have an updated asthma action plan in the school,” he said. “And with that, they do not have a rescue inhaler available.”

The Building Bridges program provides school nurses with a template for asthma management, including identifying students with asthma, coordinating asthma care plans and training in asthma treatment and asthma medication administration.

The management plan also helps nurses track students who are missing a large amount of school because of asthma.

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“Sometimes the physician does not really understand how the child is doing in school in regard to school absence, inability to participate in physical activity and the impact of poor asthma control on school performance,” Szefler said.

When the child’s physician knows that data, it allows the doctor to dig deeper, considering allergies and whether current medications are sufficient. Such information could also prompt the doctor to consider how social determinants of health might be affecting the child.

“Then you can look at the big picture and be able to assemble resources and provide advice,” he said, adding that the Building Bridges system enables school nurses to move into a more active role as a health counselor.

That kind of intervention can have a significant impact on student attendance rates. Szefler and colleagues recently published a study looking at the impact of their program on 663 students with asthma in the Denver and Hartford school districts during the 2013-14 and 2014-15 school years. Participants had an absolute decrease in absenteeism of 22 percent. Meanwhile, the percentage of students with an asthma control test score of less than 20 dropped from 42.7 percent to 28.8 percent. And students who needed to use a bronchodilator more than twice per week dropped from 35.8 percent to 22.9 percent.

Szefler noted that the American Academy of Pediatrics recently published a policy statement urging physicians to promote school attendance and inquire about links between health and school attendance.

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When he speaks to schools about the program, Szefler gets a variety of responses. Some districts are quick to implement it, while others are hesitant to add a new software program. He said implementation is easiest when school districts have an “asthma champion” to help promote better management in schools. The Denver school system, for instance, has a chronic disease management team that helps ensure school nurses are equipped to handle caring for children with chronic conditions.

Szefler said he and his team are working “to identify the schools that are really interested in doing something, where they have a commitment to helping their students with chronic disease and then kind of giving them models to make it easy for them.”

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