Utah County Asthma Plan

Transcription

1 Utah County Asthma Plan

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3 Table of Contents Section 1: The Problem... 4 Table 1. Current Asthma Prevalence Figure 1. Age at First Diagnosis Among Adults with Lifetime Asthma, Utah County, Table 2. Utah County Air Quality Table 3. Utah County Ozone Figure 2. Asthma Attack Among Adults and Children with Current Asthma During Past 12 months, Figure 3. Environmental Triggers in the Homes of Adults and Children with Current Asthma, Utah County, Combined... 7 Figure 4. Asthma Hospitalizations by Age Group, Figure 5. Asthma Emergency Department Treat and Release Visits, Figure 6. Asthma Mortality Rate by Age, Section 2: Utah County Background Section 3: The Plan Asthma Management Health Systems Population Issues Risk Factors Appendices Utah County Asthma Coalition Participants Performance Measures Asthma Management Healthy Systems Population Issues Risk Factors P a g e

4 Section 1: The Problem Asthma is a chronic lung disease caused by airway inflammation that results in a reversible airflow obstruction. An asthma attack can sometimes turn deadly if medications are not readily available. Asthma is one of the ten leading chronic conditions that restrict activity and is a leading cause of missed school days in the United States. (Healthy People 2010) Asthma Prevalence Asthma prevalence is one of the foremost indicators to measure and track the burden of disease among population groups. Since 2001, asthma prevalence has been increasing in Utah, which is similar to increasing trends nationwide. Lifetime asthma is defined as having ever been diagnosed with asthma by a doctor or other health professional. Current asthma is defined as those who have ever been diagnosed with asthma by a doctor or other health professional and who report that they still have asthma. Table 1. Current Asthma Prevalence Age Group Utah County percent (95% CI) State of Utah percent (95% CI) Children ( ) 7.0 ( ) Adults ( ) 8.1 ( ) ( ) 8.5 ( ) ( ) 8.8 ( ) ( ) 7.9 ( ) Asthma prevalence data source: Behavioral Risk Factor Surveillance System Crude prevalence. 4 P a g e

5 Figure 1. Age at First Diagnosis Among Adults with Lifetime Asthma, Utah County, % 5% 2% * 18% 44% <= % Data source: Behavioral Risk Factor Surveillance System Crude prevalence. *Estimate has a coefficient of variation greater than 30% and does not meet Utah Department of Health standards for reliability. The majority of Utah County adults who have ever been diagnosed with asthma (65%) were diagnosed by age 17. Air Quality The Environmental Protection Agency (EPA) has established health-based National Ambient Air Quality Standards (NAAQS) which consider both concentration level and duration of exposure that can cause adverse health effects. Pollution concentrations that are higher than the NAAQS are considered unhealthy. Particulate Matter (PM 2.5 ) Table 2. Utah County Air Quality City Estimated days over 24-hour standard* Lindon 12 Provo 6 *Compared with the National Ambient Air Quality 24-hour Standard for PM 2.5 of 35 μg/m 3 Wintertime temperature inversions act to trap air in valleys long enough for concentrations of PM 2.5 to build up to levels that can be unhealthy. These particles are so small that they can become embedded in 5 P a g e

6 Percentage human lung tissue, further harming those with respiratory diseases and cardiovascular problems. Depending on where one resides in Utah County, there were between six and twelve days when PM 2.5 levels exceeded the EPA national standard. Ozone Table 3. Utah County Ozone 2007 Estimated days over 8-hour standard* North 8 Central 4 South 5 *Compared with the National Ambient Air Quality 8 hour Ozone Standard of.075 ppm Ozone production is a year-round phenomenon. However, the highest ozone levels occur during the summer when strong sunlight, high temperatures, and stagnant meteorological conditions combine to drive chemical reactions and trap the air within a region for several days. In Utah County during 2007, there were between four and eight days where the EPA standard for ozone was exceeded. Asthma Management and Quality of Life Frequency and severity of asthma symptoms and quality of life are indicators of one s management of asthma. Figure 2. Asthma Attack Among Adults and Children with Current Asthma During Past 12 months, Utah County Utah * Age Group (years) 6 P a g e

7 Data source: Behavioral Risk Factor Surveillance System and Call-back Survey Crude prevalence. *Estimate has a coefficient of variation greater than 30% and does not meet Utah Department of Health standards for reliability. In each age group, the number of residents who had experienced an asthma attack in the past 12 months was similar for Utah County and Utah. Indoor Environmental Exposures Because people generally spend the majority of their time indoors, environmental factors in the home can play an important role in triggering asthma attacks. Environmental modifications can be made in the home to reduce exposure to these triggers and reduce asthma symptoms. Figure 3. Environmental Triggers in the Homes of Adults and Children with Current Asthma, Utah County, Combined Wood burning fireplace or stove used in home Gas used for cooking ** 13.1* Adults * Child Pets allowed in bedroom Indoor pets * Carpeting or rugs in bedroom Percent Data source: Behavioral Risk Factor Surveillance System, Call-back Survey Crude prevalence. *Estimate has a coefficient of variation greater than 30% and does not meet Utah Department of Health standards of reliability. **Estimate has a coefficient of variation >50% and is not considered appropriate for publication. Keeping pets out of bedrooms is one simple, low cost indoor environmental change that could reduce triggers for Utah County residents with asthma. As the data show, among adults and children with current asthma who have pets, 83.4% of children and 50.8% of adults reported allowing their pets in their bedroom. 7 P a g e

8 Inpatient Hospital Visits per 10,000 Health Care Utilization Emergency department (ED) and hospitalization data are taken from the Utah Inpatient Hospital Discharge Database and the Utah Emergency Department Encounter Database. Because hospitalizations are often a result of ED visits, only treat and release encounters are included in the ED data. In several of these figures, Healthy People 2010 Goals are shown in comparison with Utah County and state data. Healthy People (HP2010) is a comprehensive set of disease prevention and health promotion objectives of the nation. Hospitalizations Figure 4. Asthma Hospitalizations by Age Group, Utah County Utah HP Under Age group (years) Source: Utah Hospital Discharge Database, Crude rates. Note: The primary diagnosis code ICD 493 was used to identify hospitalizations due to asthma. 8 P a g e

9 ED Encounters per 10,000 Emergency Department Visits Figure 5. Asthma Emergency Department Treat and Release Visits, Utah County Utah Under Age group (years) 15.0 Source: Utah Emergency Department Encounter Database, Crude rates. Note: The primary diagnosis code ICD 493 was used to identify emergency department visits due to asthma. Data include only those who were treated and released but not admitted as inpatients. 9 P a g e

10 Deaths per 1,000,000 Asthma Mortality Asthma-related deaths are rare and most commonly occur among the elderly population. Due to the small number of asthma deaths among some age groups, data were not reportable for the youngest age groups. Figure 6. Asthma Mortality Rate by Age, Utah County Utah HP 2010 Goal * ** ** ** ** ** Under Age Group (years) Source: Utah Death Certificate Database, combined. Crude rates. Note: ICD-10 codes J45 and J46 were used to identify asthma as the primary cause of death. *Estimate has a coefficient of variation greater than 30% and does not meet Utah Department of Health standards for reliability. **The estimate has a coefficient of variation >50% and is not considered appropriate for publication. 10 P a g e

11 Section 2: Utah County Background Recognizing asthma is a major health problem among US children, and presents a special challenge for Latino communities, a group of graduate students from Brigham Young University (led by Gene Cole, DrPH) conducted an initial needs assessment in The purpose of the study was to identify existing asthma educational and resource gaps relative to the Latino population in Utah County. The results and recommendations from this study were presented to the Utah Asthma Task Force in April 2008; shortly after the Utah County Health Department applied for and received a mini-grant from the Utah Asthma Program to implement recommendations made to address the gaps identified in the initial needs assessment as well as to form a local asthma coalition. The Utah County Health Department applied for and received additional funding in 2009 from the Utah Asthma Program. This cooperative funding extended to two local health departments (Utah County Health Department being one of them) was designed to develop capacity to implement effective social, environmental, policy, and system approaches and increase asthma self management education utilizing the Utah Asthma Plan to help reduce the burden of asthma in Utah. Utah County Health Department Asthma Program Utah County Asthma Program Vision Improving lives of those with asthma. Mission Collaborate between groups and sectors of the community, in which each group retains its identity but all agree to work together toward improving life for those with asthma based on the following principles: Enhance and develop partnerships. Promote use of best practices. Share resources. Facilitate open communication. The Utah County Asthma Coalition (UCAC), the first local coalition in Utah County to address asthma, was formed in 2008 with funding from the Utah Asthma Program. Initially the purpose of the coalition was to build successful partnerships organizations/programs that either serve the Latino population or that address asthma and identify opportunities to promote asthma awareness. Members of the UCAC met 4 different times during Fiscal Year 2009 and identified various opportunities to promote asthma awareness. In October 2009, the UCAC started meeting to develop the Utah County Asthma Plan. 11 P a g e

12 The following are highlights of the Utah County Asthma Coalition to date: Schools Conducted asthma awareness week activities at a local elementary school as part of the Asthma School Advocate Project. 5 representatives from Utah County participated in the Asthma School Advocate Project. Created database of all 118 public schools in Utah County identifying what asthma interventions have occurred at each school and when. Healthy Systems and Professionals Established partnership with 2 asthma specialists in Utah County: Dr. Matheson and Dr. Yeates. Presented local asthma data and coalition projects to Provo Medical Coalition and to 29 Utah County School Nurses. Established partnership with Intermountain Healthcare s Pediatric Asthma Workgroup. Communities Environmental Other Surveyed 70 parents attending event sponsored by Centro Hispano to assess asthma prevalence among Hispanic population. Educated 100 kids along with their parents at the Day for Kids event sponsored by Centro Hispano. Promoted Winning with Asthma across the county to various organizations. A $1,500 grant was awarded by BYU s Office of Research and Creative Activities to conduct indoor home assessments. Conducted 30 indoor home assessments in multifamily dwelling units. Conducted 2 focus groups with participants of indoor home assessments. 181 Utah County WIC clients educated about asthma through bilingual asthma online class. 150 Utah County WIC clients educated about asthma through Interactive Bulletin Board. Presented at various locations within the county about asthma and coalition projects. 12 P a g e

13 Section 3: The Plan Improving lives of those with asthma. Asthma Management Health Systems Population Issues Risk Factors 13 P a g e

14 Asthma Management One of my asthmatic students had been sharing an inhaler with her mom and sibling. The problem I found is the mom would usually end up taking the inhaler with her to work, but the mother worked in a different town from where her daughter went to school. So whenever this student needed the inhaler we would need to call the mom who would then need to drive it over to the school. --Stacy (Utah County School Nurse) February P a g e

15 Asthma Management (e.g. 65 and older, uninsured, low income) Mission: To assist people with asthma in improving their quality of life by providing the tools and resources necessary to maximize and promote wellness. Objective 1: To increase awareness of how asthma affects daily life activities. Strategies: 1. Develop, promote and distribute asthma education materials in the community to be used by people with asthma, their caregivers, and the general public. 2. Identify and recruit community partners. 3. Recruit volunteers to assist in asthma education in the schools. Desired Outcomes: Improve quality of life for those with asthma. Increase number of community partners. Decrease number of school and work days missed because of asthma. Objective 2: Assist people dealing with asthma to understand the disease process and possible treatments and strategies. Strategies: 1. Identify, increase the number of and promote asthma educators and their services. 2. Encourage health systems and physicians to refer patients to asthma educators and pharmacy education programs. 3. Promote Asthma Program Web site, including education materials, data/research, and resources. Desired Outcomes: Increase use of and compliance with asthma treatment plans. Objective 3: Increase patient ownership in their individual treatment plans. Strategies: 1. Increase the use of asthma action and management plans. 2. Improve follow-up, well patient check-ups and education including proper technique for all asthma patients through a variety of methods. 3. Increase outreach by asthma educators. 4. Create and promote a database of clinics with extended hours. 15 P a g e

16 Desired Outcomes: Improve self-management skills. Increase use of compliance with asthma management/action plans. Objective 4: Improve access to asthma management systems. Strategies: 1. Identify those who are insured, underinsured, uninsured, and where they live. 2. Improve marketing of asthma management services. 3. Collaborate with emergency departments, urgent care facilities and community health centers to improve asthma education. 4. Implement Living Well with Chronic Conditions, Stanford University s Chronic Disease Self-Management Program (a program that teaches self-management skills) in Utah County to increase self-management knowledge and behavior among people with asthma, especially those at increased risk because of age, race, ethnicity, poverty, or geographic isolation. 5. Develop and implement a pharmacy education program. Desired Outcomes: Increase utilization of asthma educators. Increase information regarding asthma management services. Objective 5: Promote awareness of how the social/cultural environment affects asthma management. Strategies: 1. Understand the asthma burden in diverse communities. 2. Build partnerships in the community to improve access to culturally appropriate self-management education and resources. 3. Provide community partners access to asthma education materials and encourage distribution of materials. 4. Develop and promote asthma education materials to be used by people with asthma, their caregivers, and the general public. Continue to ensure that asthma materials are appropriate for the populations for whom they are intended. 5. Develop and promote clinically accurate asthma education materials that are culturally appropriate and easy to use by diverse populations. 6. Enhance and expand culturally appropriate asthma awareness campaigns aimed at at-risk and/or disparate populations. 16 P a g e

17 Desired Outcomes: Increase awareness of asthma burden in diverse communities. Increase collaboration with community partners. Improve access to asthma resources. Objective 6: Assure state laws and policies reflect sound asthma management. Strategy: 1. Educate caregivers, providers, schools and people with asthma and their parents about asthma policies in their schools. Desired Outcome: Increase awareness of laws and policies that impact asthma care. 17 P a g e

18 Health Systems When the first of our three children was diagnosed with asthma, he was hooked up to oxygen and receiving IV steroids in the pediatric ward of the hospital. I was quite shocked! I had my suspicions that he had asthma, and I had recently taken him to the pediatrician with an article listing common asthma symptoms. I was assured there was nothing to worry about. A short time later, there we were in the pediatric ward of the hospital. The respiratory therapist said, You know he has asthma, right? My mouth dropped open and I sputtered, the pediatrician said he doesn t have asthma! The respiratory therapist said, Well, he does. When I told him I didn t know that much about asthma, he returned with 30 pages of articles from the internet. After telling me to read through the stack, he plopped them on the bedside table and left. I m the type of person that read through everything, highlighted areas, and repeatedly called him to ask questions. Learning about asthma is very overwhelming. The medication, equipment, and terminology can be quite intimidating. It took several years (and many mistakes) before I was really comfortable in treating asthma and felt like I knew what I was doing. --Andrea January P a g e

19 Health Systems (e.g. Allergy Specialists) Mission: Assist the health care system to provide access to appropriate care as defined by National Asthma Education Prevention Program (NAEPP) guidelines. Objective 1: Promote available resources to patients and providers to encourage the underinsured and uninsured to seek appropriate care. Strategies: 1. Educate health care providers and patients about available resources. 2. Promote available resources through a variety of channels. 3. Use information obtained under objective 3 to inform the Utah County Asthma Coalition about needs and methods to educate. 4. Increase awareness among patients and providers of patient advocacy services. Desired Outcome: Increase the proportion of people with asthma who are receiving care. Objective 2: Increase the awareness of patients and providers in how to assess the adequacy of their insurance benefit package. Strategies: 1. Obtain information on published models that demonstrate a cost-benefit of inclusive asthma benefit packages. 2. Disseminate the coverage checklist to providers, patients, third-party payers, and employers. Desired Outcomes: Improve benefit packages. Improve use of covered benefits. Objective 3: From a patient perspective, explore access and barriers to health care. Strategies: 1. Develop and administer quantitative and/or qualitative methods to identify barriers and ways to improve care, from a patient perspective, including patients who are uninsured, underinsured or underserved. 2. Identify if, where, and by whom, The Chronic Care Model is being used. 3. Increase awareness and promote use of chronic care model among pharmacies, primary care providers, asthma specialists, school systems, emergency departments, and hospitals. 19 P a g e

20 4. Explore practice collaborative agreements between physicians and pharmacists and promote where appropriate. Desired Outcomes: Increase access to care. Decrease barriers to care. Improve continuity of care. Objective 4: Increase awareness of and participation in professional development opportunities for medical management and education. Strategies: 1. Offer continuing education credits for asthma education activities. 2. Promote interaction within the health care community to discuss asthma care issues through multiple channels such as Web sites, meetings, telehealth and grand rounds. Desired Outcomes: Increase use of resources and educational materials by providers. Increase communication within the health care community regarding asthma care. 20 P a g e

21 Population Issues I teach at a local elementary school in Alpine School District. After learning about the Winning with Asthma online training from our asthma school advocate I took it. Even though this training was developed for coaches I found the information very helpful being that I have 7 students in my class who have asthma. On average there are usually only 2 students per classroom who have asthma throughout the state of Utah. --4 th grade teacher P a g e

22 Population Issues (e.g. Migrant Workers, Hispanic Youth and Families) Mission: Within population systems, use best practices to provide culturally appropriate assistance for those affected by asthma so they can better manage their asthma within their social and physical environments. Objective 1: To increase awareness that asthma is a chronic disease that occurs throughout the lifespan and is a public health concern so that people with asthma are better equipped to manage their disease. Strategies: 1. Make asthma action plans readily available to students and families. 2. Utilize existing resources to ensure school age children with asthma receive appropriate care (e.g., Utah School Resource Manual Training, Winning with Asthma, Open Airways, Asthma Camp, and Tools for Schools). 3. Conduct child care personnel training on how to address asthma management in child care facilities. 4. Provide education to individuals with asthma (or families of children with asthma) on how to communicate with their health care provider (or their asthmatic child s health care provider) about their asthma. 5. Inform and educate adults about the health and social benefits of smoke-free homes, multiple-dwelling units, vehicles, worksites, and outdoor venues. 6. Distribute asthma educational materials to venues where adults live, work, and play. 7. Encourage development of disease management programs in all venues where adults live, work, and play, to include asthma management techniques, proper use of medications, preventive methods, and actions to be taken at the time of exposure to a known irritant. 8. Develop partnerships and utilize resources already in existence to help reduce driving when air quality is poor. 9. Identify who is receiving flu shots vs. who is not. Develop materials on the importance of why individuals with asthma should receive flu shots. Desired Outcomes: Increase accurate and timely diagnosis across all populations. Increase self-management Increase education among all people who oversee care of those with asthma. Improve quality of life for all people with asthma. Reduce activity limitations among persons with asthma. Ensure all materials are culturally and linguistically appropriate. 22 P a g e

23 Objective 2: To identify, network and collaborate with stakeholders to accomplish our mission by identifying increased funding for sustainability. Strategies: 1. Collaborate with the local Girl Scout programs to promote their Asthma Awareness Patch Program. 2. Identify and partner with other organizations to enhance asthma management for youth. 3. Identify and collaborate with other community-based organizations throughout Utah County to implement asthma management strategies within the communities they serve. 4. Identify and collaborate with agencies and individuals that serve older populations. 5. Promote, train, and provide technical assistance to local partners on the implementation of the Utah Secondhand Smoke Policy Implementation Guide for promoting smoke-free policies in homes, multiple dwelling units, workplaces, health care settings and outdoor venues. 6. Collaborate with Utah County s emergency and bioterrorism agencies to develop protocol for emergency response situations regarding asthma. Desired Outcomes: Utilize relationships to identify new and creative strategies for best practices. Collaborate with agencies throughout Utah County. Objective 3: To develop and promote implementation of policies that create environments free of asthma triggers, and promote positive asthma management among all populations. Strategies: 1. Promote consistent use of asthma action plans in all schools throughout Utah County. 2. Promote consistent use of air quality guidelines throughout Utah County. 3. Assist school districts in maintaining comprehensive tobacco-free school policies. 4. Publicly recognize idenitified community organizations that actively reduce employee, customer, and client exposure to asthma triggers, (e.g., secondhand smoke, mold, indoor air pollutants, etc.). Desired Outcomes: Increase number of schools in monitored areas that use air quality guidelines for recess. Develop strategies for alternative activities on bad air days. 23 P a g e

24 Reduce indoor air triggers by working with identified organizations to implement appropriate policies. 24 P a g e

25 Risk Factors This winter has been especially difficult with my 3 asthmatic children. A home in our neighborhood uses their wood burning stove to primarily heat their home in the winter. However, the smoke from their wood burning stove fills the second floor of our home making it difficult for my children to breathe. --Joanna November P a g e

26 Risk Factors (e.g. Multi-Family Housing) Mission: To identify asthma risk factors and promote intervention strategies to reduce those risks in Utah. Objective 1: To promote awareness of indoor and outdoor environmental risk factors through community cooperation. Increase awareness of the effects of water damage, flooding, sewage backups, and plumbing leaks in relations to asthma. Promote opportunities to improve indoor air quality to include public buildings, schools, daycares and homes. Strategies: 1. Identify and collaborate with agencies that have a stake in environmental issues related to asthma. 2. Develop and share standard core messages related to asthma and air quality on the following key elements: 1) exposure to secondhand smoke; 2) tobacco prevention and cessation among youth; 3) tobacco cessation among adults with asthma and caregivers of individuals with asthma. 3. Link asthma initiatives with other chronic disease and environmental initiatives and build on existing projects. 4. Develop and implement Integrated Pest Management (IPM) and air quality polices in schools. 5. Promote anti-idling programs. Desired Outcomes: Promote efforts to decrease air emissions and outdoor pollutants. Support efforts that increase awareness of environmental risks to asthma. Objective 2: To promote awareness of asthma risk associated with social, economic, ethnic, occupational and other related factors to reduce asthma morbidity and improve quality of life. (Angelica, somewhere?) Strategies: 1. Develop asthma-friendly policies for housing agencies, apartment complexes and landlords. 2. Work with agencies responsible for developing bioterrorism and emergency response plans to include steps for those with asthma. 3. Develop a resource guide of agencies and materials (e.g., how to get an in-home inspection, purchase vacuum cleaners, etc.). 4. Support ongoing efforts for tobacco-free policies in outdoor venues, worksites, health care settings, homes and multi-dwelling units. Desired Outcomes: 26 P a g e

27 Increase awareness of possible societal risk factors for asthma. Increase policies that reduce societal risk factors. Objective 3: To promote awareness of the association between behavioral choices and asthma. Strategies: 1. Develop and share standard core messages related to asthma and air quality on the following key elements: 1) exposure to secondhand smoke among individuals with asthma and caregivers of individuals with asthma. 2. Develop and implement an in-home asthma, lead and safety assessment intervention program including: asthma trigger education, dust and pest control measures; installing pillow and mattress covers; mold remediation; and eliminating or restricting smoking in housing units. 3. Promote awareness regarding hygiene and/or trigger-reducing home programs. 4. Work with partners involved in immunizations at the state and local levels to promote flu shots to those with asthma. 5. Facilitate referrals to smoking cessation programs. 6. Support smoke-free homes and vehicle programs. Desired Outcomes: Increase awareness of home hygiene practices to reduce the risks of asthma. Support efforts that increase awareness of possible behavioral risks for asthma and the implementation of effective home hygiene practices. 27 P a g e

28 Appendices Utah County Asthma Coalition Participants Steve Alder, EHS - Bureau Director, Utah County Air Quality Programs Rebecca Baird Brigham Young University Celeste Beck, MPH Epidemologist, Utah Asthma Program Carrie Bennett, CHES Parent of asthmatic child, Health Educator Utah County Health Department Sussy Bilbao Mountainlands Family Health Center Toni Carpenter - Environmental Health Educator, Utah County Health Department Eugene C. Cole, DrPh Professor, Brigham Young University Brook Dorff, CHES American Lung Association Eric Edwards, MPH, CHES - Health Promotion Director, Utah County Health Department Cecilia Fernández Brigham Young University Margie Golden, RN, BSN - School Nursing Director, Utah County Health Department Gen Gonzales Mountainlands Community Health Center Dodd Greer Community Health Connect Angélica Hernandez Centro Hispano Andrea Jensen - Asthmatic, Mother of Asthmatic Children, Health Educator, Utah County Health Department Lance Madigan Public Information Officer, Utah County Health Department Ali Martin Utah Asthma Program Joyce Lewallen, BSN, RN, RRT, Certified Asthma Educator - Utah Valley Regional Medical Center Kari Schmidt Tobacco Prevention and Control Program Manager, Utah County Health Department Jen Tischler Tobacco Prevention and Control Program, Utah County Health Department Margaret Warner Welcome Baby Maile Yuzon, RRT American Lung Association intern 28 P a g e

29 Performance Measures Asthma Management (e.g. 65 and older, uninsured, low income) Objective 1: To increase awareness of how asthma affects daily life activities. Desired Outcome 1: Improve quality of life for those with asthma. Measure 1: Rate of asthma hospitalizations (age-adjusted rate per 10,000 population). Baseline: 4.8 Target: 4.3 Data Source: Utah Inpatient Hospital Discharge Database Measure 2. Percent of those with current asthma who report one or more emergency department or urgent care visits due to asthma in the past 12 months. Baseline: 11.6% (adults) 16.2% (children) Target: 10.4% (adults) 14.6% (children) Data Source: BRFSS Desired Outcome 2: Increase number of community partners. Measure 1: Number of community leaders/organizations who are members of the Utah County Asthma Coalition. Baseline: 22 members; 12 organizations Target: 25 members; 15 organizations Data Source: Utah County Asthma Coalition Roster Desired Outcome 3: Decrease number of school and work days missed because of asthma. Measure 1: The percent of adults with current asthma who missed work or were unable to carry out their usual activities one of more days during the past 12 months due to asthma. Baseline: 23.6% ( ) Target: 21.2% Data Source: BRFSS Measure 2: The percent of school aged children with current asthma who missed at least one day of school during the past 12 months due to asthma symptoms. Baseline: 33.8% Target: 30.4% Data Source: BRFSS Objective 2: Assist people dealing with asthma to understand the disease process and possible treatments and strategies. 29 P a g e

30 Desired Outcomes 1: Increase use of and compliance with asthma treatment plans. Measure 1: Percent of those with current asthma who have been given an asthma management plan by a health professional. Baseline: 17.3% (adults) 38.4% (children) Target: 19.0% (adults) 42.2% (children) Data Source: BRFSS Measure 2: Percent of children with current asthma with an asthma management plan on file at school. Baseline: 27.7% Target: 30.5% Data Source: BRFSS Objective 3: Increase patient ownership in their individual treatment plans. Desired Outcome 1: Improve self-management skills. Measure 1: Percent of those with current asthma who have been taught to recognize asthma symptoms. Baseline: 58.3% (adults) 85.0% (children) Target: 64.1% (adults) 93.5% (children) Data Source: BRFSS Measure 2: Percent of those with current asthma who have been taught what to do during an asthma attack. Baseline: 67.7% (adults) 88.0% (children) Target: 74.5% (adults) 96.8% (children) Data Source: BRFSS Measure 3: Percent of those with current asthma who have been taught use a peak flow meter. Baseline: 38.7% (adults) 34.0% (children) Target: 42.6% (adults) 37.4% (children). Data Source: BRFSS Desired Outcome 2: Increase use of compliance with asthma management/action plans. Measure 1: Percent of those with current asthma who have been given an asthma management plan by a health professional. Baseline: 17.3% (adults) 38.4% (children) Target: 19.0% (adults) 42.2% (children) Data Source: BRFSS 30 P a g e

31 Measure 2: Percent of children with current asthma with an asthma management plan on file at school. Baseline: 27.7% Target: 30.5% Data Source: BRFSS Objective 4: Improve access to asthma management systems. Desired Outcome 1: Increase utilization of asthma educators. Measure 1: Number of children who took the Open Airways Program Baseline: 10 Target: Maintain Data Source: American Lung Association in Utah Measure 2: Number of certified asthma educators in Utah County Baseline: 1 Target: 2 Data Source: UDOH administrative records Desired Outcome 2: Increase information regarding asthma management services. Measure 1: Number of people who have taken the Living Well with Chronic Disease class(es) Baseline: 70 Target: 100 Data Source: Utah County administrative records Objective 5: Promote awareness of how the social/cultural environment affects asthma management. Desired Outcome 1: Increase awareness of asthma burden in diverse communities. Measure 1: Number of asthma assessments conducted about disparate populations. Baseline: 0 Target: 1 (Hispanic) Data Source: UDOH administrative records Desired Outcome 2: Increase collaboration with community partners. Measure 1: Number of community leaders/organizations who are members of the Utah Asthma Task Force. Baseline: 130 members; 61 Organizations Target: 150 Members 75 Organizations Data Source: Utah Asthma Task Force Roster 31 P a g e

32 Desired Outcome 3: Improve access to asthma resources. Measure 1: Number of schools with an asthma advocate. Baseline: 2 Target: Maintain Data Source: UDOH administrative records Measure 2: Number of trainings/public awareness campaigns with disparate populations. Baseline: 0 Target: 1 Data Source: UCAC administrative records Objective 6: Assure state laws and policies reflect sound asthma management. Desired Outcome 1: Increase awareness of laws and policies that impact asthma care. Measure 1: Percent of Utah s secondary schools which report that students are permitted to carry and self-administer asthma medications. Baseline: 54 % (2006) Target: 100% Data Source: School Health Profiles Survey Measure 2: Percent of students with current asthma who report being allowed to carry asthma medications at school. Baseline: 69.5% Target: 85% Data Source: BRFSS Healthy Systems (e.g. Allergy Specialists) Objective 1: Promote available resources to patients and providers to encourage the underinsured and uninsured to seek appropriate care. Desired Outcome 1: Increase the proportion of people with asthma who are receiving care. Measure 1: Percent of those with current asthma who received at least one routine checkup for asthma within the past year. Baseline: 52.4% (adults) 64.4% (children) Target: 57.6% (adults)70.8% (children) Data Source: BRFSS Measure 2: Number of resources targeting underinsured or uninsured populations promoted by the Utah Asthma Program. Baseline: 6 32 P a g e

33 Target: Maintain Data Source: Utah Asthma Program website Objective 2: Increase the awareness of patients and providers in how to assess the adequacy of their insurance benefit package. Desired Outcome 1: Improve benefit packages. Measure 1: Number of times Checklist of Needed Coverage for Asthma has been downloaded. Baseline: None Target: 200 Data Source: Utah Asthma Program website Desired Outcome 2: Improve use of covered benefits. Measure 1: Percent of those with current asthma who received at least one routine checkup for asthma within the past year. Baseline: 52.4% (adults) 64.4% (children) Target: 57.6% (adults) 70.8% (children) Data Source: BRFSS Objective 3: From a patient perspective, explore access and barriers to health care. Desired Outcome 1: Increase access to care. Measure 1: Percent of those with current asthma who received at least one routine checkup for asthma within the past year. Baseline: 52.4% (adults) 64.4% (children) Target: 57.6% (adults) 70.8% (children) Data Source: BRFSS Desired Outcome 2: Decrease barriers to care. Measure 1: Percent of those with current asthma who stated that there was a time in the past 12 months when they needed to see their primary care doctor for asthma but could not because of the cost. Baseline: 8.1% (adults) 6.5% (children) Target: 7.3% (adults) 5.9% (children) Data Source: BRFSS Desired Outcome 3: Improve continuity of care. Measure 1: Number of health care facilities using the chronic care model. Baseline: None Target: 5 33 P a g e

34 Data Source: UDOH administrative records Objective 4: Increase awareness of and participation in professional development opportunities for medical management and education. Desired Outcome 1: Increase use of resources and educational materials by providers. Measure 1: Number of health care professionals who have been sent the Asthma Education Toolkit. Baseline: None Target: 50 Data Source: UDOH administrative records Desired Outcome 2: Increase communication within the health care community regarding asthma care. Measure 1: Number of educational trainings regarding asthma care that have been conducted for health care professionals. Baseline: None Target: One training per year Data Source: UDOH administrative records Population Issues (e.g. Migrant Workers, Hispanic Youth and Families) Objective 1: To increase awareness that asthma is a chronic disease that occurs throughout the lifespan and is a public health concern so that people with asthma are better equipped to manage their disease. Desired Outcome 1: Increase accurate and timely diagnosis across all populations. Measure 1: Number of health care providers who have requested the Asthma Health Care Provider Manual. Baseline: 7 Target: 10 Data Source: UDOH administrative records Desired Outcome 2: Increase self-management Measure1: Percent of those with current asthma who have taken a course on how to manage asthma. Baseline: 6.0% (adults) 16.0% (children) Target: 6.6% (adults) 17.6% (children) Data Source: BRFSS 34 P a g e

35 Desired Outcome 3: Increase education among all people who oversee care of those with asthma. Measure 1: Number of school staff who have received Asthma School Resource Manual training. Baseline: 2254 Target: 2479 Data Source: UDOH administrative records Measure 2: Number of administrator who participated in Asthma Friendly Child Care training. Baseline: None Target: 10 Data Source: UCAC administrative records Measure 3: Number of people in Utah County who have taken the Winning with Asthma online training. Baseline: 36 Target: 75 Data Source: UDOH administrative records Desired Outcome 4: Improve quality of life for all people with asthma. Measure 1: Percent of those with current asthma who experienced an asthma attack during the past 12 months. Baseline: 57.7% (adults) 63.1% (children) Target: 51.9% (adults) 56.8% (children) Data Source: BRFSS Desired Outcome 5: Reduce activity limitations among persons with asthma. Measure 1: Percent of those with current asthma who experienced activity limitations due to asthma during the past 12 months. Baseline: 62.7% (adults) 60.1% (children) Target: 56.4% (adults) 54.1% (children) Data Source: BRFSS Desired Outcome 6: Ensure all materials are culturally and linguistically appropriate. Measure 1: Number of asthma materials translated and disseminated to culturally diverse populations. Baseline: 10 asthma education materials translated into Spanish 35 P a g e

36 Target: Maintain, add one other language Data Source: UDOH Asthma Program administrative records Objective 2: To identify, network and collaborate with stakeholders to accomplish our mission by identifying increased funding for sustainability. Desired Outcome 1: Utilize relationships to identify new and creative strategies for best practices. Measure 1: Number of new Utah County Asthma Coalition priorities developed during the year. Baseline: 8 Target: Maintain Data Source: UCAC administrative records Desired Outcome 2: Collaborate with agencies throughout Utah County. Measure 1: Number of groups/agencies we have collaborated with. Baseline: 4 (Brigham Young University, Centro Hispano, Community Health Connect, Mountainlands Family Health Center) Target: 10 Data Source: UCAC administrative records Objective 3: To develop and promote implementation of policies that create environments free of asthma triggers, and promote positive asthma management among all populations. Desired Outcome 1: Increase number of schools in monitored areas that use air quality guidelines for recess. Measure 1: Number of schools that have received Recess Guidance for Schools. Baseline: All public elementary schools in Utah County Target: Maintain Data Source: UDOH administrative records and UCAC administrative records Desired Outcome 2: Develop strategies for alternative activities on bad air days. Measure 1: Number of links to alternative activity recommendations for schools on Utah County Health Department website. Baseline: None Target: 1 Data Source: UDART Desired Outcome 3: Reduce indoor air triggers by working with identified organizations to implement appropriate policies. 36 P a g e

37 Measure 1: Percentage of Utah County schools that have implemented Integrated Pest Management. Baseline: None Target: 1 Data Source: UDART Risk Factors (e.g. Multi-Family Housing) Objective 1: To promote awareness of indoor and outdoor environmental risk factors through community cooperation. Increase awareness of the effects of water damage, flooding, sewage backups, and plumbing leaks in relations to asthma. Promote opportunities to improve indoor air quality to include public buildings, schools, daycares and homes. Desired Outcome 1: Promote efforts to decrease air emissions and outdoor pollutants. Measure 1: Number of programs to reduce air emissions and outdoor pollutants. Baseline: 1 Target: Maintain Data Source: UDART Desired Outcome 2: Support efforts that increase awareness of environmental risks to asthma. Measure 1: Number of news releases relating environmental risks to asthma. Baseline: None Target: 1 per year Data Source: UDART Objective 2: To promote awareness of asthma risk associated with social, economic, ethnic, occupational and other related factors to reduce asthma morbidity and improve quality of life. (Angelica, somewhere?) Desired Outcome 1: Increase awareness of possible societal risk factors for asthma. Measure 1: Percent of adults with current asthma who state that asthma is made worse by chemicals, smoke, fumes or dust in current job. Baseline: 27.6% Target: 24.8% Data Source: BRFSS Desired Outcome 2: Increase policies that reduce societal risk factors. Measure 1: Number of county policies that are asthma friendly. 37 P a g e

38 Baseline: 4 (Smoke-free venues, Smoke-free parks, Utah Indoor Clean Air Act, Department of Air Quality rules and restrictions for air pollution) Target: Maintain and add one (Utah County Health Department campus smoke-free) Data Source: UDART and UCHD administrative records Objective 3: To promote awareness of the association between behavioral choices and asthma. (Angelica somewhere?) Desired Outcome 1: Increase awareness of home hygiene practices to reduce the risks of asthma. Measure 1: Number of Healthy Home Guides distributed. Baseline: None Target: 200 Data Source: UDART Desired Outcome 2: Support efforts that increase awareness of possible behavioral risks for asthma and the implementation of effective home hygiene practices. Measure 1: Number of booths at public events distributing Healthy Home Guides. Baseline: None Target: 25 Data Source: UDART 38 P a g e