New York City Health Department Asthma Interventions

Transcription

1 New York City Health Department Asthma Interventions Asthma Programs in New York City Schools Commissioner Andrew Goodman, MD, MPH New York City Department of Health and Mental Hygiene New York City Department of Health and Mental Hygiene

2 DOHMH Asthma Interventions Daycare Integrated Pest Management East Harlem Asthma Center of Excellence OSH School based Asthma Interventions

3 Trends in Asthma Hospitalizations (Children 0 to 4 Years Old) 250 Rate (per 10,000 residents) Bronx Brooklyn Manhattan Queens Staten Island New York City

4 Trends in Asthma Hospitalizations (Children 5 to 15 Years Old) Rate (per 10,000 residents) Bronx Brooklyn Manhattan Queens Staten Island New York City

5 Managing Asthma in Daycare Asthma screening, coordination of care, staff training and health tracking Serve more than 20,000 children and trained over 15,000 parents and child care staff Implemented in 331 child care centers citywide

6 Integrated Pest Management Services DOHMH works with pest control agencies, and community partners to eliminate cockroaches and mice, common asthma triggers in low income apartments where people with asthma reside. The Asthma Initiative currently has community based contractors providing IPM services. Provides intervention services to approximately 450 apartments in East and Central Harlem, the South Bronx and North/Central Brooklyn

7 East Harlem Asthma Center of Excellence (EHACE) Initiated in 2007, Walk in Center opened in 2010 Strives to significantly reduce asthma hospitalization rates in East Harlem which are among the highest in the country Asthma Counselor Program Harlem Asthma Network Environmenta l Division EHACE Walk-in Center Research and Evaluation Health Care System Improvement

8 EHACE Opening

9 Mayor Bloomberg Asthma Educator

10 School based Asthma Intervention Opportunity in NYC 1000 elementary schools with nurses Data systems (School health and DOE) About 700,000 children in elementary schools 53,000 children with asthma

11 Managing Asthma In Schools Clinical Services Monitor asthma medication use Increase MAF submission rate Provide albuterol (rescue medication) in each medical room Ensure MAF on file for students with asthma Ensure that children with persistent asthma have controller medications Began offering ICS administration in schools this past year

12 Percent of school children with asthma MAFs prescribed controller medication

13 Number of Students Treated in School with ICS Percentage

14 Managing Asthma in Schools Care Coordination Services Prioritize students with poorly controlled asthma for more intensive follow up Students with multiple absences Students without a Medication Administration Form OSH clinical staff liaise with community providers to ensure students with asthma are receiving appropriate guideline based care

15 Automated Student Health Record (ASHR) Electronic health record used to monitor students with asthma (and all other chronic diseases) Reports generated to improve tracking: Children with active asthma Children with persistent asthma Children with poorly controlled asthma Absences among children with asthma Improves the case management services provided by the clinical team

16 Open Airways Curriculum Collaboration between OSH School Nurses and the American Lung Association (ALA) Evidence based asthma management curriculum for 3 rd, 4 th, & 5 th graders

17 Number of Students Receiving Open Airways Training

18 NYC ASSIST Centers for Disease Control (CDC) funded program to improve the identification and asthma management of children residing in homeless shelters. Aims to reduce ED visits, hospitalizations and school absences Collaboration between OSH, DHS, and DOE

19 NYC ASSIST Activities Shelter Increase asthma awareness asthma training for parents of students with asthma Provide Professional Development to Department of Homeless Services staff Connect students with asthma to a PCP

20 NYC ASSIST Activities Schools Track children from shelters with ASHR Follow up referrals for medical care, insurance, etc. Ensure access to medications, self management support

21 Average Days Absent Students with Asthma vs. Non Asthma

22 Mayor s Interagency Task Force on Truancy and Chronic Absenteeism Launching an innovative new campaign to promote Asthma Friendly Schools. Goal: Improve asthma prevention and treatment efforts and boost achievement in high need communities. The campaign will be piloted at five elementary schools in the spring of 2011, and will expand to 20 schools

23 Mayor s Interagency Task Force on Truancy and Chronic Absenteeism Asthma Pilot Strengthen the partnership between school and community based organizations Heighten awareness Educate families Improve the medical care of students with asthma Increase the number of students receiving medications in schools

24 Strategic Directions Strengthen school based interventions Clinical practice improvements: ICS in EDs Medicaid redesign Case management and home environmental intervention Tobacco smoke reduction in residential settings Support NYCAP for coordination and advocacy

25 THE END

26 Current Asthma in NYC CHS 2004 Source NYC Community Health Survey 2004

27 NYCAP Updates Health Care Delivery Committee working on the issue of ED/ICS policy; still in process of identifying a Chairperson No major progress as yet on Medicaid and Community Health Workers; however, more programs around the city are using them and more Community Health Workers are taking the test to become Certified Asthma Educators. The Asthma Initiative is co sponsoring a prep course with LIU.

28 NYCAP Updates Day Care project is now working on protocols to help asthmatic children in early childhood settings transition into the elementary school system. (i.e., forms UHF/MAF/AAP and orientations on available school health services such a medication administration and open airways) Day Care project has also established a referral network between Union Settlement Association and the East Harlem Asthma Center of Excellence's Asthma Counselor Program. Since February 70 referrals have been received by the EHACE Asthma Counselor Program

29 Managing Asthma In Schools Overview Clinical services Asthma case management with an emphasis on students with poorly controlled asthma. Automated Student Health Record (ASHR) Open Airways for Schools Asthma Self Management Training

30 Asthma Intervention Strategies Clinical Environmental IPM Tobacco smoke Air Pollution Community Day care Schools Case Management

31 NYC ASSIST Goals To increase the capacity to identify, track, and provide asthma coordinated care to school aged children with asthma that reside in transitional housing Decrease school absences, emergency department visits, and hospitalizations among to school aged children with asthma that reside in transitional housing

32 Asthma Management Most children with asthma do not have Asthma Action Plans Among children with current asthma: Overall less than half (42%) of children ever diagnosed with asthma have received written asthma management plan from a health care provider. Source: Schwarz AG, McVeigh KH, Matte T, Goodman AG, Kass D, Kerker B Childhood Asthma in New York City. Vital Signs 2008, 7(1), 1 4.

33 Asthma Management Most children with asthma do not have Asthma Action Plans Among children with current asthma: Overall less than half (42%) of children ever diagnosed with asthma have received written asthma management plan from a health care provider. Source: Schwarz AG, McVeigh KH, Matte T, Goodman AG, Kass D, Kerker B Childhood Asthma in New York City. Vital Signs 2008, 7(1), 1 4.

34 Exposure to Asthma Triggers in NYC Source: Schwarz AG, McVeigh KH, Matte T, Goodman AG, Kass D, Kerker B Childhood Asthma in New York City. Vital Signs 2008, 7(1), 1 4.