Effectiveness of Community Based Interventions for Children with Asthma

1
Effectiveness of Community Based Interventions
for Children with Asthma

• Noreen M. Clark, PhD
• Myron E. Wegman Distinguished University
  Professor
• Director, Center for Managing Chronic Disease
• University of Michigan

2
Status of Adoption/Implementation of Asthma
Guidelines Kevin Weiss

• one best idea for reducing asthma morbidity
  among children

3
Environmental background for initial
implementation

• Disturbing increases in asthma prevalence
• Large apparent disparities
• Substantive geographic variations in asthma
  morbidity
• Significant changes in understanding mechanisms
  of asthma and Rx
• First national consensus on asthma diagnosis
  and management

4
Asthma hospitalization per 1,000
population Persons under 35 years, New York City
neighborhoods
Source Carr et al, AJPH 1994
5
Some highlights of External Factors that drove
guideline implementation

• CAMP, NICAS, ICAS, PACRN, and many other NIH
  studies (NHLBI, NIAID, NIESH)
• CDC state funded community and public health
  efforts
• RWJ Pediatric Asthma Initiative (including Allies
  Against Asthma)
• New Initiatives by EPA

6
Some highlights of External Factors that drove
guideline implementation

• Substantive Pharma efforts
• even for a brief moment White House interest in
  the issue

• Implementation of SCHIP
• Implementation of welfare to work
• Health plan interest (HEDIS)
• Major changes in urban public housing

7
Durable Key Messages

• Asthma inflammatory disease
• Persistent asthma is different than intermittent
  asthma
• Anti-inflammatory medication (ICS) should be
  first line therapy
• Asthma action plan is critical to success

8
Trends in HEDIS measures
Measure of asthma at the health plan level
Source NCQA 2006 report
9
Environmental background for 2007 guideline
implementation

• Asthma prevalence high seems to have leveled off
• Substantive geographic variations in asthma
  morbidity
• Only modest changes in understanding mechanisms
  of asthma and Rx
• Major update more evidence-based, but 2nd
  edition, new and improved status
• NAEPP creates Guideline Implementation Panel

10
Trends in US Black/White mortality rates
persons 5-34 years, 1979-2002
rate per 100,000 population
Black
White
Source Gupta R et al. JACI 2006
11
New GINA Treatment Goals
Bateman et al. Eur Resp Journal 2001
12
Some highlights of External Factors for 2007
guideline implementation

• CAMP continues, CARE Network, NIAID Inner-City
  Asthma Consortium, and some other NIH studies
  continue
• Chronic Care model emerges
• CDC state funded community and public health
  efforts at risk
• RWJ Pediatric Asthma Initiative (including Allies
  Against Asthma) ending
• Noreen talks of asthma fatigue

13
Some highlights of External Factors 2007
guideline implementation

• SCHIP continues, Americas uninsured increase
• Health plan interest (HEDIS) continues, perhaps
  new measures
• National employer and Congress momentum for
  physician accountability and value-based health
  care (Pay 4 Performance)
• Pharma interest continues but different
  environment for such support
• New environment of H.I.T.

14
Institute of Medicine Report

• S.T.E.E.P.E.
• Continuous decrease in waste. The health system
  should not waste resources or patient time.

15
Chronic Care Model
Health System
Community
Health Care Organization
Resources and Policies
DeliverySystem Design
ClinicalInformationSystems
Self-Management Support
Decision Support
Prepared, Proactive Practice Team
Informed, Activated Patient
Productive Interactions
Functional and Clinical Outcomes
Source Wagner E. et. al, ICIC
16
Percentage of All Firms Offering Health Benefits,
1999-2005
10 decline since 1999
Source Kaiser/HRET Survey of Employer-Sponsored
Health Benefits, 1999-2005
17
Durable Key Messages(not availableeducated
guess)

• Asthma inflammatory disease
• Persistent asthma is different than intermittent
  asthma
• Asthma control is based on burden of asthma
• Anti-inflammatory first line therapy (ICS?)
• More focus on step up and step down
• Asthma education program with an action plan is
  critical to success
• And lots of others

18
Status of Adoption/Implementation of Asthma
Guidelines Kevin Weiss

• one best idea for reducing asthma morbidity
  among children

19
Establish a new multi-stakeholder National
Childrens Asthma Health Policy Consortiumto
Advance Guideline Implementation
Draft Mission StatementTo improve quality,
access, equity in asthma care for U.S. children
by catalyzing rapid guideline implementation
20
National Childrens Asthma Health Policy
ConsortiumGoals

• To shape commercial health plan adoption and
  promotion of key guideline messages
• To advance national health policy as it relates
  to rapid diffusion of asthma guidelines
• To guide state policy on guideline implementation

21
National Childrens Asthma Health Policy
Consortium
Marketing Expertise
Health Benefit Managers
Health Policy Expertise
Commercial Health Plans
Council of Mayors
Medicaid Programs
Federal Agencies Liaison
State Legislature
Physician and other health care providers
Public Health Community
School Boards
Patient Consumer Interest
22
National Childrens Asthma Health Policy
Consortium

• Work closely with NAEPP
• Integrate prior efforts (e.g. RWJF, CDC, AHRQ)
• Multi-stakeholder funding

23
National Childrens Asthma Health Policy
Consortium
Examples of products

• Draft Evidence-based Health Benefit Design for
  Commercial Health Plans
• Suggested HIT specifications for asthma
  guidelines implementation
• Draft Model State Legislation for Asthma
  Guideline Implementation

24
Status of Adoption/Implementation of Asthma
Guidelines Kevin Weiss

• one best idea for reducing asthma morbidity
  among children

25
Effectiveness of Community Based Interventions
for Children with Asthma

• Noreen M. Clark, PhD
• Myron E. Wegman Distinguished University
  Professor
• Director, Center for Managing Chronic Disease
• University of Michigan