National initiative fosters better asthma management through school partnerships

With 6.8 M school-aged children living with asthma in the United States, it’s likely that every school in the nation enrolls students who are managing their condition and their studies at the same time. 

That’s a hard balance. Children with asthma miss three times as many school days compared to students who don’t have asthma, and data shows that 55 percent of Wisconsin students with asthma have had disease-related absences. “Asthma-related health burdens directly affect students’ readiness to learn, which in turn impacts their life-long opportunities well into adulthood,” said Sujani Kakumanu, MD, clinical assistant professor, Allergy, Pulmonary and Critical Care Medicine. 

A new, coordinated national effort called the School-Based Asthma Management Program (SAMPRO™) is taking an all-hands-on-deck approach to reduce the impact of asthma on schoolchildren. The initiative is sponsored by the American Academy of Allergy, Asthma and Immunology (AAAAI) in concert with nearly 50 other organizations including the UW School of Medicine and Public Health and the UW School of Pharmacy. Through this work, the SAMPRO initiative is creating tools, resources, and processes for school-based partnerships that focus on integrated care coordination among families, clinicians, and school nurses.

“One of the goals of SAMPRO is to better communicate the care of children with asthma—what’s going on in the clinic as well as what is going on in the schools. The school nurse plays an incredibly important role in that, and we want to make sure that we’re doing everything possible to make that communication happen, and be effective,” said Robert Lemanske, Jr., MD, professor, Allergy, Pulmonary and Critical Care Medicine and Department of Pediatrics and former AAAAI president.

The approach advocates four components to facilitate coordination: 

  • establishing a Circle of Support between the families, clinicians and schools nurses centered around the child with asthma, 
  • communicating standardized Asthma Management Plans with both emergency ad individualized treatment plans for each child with asthma, 
  • implementing an Asthma Education Plan for school personnel, and 
  • executing an Environmental Asthma Plan to assess and remediate asthma triggers in home and school settings.

A toolkit of informational resources to support each of these components is available on the SAMPRO web site. “From September, 2016 to date, the toolkit has been downloaded over 550 times from organizations across the country, including school nurses, clinicians, health care departments, and outreach/advocacy organizations,” said Colleen Brown, associate information processing consultant, UW-Madison Health Innovation Program (HIP). Metrics on toolkit downloads are being tracked by HIP, which reports that the most downloads (43 percent) have been by school nurses, consultants, or educators, followed by physicians (20 percent) and public health professionals (14 percent). 

SAMPRO stakeholders are also working with Congressional Representatives who have introduced legislation to support implementation of the four components (HR 2285 - School-Based Respiratory Health Management Act). The bill would amend the Public Health Service Act to increase preference for awarding grants for asthma and allergy disorders to states that require school-based reversible lower airways disorder (asthma) management programs.

According to AAAAI, 11 House members have signed onto the legislation, which is receiving bipartisan support from Rep. Gregg Harper, R-MS (co-chair of the Congressional Asthma and Allergy Caucus and a member of the Energy and Commerce Committee), Rep. Eliot Engel D-NY (also co-chair of the Asthma and Allergy Caucus), and Energy and Commerce Committee members Rep. Marsha Blackburn, R-TN, Rep. Ryan Costello, R-PA, Rep. Diana DeGette, D-CO, Rep. John Sarbanes, D-MD, and Rep. Bobby Rush, D-Il.

Additional work led by Dr. Kakumanu and Dr. Lemanske at the local level has involved pilot studies to develop new methods for communicating and coordinating care, such as the Extending EMR Access to School Nurses (EMRSN) study. This pilot provides school nurses in the Madison Metropolitan School District (MMSD) with access to health information exchange (HIE) to enhance the treatment of children ages 12 and under in elementary schools who live with asthma. Launched in April, 2016 and funded by the Office of the National Coordinator, the EMRSN study granted electronic medical records (EMR) access to elementary school nurses using EpicCare Link®, a web-based application for connecting organizations to their community affiliates. EpicCare Link allows school nurses to view the patient’s medical history, access the most recent Asthma Action Plans (AAP), and send direct secure messages to the child’s pediatrician. Ninety-eight children are currently enrolled in the program, which is broadly supported by UW Health physicians, patients and school nurses. It was developed in collaboration with Gail Allen, MD, clinical associate professor, Department of Pediatrics, the General Pediatric and Adolescent Medicine divison, the Madison Metropolitan School District, and UW Health Information Services.

Through these efforts, SAMPRO members are determined to reduce the burden of asthma on academic opportunities for millions of schoolchildren. “We know that we need to create a community around each child with asthma, so that their care is supported by clinicians, their families, as well as their schools,” said Dr. Kakumanu.

Resources:

Robyn Perrin, PhD