From Need to Succeed: An Outreach Program That Works

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From Need to SucceedAn Outreach Program That
Works
Asthma Education Medical Care in South Orange
County
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Mission Hospital

• Non-profit hospital in the St. Joseph Health
  System in Orange County, California
• Values
• Dignity
• Service
• Excellence
• Justice
• Community Benefit program

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Asthma

• the most common
• chronic disease of childhood

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Asthma not just your average childhood
affliction

• 9 million children and increasing
• 5,500 of all ages die every year
• One of the most common reasons for
• Emergency Dept. visits
• Hospitalizations
• School absences
• No cure, but controllable

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A Problem Identified
Some idiot poured fabric softener in the
birdbath!

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But is it a problem here?

• Orange
• County,
• California
• 
  

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Dont be blinded by the sunlight flashing off all
the Mercedes Benzs
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Asthma in Orange County

• 315,000 people have asthma
• 97,000 are children under 14 years
• 1,000 children are hospitalized a year
• Affected by economic and environmental
  disparities

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Chronic Childhood Diseasesin School

• SVUSD (2003-2004)

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Orange County (OC) Health Needs Assessment
(1999, 2002)

• Asthma is a major disease of concern
• 18 of residents report a child with asthma
• Disparities
• Low income communities
• higher with asthma
• primarily Spanish speaking
• less access to care

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What is asthma?
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Asthma

• A chronic disease
• A disease of inflammation in the airways
• Airways are always inflamed and sensitive
• ? sensitivity frequent exacerbations

Swelling Redness Mucus
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Asthma Can

• Limit or prevent activity
• Disrupt sleep
• Interfere with school
• Be frightening
• Kill

• But it doesnt have to!

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The Goal is Control

• The right medicines prescribed and used
• Two types
• Quick-relief
• Long-term controllers

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Quick-Relief Inhaler

• Relieves asthma attack within minutes
• Essential for all asthmatics
• If using a lot need more control
  
  
• Albuterol, Ventolin, Proventil, Maxair,
  Xopenex

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Controller Medications

• Controls inflammation?protects against getting
  attacks
• Daily medicine
• Gives the asthmatic freedom and control

Advair Flovent QVAR Pulmicort
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Spacers

• Hollow chamber used with inhaler
• Makes inhaler use easier and more efficient

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Peak Flow Meter

• A thermometer for asthma
• Early warning sign
• Used for self-management

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Asthma Action Plan

• A recipe for preventing and treating asthma
• A joint project between family and doctor
• Provides for more self-management

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Triggers

• Colds/flu
• Exercise
• Pollen
• Tobacco smoke
• Dust mites
• Cold air
• Weather changes
• Pets
• Mold

• Air pollution
• Stress/emotions
• Feathers
• Wood fire fumes
• Food
• Medications
• Chemicals/smells

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Exercise-Induced Asthma

• Asthma symptoms brought on by exercise
• Very common
• Can be controlledjust ask the Olympic athletes

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Asthma Allergies

• In most children, asthma and allergies go hand in
  hand

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Jumping In

• Started Program in 1999 with a focus on
  education and schools but without outcomes
• At the end or 1 years had numbers, but no
  meaningful outcomes
• Recognized need to re-examine interventions and
  develop measurable outcomes

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Stepping Back

• Reassess
• Re-evaluate
• Plan
• Project

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Getting Our Ducks in a Row

• What do we want to achieve?
• How will we know when we did it?
• How do we do it?

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What Do We Want to Achieve?

• Goal increase quality of life for (underserved)
  children with asthma and their families
• Preserve the dignity of the families
• Provide justice to those affected by disparities

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How will we know when we did it?

• Outcomes
• Measurable and meaningful
• Hospitalizations
• Emergency Department visits
• School absences
• Effectiveness of Outreach
• Number of children enrolled each year

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How Do We Do It?

• Mission Hospital Asthma Program
• Education
• Awareness
• Outreach
• Focus on under-served

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Education

• Community classes
• School-aged children, parents adults
• English and Spanish
• School
• ALAs Open Airways for school students
• Teachers, staff, district nurses
• Medical community education and 2-way referrals
  
• Hospitals and clinics
• Healthcare providers

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Hospital

• Visits to hospitalized children
• education
• referrals
• Emergency Department Program
• Follow-up with ED and hospitalized patients
• Phone and mail
• Offer support, education and referrals

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Awareness

• Where and Who
• Parent groups, schools, organizations
• Fairs
• Medical groups
• Learn
• What asthma is
• How to identify it
• What the Program is
• Entry point to Program

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Outreach

• Find the children and families who need help
• Schools and parent groups
• Organizations
• Health and community fairs
• Word of mouth
• Flu vaccine
• Medical Community

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Under-Served

• Partnership with CHOC Breathmobile
• Education and outreach
• Home visits
• Supplies
• Bilingual Community Health Liaison
• Referral to health insurance

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Breathmobile

• Mobile asthma/allergy clinic supported by grants
  and CHOC Hospital
• For underserved children without insurance or
  with low-cost government insurance
• Travels to schools
  in Orange County

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Partnering with the Breathmobile

• Demonstrating the need
• Synergistic collaboration expands access to
  care
• Sharing the same outcomes
• Making it work
• In the end a delicious Asthma Sandwich

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The South Orange County Asthma Sandwich

• Asthma Program
• Breathmobile
• Asthma Program

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Top Bun

• Mission Hospital Asthma Program
• Proactively searches for children
• Provides awareness programs
• Educates schools and others
• Connects to community clinics and other
  healthcare providers

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The Middle

• CHOC Breathmobile
• Medical care with a bilingual specialist
• Asthma and allergy testing
• Education
• Diagnose treat
• Medications
• Plan follow-up

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Bottom Bun

• Mission Asthma Program
• Asthma education at the Breathmobile, class,
  office or home
• Promotora model
• Home visit
• Supplies
• Support and follow-up

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Home Visit

• Usually follows Breathmobile visit or class
• Promotora and nurse
• Assess understanding of doctors directions
• Review medication use
• Assess inhaler, spacer, peak flow meter use
• Basic asthma education with printed material
• Allergy environment assessment
• Provide needed supplies
• Health insurance status
• Encourage follow-up to doctor
• Support

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Promotora Model

• Community health worker and liaison
• Bilingual
• Educated in asthma
• Bridge between the community and the Western
  medical system
• Provides cultural sensitivity and connection
• Best of intentions meets cultural reality ?
  change in goals and process

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Cultural Sensitivity

• Reassess
• Re-examine
• Respect
• Adapt
• Integrate

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Mission Asthma Programtoday

• Awareness classes
• Community classes for families
• Activities with schools
• Outreach activities
• Physician outreach
• Referrals for medical insurance
• Home visits
• Hospital visits
• ER Program
• Flu vaccine clinics
• Asthma supplies
• Collaboration with CHOC Breathmobile

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Outcomes

• Children who participate in the
  Asthma Program Breathmobile decrease
• Hospitalizations--85
• Emergency Dept. visits--65
• Absenteeism--66
• Approximately 100 new children each year

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Mission Hospital Asthma Program

• 27700 Medical Center Rd., Suite 150
• Mission Viejo, CA 92691
• Asthma Education Coordinator
• Judi Kennard, RN, AE-C
• [phone]
• Judi.kennard_at_stjoe.org
• Community Health Liaison
• Catina Copete
• [phone]
• Catina.copete_at_stjoe.org