Improving Asthma Outcomes in Primary Caregiver Offices
A Quality- Improvement Project
by the SC Asthma Alliance (SCAA)
Quality From Start To Finish
“M & Ms for Asthma”
Problem: Care of children with asthma is complex, involving numerous steps, from making the correct diagnosis and appropriate medication selection to attainment of chronic medication use with effective follow-up. Because symptoms are intermittent and variable in intensity, families often think that their child’s condition is trivial or has gone away. Furthermore, the mainstay of management for persistent asthma, daily inhaled corticosteroid (ICS) use, does not provide the patient with any sensation of change. When families do not feel controllers “do anything”, they stop taking them. If their inhalation technique is poor, the ICS does not reach the lungs and can truly provide no benefit. In addition, with increasingly strict productivity guidelines that most practitioners face, the provider typically has only 7-10 minute encounters with each of their patients, even those with chronic illnesses such as asthma. When patients seek much of their care from urgent care / ER settings, the medical home may under-estimate the severity of the patient’s problems because they were not notified of significant acute flares.
Approach: In order for patients and families to use asthma medications effectively, it is crucial that they be appropriately and repeatedly taught about their condition and its treatment. They must under-stand the fluctuating symptoms of asthma, the differences between the controller and rescue medica-tions as well as the indications for each, and how to use the inhaler devices correctly. Even when they know exactly what medicines are needed, this education is impossible for the prescriber to do in a brief office visit. It is, therefore, crucial to add an asthma coach to the office team of primary care doctors seeking to offer best care for their patients with asthma. The SCAA seeks to make it possible for primary care offices to have a Certified Asthma Educator (AE-C) on their staff to improve the care and outcomes of their patients with asthma. (As a comparison, no one would try to coach football with only written instructions. Detailed device technique must be improved in person, repeatedly.)
Plan: This “M & Ms for Asthma” program through the SCAA involves two important parts – Money and Mentoring. Professionals seeking to attain AE-C status must pass an examination. Most applicants take a preparation course (on-line or in-person) before taking the exam. The Board of Directors of the SCAA has now established this grant program which will provide a practice with Money to partially de-fray the cost of the prep course and examination. This program is funded by grants to the SCAA and will reimburse a practice for a portion of costs of having a staff member become certified as an AE-C.
A practice will apply to the SCAA program for a grant. (The application form is attached, but should be completed on-line.) The specified applicant (usually RN, LPN or RT) will then have a maxi-mum of 8 months to successfully complete the preparation and testing process. When the preparation course has been completed, the practice will submit the receipt from their expenses and the SCAA will provide a check up to $250. When the applicant passes the certification exam and the examination receipt is submitted, the SCAA will provide another check for $250. The time frame of 8 months is intended to allow an applicant to have the chance to pass the exam on their second try if necessary.
In addition to becoming certified as an AE-C, the person must learn practical approaches to becoming an effective AE-C. As in many professions, “book learning” is not all that is needed to become excellent at the new job. Thus, the SCAA will also provide (at no cost) 1:1 mentoring / coaching from an experienced AE-C for the individuals who seek to become certified through this program. In this way, the applicant will feel more confident in the exam preparation and won’t feel isolated when they take on their new tasks for their practices once successfully certified.
It is expected that, in addition to improving the patient outcomes for patients with asthma in the practice, the provision of asthma education (and possible spirometry) services will generate new income. This new income will not only pay the rest of their certification costs, but will also bring new income to the practice from their asthma teaching. Furthermore, if the practice chooses to offer spirometry, the AE-C would be the ideal person to manage the testing. As long as the AE-C does asthma-related continuing education, renewal of the certification does not require retesting in the future.
Outcomes: Practices enrolling in this grant program are expected to document improved out-comes in their patients with asthma. Some important markers could be appointment adherence, asthma-related school/work absences, Emergency Room encounters, hospitalizations, medication refill history, and oral steroid prescriptions. It is likely that the practice would realize financial gain as well (not to be documented to SCAA).
Application process: The SCAA website www.scasthmaalliance.org is the location for application for this program. There is a FAQ section for those (individuals and practices) who are uncertain about what an AE-C does and why this program could be remarkably helpful. Complete the application form there or contact the help desk / email to get answers to your questions. Executive director Barry Clayton will be in touch with you shortly after your application is received.
Application and test information: Initial exam (3.5 hrs at 110 testing centers) $295; self-assessment pre-test $65 https://www.naecb.com (includes specifics of who may apply for certification and the process; follow the “register on-line link.)
Preparation courses: American Association of Respiratory Care: online course totaling 10.5 hr — $225 www.learning.aarc.org/store/seminar.php?seminar=53007 In-person courses may also be available.
Association of Asthma Educators: multiple in-person review courses (variable fees, not including transportation to site; $200 or so); www.asthmaeducators.org/Asthma-Education-Courses.
Kettering Seminars courses can be found at www.ketteringseminars.com/seminars/aec.aspx
Asthma education, spirometry billing codes: AAP Asthma Coding Fact Sheet, part of preparation course