Combating an elusive, often-overlooked killer that preys on the youngest and most vulnerable among Kansas City’s African-American community is the objective behind Asthma Empowerment-Kansas City, a far-reaching program supported by Health Forward Foundation.
The three-year-old initiative uses evidence-based strategies to fight the chronic respiratory disease on multiple fronts: In public schools with training, screenings and life-saving interventions; in the home with family education and prevention; and in clinics with tools to improve responsive care and reduce acute episodes.
Asthma disproportionately affects African-Americans in the U.S. but has an even higher burden in Kansas City, with 16 percent of minority children aged 0 to 17 impacted — twice the national average, according to Medicaid data. Emergency room visits for asthma attacks in Kansas City were 13 times higher for black children than white in 2014.
A range of factors increase asthma’s prevalence among African-Americans, including environmental, genetic, and socio-economic triggers. In 2015, black children nationwide died from the illness at a rate 10 times that of white children. Although asthma can’t be prevented and a cure does not exist, people with the disease can lead symptom-free, active lives with appropriate treatment and services.
“Our goal is to get more eyes, ears, and hearts to understand that we have a silent emergency in Kansas City,” said Ben Francisco, a nurse practitioner who heads up Asthma Ready® Communities at the University of Missouri School of Medicine, the lead organization for the Kansas City program. Similar community-initiated efforts are supported across the state by the Missouri Asthma Prevention and Control program, a Centers for Disease Control-funded initiative.
“We have a lot of kids who are walking around breathing at about 60 percent of normal, and all it takes is one crisis to put them in a life-threatening situation.”
Asthma Empowerment has partnered with 11 area organizations to implement a comprehensive program for reducing risk and improving quality-of-life for asthma patients. Francisco said the central ideas behind the initiative emerged from focus group discussions with more than 40 Kansas City-area asthma family members during the summer of 2016.
“The parent group has really been the guiding force behind what we’re doing,” he said. “They are afraid for their children’s lives, at school, and in the community, and they told us what they need.”
Asthma Ready Schools
Based on that input, one of the program’s first steps was to equip school nurses in 36 Kansas City-area schools with training and nebulizers that allow them to identify life-threatening asthma events and perform critical interventions. The nebulizers deliver medication to help restore normal breathing.
Along with emergency response preparedness, the school component of the program — known as Asthma Ready Schools — trains school nurses around a standardized curriculum to conduct evidence-based asthma assessments and screenings of students. The initiative also provides equipment to measure lung capacity and impairment and supports multimedia education to promote asthma literacy and appropriate self-care.
Educational efforts target both the student and family and are aimed at improving day-to-day management of the disease, including medication adherence, as well as mitigating risks that can that worsen the disease. The Center for Environmental Health at Children’s Mercy Hospital is available to program participants for home visits that can help identify external factors that exacerbate asthma, including mold, secondhand smoke, pets, rodents, pests or other allergens.
Paul Foreman, project director of Asthma Empowerment in Kansas City, said Medicaid data shows the school program has resulted in lower emergency room use and resulting annualized cost savings of approximately $1,300 for each of the 164 school children who participated in three check-ups by school nurses over the academic year.
In addition to schools, Asthma Empowerment is teaming up with area safety net clinics that provide care for 85-to-90 percent of the approximately 3,000 children with asthma in the Kansas City public school catchment area.
The program is helping physicians and nurse practitioners adopt best practices for diagnosing, assessing, treating, and monitoring patients with asthma. It also assists clinicians in maintaining their board certification through educational credits for continued improvements in asthma care.
Careful review of Medicaid administrative claims data by Asthma Empowerment is additionally helping the clinics identify children who’ve recently been to the emergency room or urgent care for their asthma, who’ve stopped picking up their protective medicine, or who may be overusing medications designed for symptom relief.
“It is a powerful innovation that enables clinicians to see who’s in trouble so they can call them and get them back into the clinic,” Foreman said.
In the years ahead, Asthma Empowerment hopes to extend its proactive approach to managing the disease deeper into the community. Ultimately, community health workers, home health services, churches, organizations like the YMCA and YWCA, neighborhood associations, and even local gathering places like barbershops could play a role in mitigating emergency events and supporting consistent, appropriate care.
“We want to bring care to where people live, learn, and play, not just to clinics,” Francisco said. “We can have a major impact by collectively trying to do the right thing everywhere.”
Foreman added that beyond providing essential financial support, Health Forward has played a critical role in connecting Asthma Empowerment with the array of area partners that are making the program so effective.
“They have been incredibly helpful,” he said.
Editor’s note: to learn more about issues Health Forward supports, download our 2018 annual report.