Teaming Up for Asthma Control: EPR-3 Compliant School Program in Missouri Is Effective and Cost-Efficient

Abstract

IntroductionTeaming Up for Asthma Control (TUAC) is a work force development intervention to improve asthma control among children by increasing the competency of school nurses and delivering guideline-based education. We hypothesized that the knowledge and skills of participating school nurses would improve and that this change would positively affect students’ asthma health and reduce health care utilization cost.MethodsAsthma education for school nurses was provided online in a pretest/posttest format or in instructor-led groups. Students with persistent asthma were identified by using a checklist. Expert evaluators obtained student participants’ preassessments/postassessments before and after the 3 asthma checkups by the school nurse, and the assessments were compared. Health care costs were assessed using Medicaid administrative claims data.ResultsA total of 54 school nurses and 178 students in Missouri participated in the TUAC evaluation from 2011 through 2014. Among school nurses who completed the online education (n = 42, 77.8%), knowledge scores significantly increased from pretest (49.1%) to posttest (90.7%, P < .001). Of school nurses who completed assessments on 3 children (n = 34), 91.2% met the ±6% equivalence for 1 or more assessments on forced expiratory volume in 1 second (FEV1) compared with the expert evaluator. At enrollment, 69.7% of students had “not well-controlled” or “very poorly controlled” asthma. Postintervention, FEV1 significantly improved (82.9% to 92.1% predicted), and self-reported impairment and tobacco smoke exposure significantly declined (P < .001). For TUAC students enrolled in Medicaid, there was an average 12-month health care cost difference (−$1,431) compared with controls.ConclusionSchool nurses effectively assessed asthma status, students’ outcomes improved, and health care utilization costs declined. This evaluation contributed to program improvements to further improve health outcomes among students with asthma.

Exploring School Nurse Interventions and Health and Education Outcomes: An Integrative Review

“…School nurse management of chronic disease was used to explore health outcome measures. Five studies addressed health outcome measures in children diagnosed with asthma: overall asthma and medication knowledge (Francisco et al, 2017; Mickel et al, 2017), health-care cost savings, number of days with/without asthma symptoms, quality of life, activity limitations, readiness to change stages, student perceptions about asthma, and asthma management barriers (Francisco et al, 2017; Halterman et al, 2011; Krenitsky-Korn, 2011; Quaranta & Spencer, 2016). Spina, McIntyre, and Pulcini (2012) and Szychlinski et al (2015) measured the number of students with available epinephrine pens, number of times epinephrine was administered, types of personnel available to respond to emergencies, reasons epinephrine was not administered, and types of school communities that do not have epinephrine available.…”

“…School nurses attended continuing education on the overall health of students diagnosed with asthma and training to conduct assessments, use equipment (e.g., peak flow meters), and implement action plans (Carpenter et al, 2013;Francisco, Rood, Nevel, Foreman, & Homan, 2017;Putman-Casdorph & Pinto, 2011;Staudt, Alamgir, Long, Inscore, & Wood, 2015). Other studies included education for school nurses about food allergies (Chokshi, Patel, & Davis, 2015), adolescent relationship abuse and how to integrate discussions of healthy/unhealthy relationships in each student encounter (Raible et al, 2017), school preparedness for biological events (Rebmann, Elliott, Artman, VanNatta, & Wakefield, 2016), how to support students as they return to the classroom (i.e., return to learn) after concussions (Wing, Amanullah, Jacobs, Clark, & Merritt, 2015), recognizing children at risk for maltreatment (Jordan, MacKay, & Woods, 2017), and improving communication with families on weight-related health issues through a web-based tutorial (Steele, Wu, Cushing, & Jensen, 2013).…”

“…Leadership principle. In three studies, under the lifelong learner component, school nurses attended education sessions to increase identification of students with food allergies, the number of epinephrine devices available in school (Chokshi et al, 2015), school nurse knowledge of asthma (Francisco et al, 2017), and percentage of asthma action plans distributed to students (Staudt et al, 2015).…”

“…Leadership principle. Under the lifelong learner component, educational interventions for school nurses were linked to decreased student allergic reactions from 15% to 0% (p ¼ .014); increased mean number of epinephrine devices per school (p < .001; Chokshi et al, 2015), health-care cost savings, weekly inhaled corticosteroid doses (6.5-8.2 doses), and improved student attitudes (p < .001; Francisco et al, 2017…”

School-Based Interprofessional Asthma Self-Management Education Program for Middle School Students: A Feasibility Trial

“…13 Several research studies have cited positive outcomes through the use of community-based asthma education programs. 12,[14][15][16][17] As a result of the education provided within these studies, several outcomes demonstrated improvements, such as enhanced knowledge; better controlled asthma; fewer emergency department visits, hospitalizations, and school absences; increased health promotion behaviors and quality of life; and improved communication with and access to health care providers. 12,[14][15][16][17] The connection with the community illustrated in these studies can also be applied to the school setting.…”