Asthma education

Why is this important?

Asthma is a chronic lung disease that makes it harder for a person to move air in and out of their lungs. During and asthma episode, the airways swell and extra mucus makes it difficult to breath, often resulting in an unexpected trip to the emergency department (ED). There is not a cure, but the symptoms can usually be managed by medications and by controlling triggers.

开云体育 initially identified 211 children on PMAP or Minnesota Care with poorly controlled asthma, putting them at risk of trouble breathing and potentially needing the urgent care or ED for asthma.

What did we do?

开云体育 worked with a Community Health Worker (CHW) organization to provide in-home education, home assessments and referrals for needed products and services to improve the children’s asthma care and control.

Over the course of 2023 and 2024, 开云体育 referred 82 members for asthma related CHW services. These services include:

• A social needs assessment and referrals to resources as needed.
• A home assessment to identify potential asthma triggers.
• Education for the parent and child, when appropriate, using the EXHALE strategy. This curriculum includes:
  • Education on asthma self-management
  • X-tinguishing smoking and exposure to second hand smoke
  • Home visits for trigger reduction and asthma self management education
  • Achievement of guidelines based medical management
  • Linkages and coordination of care across settings
  • Environmental policies or best practices to reduce asthma triggers from indoor, outdoor or occupational sources

In 2022, significant benefits were added to Minnesota Health Care Programs to provide allergen reducing products for children who are diagnosed as having poorly controlled asthma. The home assessment was vital in identifying issues in the home that could potentially be triggers for the child and cause an asthma attack. The goal was for the CHW to complete the home assessment, identify the products that would benefit the child, work with the provider to secure an order for the products and the health plan to order the products for the family. However, in practice, the enhanced asthma benefits proved to be a complicated process that we were unable to solve for in 2023, and the first children were able to receive the asthma supplies early in 2024.

The CHW communicated the assessments and recommendations for the allergen-reducing products to the member’s primary care provider so the information could be included in the child’s medical record. The CHW encouraged the child’s parents to make sure the child was up to date with all medical care and assisted the family in scheduling a medical appointment with their PCP when necessary. The most common supplies provided to members through this program include:

• Allergen encasements for mattress, box spring, and pillow
• Allergen-rated vacuum cleaner
• Dehumidifier and filters
• HEPA single-room air cleaner and filters
• Damp mopping system

Over the two years of this project, 82 children were referred to CHW Solutions for assessment and asthma educational services. This support resulted in an increase in these children attending a well child visit with their primary care provider resulting in updated Asthma Management Plan based on their current health, and updating their Asthma Control Test, which is indicator of if their asthma is considered in control.

What challenges did we face?

The enhanced asthma benefits provided for Medicaid members proved to be extremely complicated to access. Several issues needed to be worked through before we were able to provide these supplies to the members working with the CHW.

• Early in the project, it was unclear who was eligible to complete the required home assessment. We sought guidance from the state and others, but lack of clarity created delays.
• We were unable to identify Durable Medical Equipment (DME) providers who were willing to supply the products. Because the demand for these products would likely be quite limited, and as non-traditional supplies, DME providers were unclear that they would be reimbursed for them and were unwilling to keep them in stock. In the end, health plan staff worked directly with a DME provider to order supplies individually as member needs were identified and approved so they didn’t need to be kept in stock.

Members were cautious about accepting the CHW services into their home. Additionally, some members lived with relatives other than a parent and that relative was not interested in the services.

• CHW services are billable only when the child with the medical condition is present, so scheduling needed to happen around school schedules.
• Out of the 82 members referred, 19 members accepted the referral for an acceptance rate of 23%.

Ongoing work

This program has proven impactful for the families who have accepted the services offered. Initially limited to a specific zip code, we have opened the area up to allow for additional children to be referred to this ongoing program.