Appl Clin Inform 2016; 07(04): 969-982
DOI: 10.4338/ACI-2016-02-RA-0022
Research Article
Schattauer GmbH

Evaluation of a Pilot Asthma Care Program for Electronic Communication between School Health and a Healthcare System’s Electronic Medical Record

Kelly W. Reeves
1   Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC
,
Yhenneko Taylor
2   Dickson Advanced Analytics Group, Carolinas HealthCare System, Charlotte, NC
,
Hazel Tapp
1   Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC
,
Thomas Ludden
1   Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC
,
Lindsay E. Shade
1   Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC
,
Beth Burton
3   Community Care Partners of Greater Mecklenburg, Carolinas HealthCare System; Charlotte NC
,
Cheryl Courtlandt
4   Department of Pediatrics, Carolinas Healthcare System, Charlotte, NC
,
Michael Dulin
1   Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC
› Institutsangaben
The authors would like to gratefully acknowledge the contribution of Maria Bonaiuto for her mentorship of the original conceptual work and of Madelyn Welch and Chandler Gates in assistance with preparing this manuscript.
Weitere Informationen

Correspondence to:

Kelly W. Reeves, BSN, RN, UXC
Department of Family Medicine
Carolinas HealthCare System
2001 Vail Ave
Suite 400 Mercy Medical Plaza
Charlotte
NC 28207

Publikationsverlauf

received: 26. Februar 2016

accepted: 10. September 2016

Publikationsdatum:
18. Dezember 2017 (online)

 

Summary

Objective Asthma is a common childhood chronic lung disease affecting greater than 10% of children in the United States. School nurses are in a unique position to close gaps in care. Indeed, effective asthma management is more likely to result when providers, family, and schools work together to optimize the patient’s treatment plan. Currently, effective communication between schools and healthcare systems through electronic medical record (EMR) systems remains a challenge. The goal of this feasibility pilot was to link the school-based care team with primary care providers in the healthcare system network via electronic communication through the EMR, on behalf of pediatric asthma patients who had been hospitalized for an asthma exacerbation. The implementation process and the potential impact of the communication with providers on the reoccurrence of asthma exacerbations with the linked patients were evaluated.

Methods By engaging stakeholders from the school system and the healthcare system, we were able to collaboratively design a communication process and implement a pilot which demonstrated the feasibility of electronic communication between school nurses and primary care providers. Outcomes data was collected from the electronic medical record to examine the frequency of asthma exacerbations among patients with a message from their school nurse. The percent of exacerbations in the 12 months before and after electronic communication was compared using McNemar’s test.

ResultsThe pilot system successfully established communication between the school nurse and primary care provider for 33 students who had been hospitalized for asthma and a decrease in hospital admissions was observed with students whose school nurse communicated through the EMR with the primary care provider.

Conclusions Findings suggest a collaborative model of care that is enhanced through electronic communication via the EMR could positively impact the health of children with asthma or other chronic illnesses.

Citation: Reeves KW, Taylor Y, Tapp H, Ludden T, Shade LE, Burton B, Courtlandt C, Dulin M. Evaluation of a pilotasthma care program for electronic communication between school health and a healthcare system’s electronic medicalrecord.


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Conflicts of interest

We have read and understood ACI policy on declaration of interests and declare that we have no competing interests.

  • References

  • 1 CDC. Asthma’s Impact on the Nation: Data from the CDC National Asthma Control Program: National Center for Environmental Health. 2012 [cited 2014 July 20]. Available from: http://www.cdc.gov/asthma/impacts_nation/AsthmaFactSheet.pdf
  • 2 Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, Liu X. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief 2012; (94) 1-8 Epub 2012/05/24. PubMed PMID: 22617340.
  • 3 Akinbami LJ, Sullivan SD, Campbell JD, Grundmeier RW, Hartert TV, Lee TA, Smith RA. Asthma outcomes: healthcare utilization and costs. The Journal of allergy and clinical immunology 2012; 129 (Suppl. 03) S49-S64 Epub 2012/03/14. doi: 10.1016/j.jaci.2011.12.984. PubMed PMID: 22386509.
  • 4 Moorman J, Rudd R, Johnson C, King M, Minor P, Bailey C, Scalia M, Akinbami L. National surveillance for asthma – United States, 1980-2004. MMWR Surveill Summ 2007; 56 (08) 1-54.
  • 5 Skrepnek G, Skrepnek S. Epidemiology, clinical and economic burden, and natural history of chronic obstructive pulmonary disease and asthma. Am J Manag Care 2004; 10 (Suppl. 25) S129-S138.
  • 6 American Lung Association, Epidemiology and Statistics Unit, Research and Program Services. Trends in asthma morbidity and mortality. 2009 [cited 2014 July 20]. Available from: https://www.lung.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf
  • 7 Moonie SA, Sterling DA, Figgs L, Castro M. Asthma status and severity affects missed school days. J Sch Health 2006; 76 (01) 18-24 doi: 10.1111/j.1746–1561.2006.00062.x. PubMed PMID: 16457681.
  • 8 Meng YY, Babey SH, Wolstein J. Asthma-related school absenteeism and school concentration of low-income students in California. Preventing chronic disease 2012; 09: E98 PubMed PMID: 22595322; PubMed Central PMCID: PMCPMC3431954.
  • 9 Flores G, Bridon C, Torres S, Perez R, Walter T, Brotanek J, Lin H, Tomany-Korman S. Improving asthma outcomes in minority children: a randomized, controlled trial of parent mentors. Pediatrics 2009; 124 (06) 1522-1532 doi: 10.1542/peds.2009-0230. PubMed PMID: 19948624.
  • 10 Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002-2007. The Journal of allergy and clinical immunology 2011; 127 (01) 145-152 doi: 10.1016/j.jaci.2010.10.020. PubMed PMID: 21211649.
  • 11 National Asthma Education and Prevention Program. Expert panel report-3: guidelines for the diagnosis and management of asthma Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Institute. NIH Publication No 08-4051 2007;
  • 12 Bergert L, Patel SJ, Kimata C, Zhang G, Matthews Jr WJ. Linking patient-centered medical home and asthma measures reduces hospital readmission rates. Pediatrics 2014; 134 (01) e249-e256 doi: 10.1542/peds.2013-1406. PubMed PMID: 24936001.
  • 13 Bannister A, Kelts S. NASN position statement: the role of the school nurse and school-based health centers. NASN school nurse 2011; 26 (03) 196-197 PubMed PMID: 21675306.
  • 14 Findley S, Rosenthal M, Bryant-Stephens T, Damitz M, Lara M, Mansfield C, Matiz A, Nourani V, Peretz P, Persky VW, Valencia GR, Uyeda K, Viswanathan M. Community-based care coordination: practical applications for childhood asthma. Health Promot Pract 2011; 12 6 Suppl. 1): 52S-62S doi: 10.1177/1524839911404231. PubMed PMID: 22068360.
  • 15 AHRQ. Care Coordination Rockville, MD: Agency for Healthcare Research and Quality. 2015 [cited 2016 Jun 24 2015]. Available from: http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html
  • 16 Rasberry CN, Cheung K, Buckley R, Dunville R, Daniels B, Cook D, Robin L, Dean B. Indicators of asthma control among students in a rural, school-based asthma management program. The Journal of asthma: official journal of the Association for the Care of Asthma 2014; 51 (08) 876-885 doi: 10.3109/02770903.2014.913620. PubMed PMID: 24730771; PubMed Central PMCID: PMC4587486.
  • 17 Halterman JS, Sauer J, Fagnano M, Montes G, Fisher S, Tremblay P, Tajon R, Butz A. Working toward a sustainable system of asthma care: development of the School-Based Preventive Asthma Care Technology (SB-PACT) trial. The Journal of asthma: official journal of the Association for the Care of Asthma 2012; 49 (04) 395-400 doi: 10.3109/02770903.2012.669441. PubMed PMID: 22455402; PubMed Central PMCID: PMC3381057.
  • 18 Langenfeld NA, Mast DK, Rasberry CN, Cheung K, Luna P, Buckley R, Merkle S, Huhman M, Robin L. Strategies for Identifying Students in Need of School-Based Asthma Services: Challenges and Questions That Emerged From a Rapid Evaluation of a School-Based Asthma Program. Journal of Asthma & Allergy Educators 2010; 01 (03) 109-116 doi: 10.1177/2150129710372397.
  • 19 Institute ANS. HL7® Essential Requirements: Due process requirements for HL7 American National Standards. 2013: 4-20.
  • 20 Fridsma D. Interoperability vs Health Information Exchange: Setting the Record Straight. Health IT Buzz. 2013
  • 21 Hinman AR, Davidson AJ. Linking children’s health information systems: clinical care, public health, emergency medical systems, and schools. Pediatrics 2009; 123 (Suppl. 02) S67-S73 doi: 10.1542/peds.2008–1755D. PubMed PMID: 19088232.
  • 22 Tapp H, Hebert L, Dulin M. Comparative effectiveness of asthma interventions within a practice based research network. BMC Health Serv Res 2011; 11: 188 Epub 2011/08/19. doi: 10.1186/1472–6963–11–188. PubMed PMID: 21846401; PubMed Central PMCID: PMC3176175.
  • 23 Mowrer JL, Tapp H, Ludden T, Kuhn L, Taylor Y, Courtlandt C, Alkhazraji T, Reeves K, Steuerwald M, Andrew M, Dulin M. Patients’ and providers’ perceptions of asthma and asthma care: a qualitative study. J Asthma. 2015: 1-8 doi: 10.3109/02770903.2015.1010731. PubMed PMID: 25975701.
  • 24 Tapp H, Kuhn L, Alkhazraji T, Steuerwald M, Ludden T, Wilson S, Mowrer L, Mohanan S, Dulin MF. Adapting community based participatory research (CBPR) methods to the implementation of an asthma shared decision making intervention in ambulatory practices. The Journal of asthma : official journal of the Association for the Care of Asthma 2014; 51 (04) 380-390 Epub 2013/12/20. doi: 10.3109/02770903.2013.876430. PubMed PMID: 24350877.
  • 25 Beckett CD, Kipnis G. Collaborative communication: integrating SBAR to improve quality/patient safety outcomes. Journal for healthcare quality : official publication of the National Association for Healthcare Quality 2009; 31 (05) 19-28 PubMed PMID: 19813557.
  • 26 Bergren MD. HIPAA-FERPA revisited. The Journal of school nursing : the official publication of the National Association of School Nurses 2004; 20 (02) 107-112 PubMed PMID: 15040763.

Correspondence to:

Kelly W. Reeves, BSN, RN, UXC
Department of Family Medicine
Carolinas HealthCare System
2001 Vail Ave
Suite 400 Mercy Medical Plaza
Charlotte
NC 28207

  • References

  • 1 CDC. Asthma’s Impact on the Nation: Data from the CDC National Asthma Control Program: National Center for Environmental Health. 2012 [cited 2014 July 20]. Available from: http://www.cdc.gov/asthma/impacts_nation/AsthmaFactSheet.pdf
  • 2 Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, Liu X. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief 2012; (94) 1-8 Epub 2012/05/24. PubMed PMID: 22617340.
  • 3 Akinbami LJ, Sullivan SD, Campbell JD, Grundmeier RW, Hartert TV, Lee TA, Smith RA. Asthma outcomes: healthcare utilization and costs. The Journal of allergy and clinical immunology 2012; 129 (Suppl. 03) S49-S64 Epub 2012/03/14. doi: 10.1016/j.jaci.2011.12.984. PubMed PMID: 22386509.
  • 4 Moorman J, Rudd R, Johnson C, King M, Minor P, Bailey C, Scalia M, Akinbami L. National surveillance for asthma – United States, 1980-2004. MMWR Surveill Summ 2007; 56 (08) 1-54.
  • 5 Skrepnek G, Skrepnek S. Epidemiology, clinical and economic burden, and natural history of chronic obstructive pulmonary disease and asthma. Am J Manag Care 2004; 10 (Suppl. 25) S129-S138.
  • 6 American Lung Association, Epidemiology and Statistics Unit, Research and Program Services. Trends in asthma morbidity and mortality. 2009 [cited 2014 July 20]. Available from: https://www.lung.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf
  • 7 Moonie SA, Sterling DA, Figgs L, Castro M. Asthma status and severity affects missed school days. J Sch Health 2006; 76 (01) 18-24 doi: 10.1111/j.1746–1561.2006.00062.x. PubMed PMID: 16457681.
  • 8 Meng YY, Babey SH, Wolstein J. Asthma-related school absenteeism and school concentration of low-income students in California. Preventing chronic disease 2012; 09: E98 PubMed PMID: 22595322; PubMed Central PMCID: PMCPMC3431954.
  • 9 Flores G, Bridon C, Torres S, Perez R, Walter T, Brotanek J, Lin H, Tomany-Korman S. Improving asthma outcomes in minority children: a randomized, controlled trial of parent mentors. Pediatrics 2009; 124 (06) 1522-1532 doi: 10.1542/peds.2009-0230. PubMed PMID: 19948624.
  • 10 Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002-2007. The Journal of allergy and clinical immunology 2011; 127 (01) 145-152 doi: 10.1016/j.jaci.2010.10.020. PubMed PMID: 21211649.
  • 11 National Asthma Education and Prevention Program. Expert panel report-3: guidelines for the diagnosis and management of asthma Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Institute. NIH Publication No 08-4051 2007;
  • 12 Bergert L, Patel SJ, Kimata C, Zhang G, Matthews Jr WJ. Linking patient-centered medical home and asthma measures reduces hospital readmission rates. Pediatrics 2014; 134 (01) e249-e256 doi: 10.1542/peds.2013-1406. PubMed PMID: 24936001.
  • 13 Bannister A, Kelts S. NASN position statement: the role of the school nurse and school-based health centers. NASN school nurse 2011; 26 (03) 196-197 PubMed PMID: 21675306.
  • 14 Findley S, Rosenthal M, Bryant-Stephens T, Damitz M, Lara M, Mansfield C, Matiz A, Nourani V, Peretz P, Persky VW, Valencia GR, Uyeda K, Viswanathan M. Community-based care coordination: practical applications for childhood asthma. Health Promot Pract 2011; 12 6 Suppl. 1): 52S-62S doi: 10.1177/1524839911404231. PubMed PMID: 22068360.
  • 15 AHRQ. Care Coordination Rockville, MD: Agency for Healthcare Research and Quality. 2015 [cited 2016 Jun 24 2015]. Available from: http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html
  • 16 Rasberry CN, Cheung K, Buckley R, Dunville R, Daniels B, Cook D, Robin L, Dean B. Indicators of asthma control among students in a rural, school-based asthma management program. The Journal of asthma: official journal of the Association for the Care of Asthma 2014; 51 (08) 876-885 doi: 10.3109/02770903.2014.913620. PubMed PMID: 24730771; PubMed Central PMCID: PMC4587486.
  • 17 Halterman JS, Sauer J, Fagnano M, Montes G, Fisher S, Tremblay P, Tajon R, Butz A. Working toward a sustainable system of asthma care: development of the School-Based Preventive Asthma Care Technology (SB-PACT) trial. The Journal of asthma: official journal of the Association for the Care of Asthma 2012; 49 (04) 395-400 doi: 10.3109/02770903.2012.669441. PubMed PMID: 22455402; PubMed Central PMCID: PMC3381057.
  • 18 Langenfeld NA, Mast DK, Rasberry CN, Cheung K, Luna P, Buckley R, Merkle S, Huhman M, Robin L. Strategies for Identifying Students in Need of School-Based Asthma Services: Challenges and Questions That Emerged From a Rapid Evaluation of a School-Based Asthma Program. Journal of Asthma & Allergy Educators 2010; 01 (03) 109-116 doi: 10.1177/2150129710372397.
  • 19 Institute ANS. HL7® Essential Requirements: Due process requirements for HL7 American National Standards. 2013: 4-20.
  • 20 Fridsma D. Interoperability vs Health Information Exchange: Setting the Record Straight. Health IT Buzz. 2013
  • 21 Hinman AR, Davidson AJ. Linking children’s health information systems: clinical care, public health, emergency medical systems, and schools. Pediatrics 2009; 123 (Suppl. 02) S67-S73 doi: 10.1542/peds.2008–1755D. PubMed PMID: 19088232.
  • 22 Tapp H, Hebert L, Dulin M. Comparative effectiveness of asthma interventions within a practice based research network. BMC Health Serv Res 2011; 11: 188 Epub 2011/08/19. doi: 10.1186/1472–6963–11–188. PubMed PMID: 21846401; PubMed Central PMCID: PMC3176175.
  • 23 Mowrer JL, Tapp H, Ludden T, Kuhn L, Taylor Y, Courtlandt C, Alkhazraji T, Reeves K, Steuerwald M, Andrew M, Dulin M. Patients’ and providers’ perceptions of asthma and asthma care: a qualitative study. J Asthma. 2015: 1-8 doi: 10.3109/02770903.2015.1010731. PubMed PMID: 25975701.
  • 24 Tapp H, Kuhn L, Alkhazraji T, Steuerwald M, Ludden T, Wilson S, Mowrer L, Mohanan S, Dulin MF. Adapting community based participatory research (CBPR) methods to the implementation of an asthma shared decision making intervention in ambulatory practices. The Journal of asthma : official journal of the Association for the Care of Asthma 2014; 51 (04) 380-390 Epub 2013/12/20. doi: 10.3109/02770903.2013.876430. PubMed PMID: 24350877.
  • 25 Beckett CD, Kipnis G. Collaborative communication: integrating SBAR to improve quality/patient safety outcomes. Journal for healthcare quality : official publication of the National Association for Healthcare Quality 2009; 31 (05) 19-28 PubMed PMID: 19813557.
  • 26 Bergren MD. HIPAA-FERPA revisited. The Journal of school nursing : the official publication of the National Association of School Nurses 2004; 20 (02) 107-112 PubMed PMID: 15040763.