Kansas Asthma Initiative
- Need: Many of Kansas's rural residents have low incomes and are medically underserved, putting them at a potential increased risk for uncontrolled asthma.
- Intervention: The Kansas Asthma Initiative is a partnership that provides education and professional development opportunities via telehealth for healthcare providers and caregivers of asthma patients.
- Results: The partnership has developed a better methodology for working with physicians. Telehealth technology is helping facilitate a positive collaboration among providers in Kansas in order to decrease the burden of asthma.
Contrary to common belief, asthma is as prevalent in rural adults as it is in their urban counterparts, and even though asthma prevalence was shown to be similar between rural and urban youth, asthma-related morbidity was higher in the rural group. Rural asthma morbidity and mortality may be exacerbated due to barriers to asthma care that can exist in rural areas, including geographical distance, lack of access to healthcare information, and scarcity of specialists in asthma care.
According to this Kansas Asthma Initiative presentation, 8.4% (174,713) of the adult population and 8.3% of the children population in Kansas has asthma. Kansas suffers from about 300 asthma-related deaths each year.
In order to teach and to learn from those who treat asthma patients in rural areas, Dr. Matthew Sharpe and Dr. Dave Burnett from the University of Kansas Medical Center's (KUMC) Asthma Center collaborated with Newman Regional Health to help create a rural community-based partnership for asthma care that has led to the development of an asthma TeleECHO program. This quality improvement project focuses on:
- Continuing education and professional development
- Decreasing unplanned asthma-related healthcare usage
- Improving practice adherence to guidelines for the diagnosis and treatment of asthma
- Developing a toolkit for providers without the most current national guidelines
The asthma TeleECHO program, which will officially begin in the fall of 2016, will facilitate four weekly sessions over the course of a month. In these sessions, participating clinics will pick and present an asthma-related case, and everyone in the session can provide input. The TeleECHO program is made possible through collaborations with KUMC’s rural education program led by Michael Kennedy, MD, and the telemedicine/telehealth department led by Eve-Lynn Nelson, PhD. KUMC’s TeleECHO’s program coordinator, Carla Deckert, will initiate contact with community-based practices serving asthma patients. Rural medical education preceptor sites will serve as points of contact for the community partnerships.
The Kansas Asthma Initiative also provides community engagement, often in the form of health fairs and site visits to hospitals. These events are open to the public, so groups such as teachers, school nurses, coaches, and parents of asthma patients can learn more about treatment options.
The Kansas Asthma Initiative is also working on a type of patient-centered medical home (PCMH) model where the KU Asthma Center connects with respiratory therapists who discuss asthma self-management with patients via a simple telehealth connection in their homes.
In addition, the KU Asthma Center works with nearby colleges such as the University of Kansas, Kansas State University, and the University of Central Missouri to screen for exercise-induced bronchoconstriction (EIB) in their student-athletes.
Initially, members of the Kansas Asthma Initiative wanted to better understand the perceptions and needs of family practice providers for providing asthma care. They were able to receive surveys from 63 rural physicians in the summer of 2015 and plan to publish the results in a rural family practice journal. This survey focused on the perception and use of asthma guidelines by rural family practice providers.
In addition, these researchers are measuring the effectiveness of the Kansas Asthma Initiative’s programs at both the clinician and patient levels in rural communities. The plan is to collect data on the use of three key components of the asthma guidelines and on improvement in asthma control and self-management knowledge of the patient. The outcomes involve using:
- Three key components of asthma management guidelines
- Spirometry to identify severity of asthma
- Mainstay treatment for control of asthma (inhaled corticosteroids)
- Asthma Action Plan for patients’ self-management
- Validated asthma control, quality of life, and self-management questionnaires
The guidelines for asthma care are neither simple nor user-friendly. Reading 440-some pages of guidelines is unrealistic for doctors during a routine busy clinic day. Also, rural healthcare providers often cannot specialize in one area like asthma, since they are needed to fill many roles in their communities. The partnership hopes to create a simplified algorithm in the future but now focuses on pooling its knowledge of the guidelines with other healthcare providers.
Despite being one of three key components of the guidelines for asthma care, the use of spirometry is not very common in rural family practice. The educational partnership facilitates a better understanding of spirometry interpretation as well as reimbursement for spirometry and asthma self-management clinic services.
At first, the Kansas Asthma Initiative traveled to different communities in Kansas. As the demand for education and collaboration grows, however, the KU Asthma Center with the University of Kansas Center for Telemedicine & Telehealth will offer teleECHO sessions instead of face-to-face visits. TeleECHO will allow the partnership to reach more rural healthcare providers without needing to travel all over the state.
Collaboration is key. The point of the Kansas Asthma Initiative is not for one organization to act as an expert but for all healthcare providers – rural and urban – to share their experiences and advice.
Interested healthcare providers can become Certified Asthma Educators through the National Asthma Education Certification Board.
Dave Burnett, Cofounder and Director
KU Asthma Center
Chronic respiratory conditions
July 7, 2016
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.