Asthma Education Program Saves Insured Pediatric Participants $500,000 In First Year

CAPE GIRARDEAU, Mo., May 2, 2007 — Southeast Missouri State University’s Center for Environmental Analysis has saved insured pediatric asthma patients in southeast Missouri an estimated $500,000 during the first year of a study designed to reduce asthma-related emergency room visits.

“We have healthier children, which means we have fewer revisits to the emergency room,” said Dr. John Kraemer, director of Southeast’s Center for Environmental Analysis.

The free and confidential asthma education program is continuing through 2008, and Kraemer encourages pediatric asthma patients in the region to participate.

“There have been many people in southeast Missouri who have participated,” he said. “Our key outcome has been that children are enjoying a better life.”

 The results follow a $21,460 Environmental Protection Agency (EPA) grant awarded to the Center in 2005 to direct an asthma education program intended to reduce asthma-related emergency room readmission through environmental trigger education and home assessments.  The funds were made available by the EPA Region 7 Indoor Air Quality Allocation for activities relating to the Clean Air Act. 

The EPA-funded project is directed by Kraemer and involves a consortium consisting of Southeast Missouri Hospital, Cape Girardeau County Public Health Center’s Rural Clinic and Southeast Missouri State University.  The program includes three distinct operations:  physician education; patient/patient family education; and, home assessment and action plan development.

“We are educating participants and their families and health care providers, and refreshing them on environmental asthma triggers,” he said.

Charlotte Craig, director of the Cape Girardeau County Public Health Center, said, “There’s no question that education is the best tool for prevention.”

Craig said the Cape Girardeau County Public Health Center’s Pediatric Primary Care Clinic statistics were used as part of the groundwork in applying for grant funding for this program. 

“Our staff visited with school nurses and local emergency rooms to determine if others could verify what we observed, and to the letter everyone did,” Craig said. “Asthma is a true health concern for our community.”

She says the Cape Girardeau County Public Health Center’s Community Assessment also confirmed this concern. Therefore, she said, if a request is made for Kraemer and his staff to conduct a home assessment in Cape Girardeau County, one of county’s environmental public health specialists and an asthma certified public health nurse also participate, Craig said.  Additionally, she said, Cape Girardeau County Public Health Center offers a patient/family asthma case management program for youths 19 years and under that provides even more one-on-one education. 

“If the family, friends and other associates of a child with asthma can learn more about what triggers asthma attacks and how to manage the disease, then the child is much more likely to stay healthy, miss less school and have fewer emergency or urgent asthma related medical visits,” Craig said. “A call to either Dr. Kraemer or Cape Girardeau County Public Health Center is all that’s needed to request a home assessment.”

Pediatric asthma is the most serious chronic health problem facing children in the United States, Kraemer said. Numerous treatment and prevention options are available, he said, but effective intervention requires the combination of medication, education and environmental changes.

During the past year, Kraemer and his staff have visited the homes of pediatric asthma patients throughout southeast Missouri. They provide participants and their family members with educational information on asthma and its symptoms, environmental triggers and indoor air pollution that may affect the return of symptoms, a home environmental checklist and a list of exposure reduction or elimination activities that can be performed at the home of the patient.  In addition, they assist patient families in developing an exposure reduction plan.

During the in-home assessment, Kraemer and his staff administer a questionnaire to assess indoor environmental triggers in the home. They also conduct a walk-through assessment of the patient’s home to observe obvious sources of indoor air pollution and environmental asthma triggers. Participants then receive quarterly return visits from Center staff to monitor their progress.

To assess the effectiveness of the program, the Center established a case group and a control group. The control group received only an educational package. The case group received all educational materials, in-home assessment and quality reassessments.

The Center assessed the program’s effectiveness based on the number of emergency room or physician visits by the group over a one-year period and improved behavior by patient families after receiving the in-home environmental trigger action plan, Kraemer said.

“A significant reduction of health care usage was observed in the case group,” he said.

Since the Center received the EPA grant, Kraemer and his staff not only have assisted pediatric asthma patients and their families but also have educated and refreshed the knowledge of area physicians, pediatricians and health care providers about in-home environmental triggers for asthma and components of an exposure reduction plan. They also have given health care providers an overview of the techniques they use during their in-home assessments and have reviewed the information packet they provide to participants and their families.

The Center measured its success, to date, in educating health care providers by testing providers’ knowledge before and after participating in the program

“A significant increase in knowledge was measured,” Kraemer said.

Overall, he says, the research demonstrates the enormous impact that a global intervention program can have.

Asthma affects seven percent of the U.S. population, and about 33 percent of these affected individuals are under the age of 18, Kraemer said. Asthma is the most common chronic disease in children, the leading non-injury cause of hospitalization for pediatric patients ages 0-15 and a common medical cause for missed school days, he said.

Kraemer says he launched the education program 18 months ago because the emergency room admission rate in southeast Missouri was about three times the state average admission rate for pediatric asthma. He said the emergency room patient return rate within 30 days of the patient’s last visit also was well above the state average.

Kraemer says the Center received a $25,000 EPA grant in 2006 to extend the program, which is expected to continue in southeast Missouri through 2008.

Those interested in participating in the free and confidential asthma education program are asked to contact Kraemer at (573) 651-2355.