Survey tracks progress in asthma program
4% of population receives personal interventions
Blue Care Network of Michigan began its asthma disease management program to target one of the most prevalent chronic diseases in the member population and one of the most frequent reasons for member visits to the emergency room.
"National statistics showed that there had been an ongoing increase in the diagnosis of asthma in the past five years," says Pam Reinert, MSM, director of quality management for Blue Care Network of Michigan, based in Southfield.
Blue Care Network was formed from four independently licensed HMOs. It is affiliated with Blue Cross Blue Shield of Michigan.
The insurer developed its own asthma management programs — one for children and one for adults.
All participants in the disease management program are asked to fill out a Functional Status Survey at the time they enter the program, at the end of six months, and annually after that.
Among the questions on the survey are: Do you feel better now than six months ago? Do you have more energy than six months ago? How many days of work or school did you miss because of your condition?
"We want to track the ongoing progress of our members so we can respond to trends," Reinert says. For instance, last year’s survey showed an increase in asthma patients going to the emergency room for treatment. "During this year, we tried to monitor it closely and determine what steps we could take before the patient goes to the emergency room."
Respondents to a survey of the adult population report a decrease in the amount of time they missed from work because of asthma in 2001 compared to 2000.
"Members responded that they felt they knew better how to manage asthma than a year ago," she added.
Parents said they missed fewer workdays in 2001 because of their child’s asthma and that the children had missed less school.
The development team began by developing practical guidelines for their physicians and identifying members to be included in the program.
Members were identified by hospital and emergency room claims data or through pharmacy claims if they are prescribed a typical asthma medication.
"We looked at the current and recommended treatment that most physicians used. We collaborated with our pharmacy representatives and looked at the member educational materials we had and what was available," Reinert says.
Blue Care Network of Michigan identifies members eligible for their disease management program through claims data, either from diagnosis or from medications prescribed for diseases covered in the program. Physicians recommend members, and some members choose to self-enroll.
When members with asthma are identified for the program, they receive an introductory letter and educational materials.
Blue Care Network has found that it works better to give the patients an opportunity to opt out of the program, rather than asking them if they choose to join.
Very few people opt out of the program, Reinert says.
Members who do not opt out of the program receive educational materials on an ongoing basis and are put into the patient data registry tracking system.
Members are stratified into three risk levels based on frequency of hospitalization or emergency room visits, type and amount of medication they take, and other conditions.
Individual attention
Those in the high-risk group are referred to case management for comprehensive care that may include home visits to determine if environmental factors are triggering the asthma attacks.
The rest receive ongoing educational materials in the mail three times a year and are entered into a patient registry that tracks their physician visits, medication use, and any visit to the hospital or emergency room.
About 4% of people in the asthma management program get individualized attention.
"The case managers may offer them an asthma management course or help them address any other needs they identify. These members are followed very closely," Reinert says.
If members have an emergency room claim, the system triggers them for a personal telephone call.
"Our goal is to help members determine what caused the attack and how to prevent it in the future," Reinert says.
For instance, the disease management team may work with children to help them reduce stress if it appears that is what causes their asthma attacks.
"We always want to discourage smokers and to let parents know that a smoker could be causing a child’s asthma attack. We have to deal with the parents’ behavior as well as the child’s," Reinert says.
The asthma management staff follow through with the members and make their physicians aware of the emergency room visits.
Asthma is a condition in which the benefits of compliance with the treatment regime is immediate, compared with diseases such as diabetes, where the effects of noncompliance may not show up for years.
"If you have asthma and don’t manage it properly or encounter stress or something that triggers an attack, you have an immediate reaction," Reinert points out.
7 steps to creating a disease management program
- Start with clinical practice guidelines.
- Compile and develop member educational material.
- Educate your physicians on what you’re trying to do.
- Identify the population.
- Roll out the program.
- Monitor outcomes.
- Modify the program as you analyze the outcomes.
Resources for asthma management programs
If you’re looking for resources for asthma management, there is a wealth of Internet sites that may contain the information you need. Here are some:
- National Health Lung and Blood Institute: www.nhlbi.nih.gov
- National Institutes of Health: www.nih.gov
- American Academy of Family Physicians: www.familydoctor.org
- American Academy of Allergy, Asthma & Immunology: www.aaaai.org
Plan your program carefully and track your results
If you’re considering an asthma-management program, here are some tips from the experts:
- Make sure you have full corporate support before you begin. Planning a program takes an incredible amount of time and you don’t always see the rewards right away.
- Get early support from your physicians. Their input in planning the program and involvement after it’s under way is crucial to your success.
- Consider building your own program rather than buying one from an outside vendor. A homegrown program allows you to tailor the plan to meet the needs of your own population and to make changes quickly as you examine your data and see a need.
- Develop a method for tracking interventions and outcomes. Examine your data regularly to make any changes in the program.
- Use your data to keep all your stakeholders informed. Physicians need to get regular reports on their patients. The management team at your organization needs information on outcomes to understand the value of the program.
- Make sure your staff are flexible and willing to work evenings or weekends at home to reach the patients who need interventions. Many people with asthma work or attend school, and the only time you can reach them is after hours.
- Expect to make multiple interventions with your population before you make an impact.
- In the case of young patients, concentrate your efforts on the parents. They need to understand what triggers the asthma in their children and the importance of taking regular anti-inflammatory medication instead of relying on rescue medication.
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