Pursuing perfection: an asthma quality improvement initiative in school-based health centers with community partners

Abstract

This article describes an innovative asthma quality improvement initiative conducted in school-based health centers (SBHCs) with collaboration among multiple community partners including the children's hospital, a federally qualified health center, the health department, the public school, and parents of children with asthma. The aim was to improve the health of children with asthma in these schools, as measured by minimal asthma-related activity restriction and reduction in asthma-related emergency department (ED) visits. Process measures tracked included the percent of children with (1) asthma severity classified, (2) persistent asthma with controller medication prescribed, and (3) written care plans. Data supported a statistically significant decreasing trend for the percent of SBHC children reporting activity restriction due to asthma. In addition, trend analysis demonstrated a statistically significant difference in ED visits for asthma in the SBHC group compared with a non-SBHC group. Improvements were demonstrated for all process measures. Factors contributing to success included emphasis on community engagement, transparency in sharing ideas and results, benefits outweighing human resource costs of participating, readily available data to drive improvement, and the use of multiple intervention strategies.

Figures

Figure 3. Number of children seen and identified with asthma

Figure 4. Comparison of ED visits per 1,000 population of children known to have asthma: SBHCs vs. CPS

ED = emergency department SBHC = school-based health center CPS = Cincinnati Public Schools

Figure 5. Number of ED visits for children seen at SBHCs per month per 1,000 population

ED = emergency department SBHC = school-based health center

Figure 6. Percent of identified children reporting activity restriction due to asthma as “never” or “rarely”

Figure 7. Percent of identified children with asthma at SBHCs with severity classification in chart

SBHC = school-based health center

Figure 8. Percent of identified children with persistent asthma with appropriate controller medication prescribed

Figure 9. Percent of identified children with asthma with written care plan in chart

Figure 10. Percent of identified children receiving perfect care

Figure 11. Percent of identified children with albuterol inhaler and consent to use at school