Stanford School of Medicine
Pediatric Advocacy Program–

Ravenswood-LPCH Asthma Project

2003-2005 INTER CLASS PROJECT

The Ravenswood-LPCH Asthma Project is a resident driven endeavor that brings together community leaders, community physicians, teachers, pharmacies and community based organizations with the intern pediatric class to provide an asthma program for the 5,000 children in the Ravenswood City School District. Asthma was selected by the District Nurse as a priority health problem since asthma hospitalization rates for children in East Palo Alto are three times higher than other areas in the county. This sustainable program to address asthma has been overwhelmingly well received. In addition it has allowed the interns to experience practicing as a physician advocate outside of the traditional medical setting.

Objective: To test the feasibility of a population-based approach to improve the health outcomes for asthmatic children, by developing a partnership between:

  1. Ravenswood City School District (RCSD), East Palo Alto , CA
  2. Pediatric Residents from an academic medical center
  3. Local pediatric providers (County and community clinics, private practice)
  4. Community-based organizations (CBOs)

Strategic Plan:

LPCH residents along with the District Nurse and various community partners developed a strategic plan that included identifying asthmatic students and conducting a needs assessment with local pediatricians and pharmacists to determine what standards of asthma care are being used. Then the district nurse and residents developed a list of asthma management goals for individual children, district schools and local pediatricians. The plan also included promoting comprehensive asthma management through collaborate efforts with CBOs and hiring an asthma case manager.

Needs Assessment:

The preliminary needs assessment helped gage the impact of asthma in the District. Through a district wide emergency card mailer to parents to identify self-reported asthmatics, 319 asthmatics responded-with only 1% of whom carry inhalers to school. Discussions with local pharmacists revealed the following:

Asthma Management Goals:

As part of the strategic plan, the pediatric residents worked with the district nurse to develop asthma management goals for the children, the district and local pediatricians.

Individual Child Goals

Objectives Activities
•  Correct medications prescribed •  Resources created to ensure standard of care
•  Peak flow meters (not covered by health plan) •  Donations of peak flow meters
•  Asthma plans •  Outlined by MDs
•  Flu shot each fall •  Recommend flu shots
•  Parent/child asthma class •  Resident run classes
•  Home visits by trained home visitors •  Referrals to home visiting program
•  School-based asthma case manager •  Hire asthma case mgr.

*Asthma actions plans are courtesy of RAMP (Regional Asthma Management and Prevention)

RCSD Goals

Objectives Activities
•  Identify asthmatics •  Self-reported asthma on Emergency cards
•  Student asthma plan & med. authorization on file at each school •  Work w/ school admin.
•  Open Airways curriculum •  For asthmatics (grades 3-5)
•  Train staff & teachers •  Resident led asthma trainings
•  Asthma classes for all parents & students •  Resident led asthma classes

Local Physician Goals

Objectives: Resources:
•  Prescribe appropriate meds. •  Asthma cards
•  Medications covered by local health plans
•  Discuss asthma action plans w/ parents & children
•  Give copy to parents
•  Fax copy to school 		•  Asthma action plans
•  Plans tell family what to do to PREVENT attacks
•  Medication stamps
•  Distribute peak flow meters •  Peak flow meters for students

Teacher Trainings

A significant component of asthma management program included teacher trainings for school staff and teachers, who were taught about the definition of asthma, how to recognize an asthma attack, how to help students manage their asthma, and how to use an inhaler. LPCH residents created and conducted trainings at 9 out of 11 district schools, reaching approximately 190 teachers and staff.

Pediatric resident teaching teachers about asthmaPediatric resident teaching teachers about asthma

Parent/Student Asthma 101 Classes

Residents designed and organized bilingual asthma management classes for parents and asthmatic children. Physicians trained bilingual teachers to teach the classes to parents and students. This cross training was done to promote sustainability within the District and provide schools with asthma experts that can be resources to other teachers and staff. To date, over 100 parents have participated in an Asthma 101 class with a trained teacher and/or LPCH resident.

Teachers and pediatric residents teaching parents about asthma

Evaluation

  1. Plan to evaluate ER/hospitalization data
    • 3 years prior (2000-2003)
    • 3 years after (2004-2007)
  2. Compare pharmacy data
    • Ratio of controller to rescue medication prescription rate (Health Plan of San Mateo data)
  3. Geographical Information Systems
    • Mapping to facilitate community based research and hypothesis generation

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