This year-long program works to reduce or eliminate asthma triggers inside the schools and homes of our patients, underserved and uninsured children and adults. Our patients have asthma so severe that they often occupy hospital beds or miss school – many are absent 30 days or more each year due to asthma hospitalizations or related illness. We work with school officials, parents, educators, caregivers and families to reduce hospitalizations and conditions that trigger the onset of an asthma “attack.” Our program also empowers parents who then begin to proactively advocate for their child's health with medical and school professionals and begin to value the significant role they play in the health and well being of their child (or children).

The Asthma Network of West Michigan began in 1994 when several individuals from area health care institutions and asthma support groups joined forces to centralize asthma resources and focus on collaboration and education. In addition to the staff, its 42 volunteer members represent hospitals, pharmacists, physician offices, nursing organizations, schools and managed care organizations from five counties.

Our model of education involves sending an asthma educator—a nurse (at the RN level) or respiratory therapist (at the RRT level) and Medical Social Worker into the homes of our patients. All of our asthma educators are certified asthma educators (AE-C®).

In 2005, the United States Environmental Protection Agency (EPA) funded the Asthma Health Outcomes Project (AHOP), a study conducted by the University of Michigan. The ANWM has been selected as a model program.

The ANWM is believed to be the first asthma coalition in the nation to succeed at negotiating reimbursement with health insurance providers. By continuing to prove that our intervention keeps patients out of the hospital and by extrapolating those savings over a lifetime, the ANWM hopes to continue to renegotiate our contracts with managed care organizations, bring more managed care organizations on board and develop a written model for other asthma coalitions to follow - and provide this information to other asthma coalitions nationwide.

The ANWM program consists of up to eighteen in- home visits and lasts up to twelve months. During those twelve months, ANWM staff work with parents, educators, caregivers, physicians and the patient to reduce or eliminate asthma triggers in their home and school and get asthma under control.

In this program, asthma educators (registered nurses or respiratory therapists), coupled with a medical social worker, provide a home-based educational intervention using the National Institutes of Health’s (NIH) asthma guidelines. Specifically, the asthma educators meet with the child and his/her family as frequently as bi-weekly to discuss asthma-related topics necessary to understand and better self- manage the disease.

Certified asthma educators (AE-C®), work with each child and his/her family and school/caregivers to reduce asthma triggers, identify ideal usage of medication and therapeutic devices (e.g., inhalers), recognize the signs of an approaching attack, and help reduce the number and severity of the attacks. The educators also meet with the child’s key school personnel and the primary care physician, the latter with whom a written asthma management plan, for distribution to the family and school, is created.

Key to the ANWM's innovative approach is the utilization of a medical social worker (MSW), whose services augment the clinical case management team. While the case managers focus on specific asthma management and control issues, the MSW helps the family access additional resources to meet basic needs. The ANWM’s case managed families typically have multiple stressors, ranging from environmental to financial to socio-legal; the utilization of the MSW to identify and assist with a family’s problems leads to greater effectiveness in caring for the child’s asthma as the MSW makes appropriate referrals/contacts to the Family Independence Agency, Medicaid, mental health agencies, food banks, hospitals, and landlords, among others.

A second focus of the ANWM is community education that takes place via regularly scheduled school, medical and allied professional conferences. The ANWM uses specially trained physicians, nurses and respiratory therapists to accomplish this. In the past ten years, the ANWM has reached over 35,000 individuals through our community outreach and education efforts.

In a recent study, ANWM patients' hospitalizations decreased 70% while the control group's hospitalizations increased 25%. This is a drastic difference especially when considering that the decrease in hospitalizations helps allow children with asthma to have a more “normal” childhood. Decreasing their hospitalizations allows them to attend school, an act many children and parents take for granted.

We reviewed the charts of 37 managed care (Commercial and Medicaid) patients who were enrolled in our case management services for one year and were served between 2003 and 2005. The results are as follows:

• Hospital stays prior to enrollment: 6
• Days hospitalized prior to enrollment: 13
• ED visits one year prior to enrollment: 30
• Hospital stays one year after enrolled: 2 (66% decrease)
• Days hospitalized after enrolled: 7 (46% decrease)
• ED visits one year after enrolled: 12 (60% decrease)

The Asthma Network of Western Michigan has achieved several notable outcomes:

• Reimbursement from third-party payers
• Measurable decrease in hospital length of stay
• Measurable decrease in ED visits
• Inclusion of AE-C® credentialed providers
• In-home program for each patient and family
• Education of health care professionals
• Service to the uninsured and underserved

This abstract was presented at the National Conference on Asthma 2003: Meeting the Challenge of Healthy People 2010: Preventing and Controlling Asthma, sponsored by the National Heart, Lung and Blood Institute (NHLBI) in Washington, D.C., in June 2003.

A COLLABORATION PRODUCING HEALTHIER CITIZENS: AN ASTHMA COALITION AND A MANAGED CARE ORGANIZATION.

K. Meyerson, RN, BSN, G.M.Kirk, MD and B. Meconis. Pediatric and Adult Asthma Network of West Michigan, Grand Rapids, Michigan; Western Michigan University, Kalamazoo, Michigan and Spectrum Health, Grand Rapids, Michigan.

PURPOSE: We intended to improve the clinical outcomes for identified managed care members with asthma by enrolling them in our community-based case management program, thereby decreasing emergency room visits and inpatient admissions for exacerbations of asthma.

METHODOLOGY: Health professionals conducted home visits, physician care conferences to elicit asthma management plans and school staff in-services.

RESULTS: Of 41 managed care members enrolled in our program the first year of collaboration, inpatient costs were reduced from $17 per member per month (pmpm) to $15 pmpm during, to $0 pmpm the year after enrollment (p<0.0001). Total utilization costs went from $241 pmpm prior, to $260 pmpm during, to $117 pmpm the year after enrollment (p<0.0001). Separately, the managed care organization (MCO) demonstrated a significant reduction in total costs over two years, which included our services. Likewise, we were able to demonstrate significant reductions in hospitalizations (41 to 13) and days hospitalized (114 to 25) through our case management program (n=45). These reductions were highly significant (p<0.0001) when compared to a matched control group (n=39) which did not receive our services.

CONCLUSIONS: This relationship, a first between an MCO and an asthma coalition in this country, significantly improved the clinical outcomes of members with asthma.

FUNDED BY: Centers for Disease Control and Prevention (CDC), DeVos Children’s Hospital Foundation, Frey Foundation, Grand Rapids Community Foundation, Heart of West Michigan United Way, Michigan Department of Community Health, Priority Health, Saint Mary’s Mercy Medical Center, Slemons Foundation, and Steelcase Foundation

The NAECB would like to know if you are aware of others, besides the ANWM, who have sucessfully received reimbursement for asthma-education services.

The fees for the National Asthma Educator Certification Board will increase on August 4, 2006. The fee increases are as follows: Initial Examination and Recertification $295 Repeat Examination $195 For any questions regarding the fee increase, please contact the Executive Office at info@naecb.org

Your newsletter editors are: Tim Op't Holt toptholt@jaguar1.usouthal.edu and Bill Pruitt wpruitt@jaguar1.usouthal.edu, faculty at the University of South Alabama. Send your articles and ideas!

If you want to mail something to us: Cardiorespiratory Care, University of South Alabama, 1504 Springhill Ave., Mobile, Alabama 36604. Phone: (251)434-3405, fax (251) 434-3941. We look forward to hearing from you!

The following changes are effective January 1, 2006. The page numbers correspond to the pages and sections in the candidate handbook which can be downloaded from the website. Changes are noted with an asterik (*) before and after the policy change.

Page 1. Eligibility Requirements

• Physician (MD, DO)
• Physician Assistant (PA-C)
• Nurse (RN, LPN, NP)
• Respiratory Therapist (RRT, CRT)
• Pulmonary Function Technologist (RPFT, CPFT)
• Pharmacist (RPh)
• Social Worker (CSW)
• Health Educator (CHES)
• Occupational Therapist (OT)*
• Physical Therapist (PT)*

Page 14. If You Do Not Pass The Examination: If you do not pass the examination, you may reschedule a reexamination appointment within on year of your application date by contacting AMP at www.goamp.com or 1-888-519- 9901. Repeat candidate fees apply ($150.00) for each time the examination is repeated. *There is a waiting period of ninety (90) days between examination attempts with a maximum of three (3) attempts in a one (1) year period. In the case of extenuating circumstances, candidates may petition the NAECB.* If the time has exceeded one year since the date of your application to NAECB, you will need to apply to the NAECB again for permission to take the NAECB examination with all the associated fees ($275.00).

Page 14. Renewal of Certification: Attaining certification is an indication of mastery of a well-defined body of knowledge at a point in time. Periodic renewal of the certification is required to maintain certified status. Initial certification or renewal of certification is valid for *seven years.* Certificants may renew their certification by re-examination only *up to one year prior to the expiration of initial certification.* The recertification fee is $275

If you have any questions regarding these changes and how they affect your status as a candidate or certificant, please contact Lisa Overman, Administrative Director, at LOverman@naecb.org or 202-785-3355 ext. 240.