Teaming up for asthma control: Epr-3 compliant school program in missouri is effective and cost-efficient

Abstract

Introduction :Teaming Up for Asthma Control (TUAC) is a work force develop ment intervention to improve asthma control among children by increasing the competency of school nurses and delivering guideline-based education. We hypothesized that the knowledge and skills of participating school nurses would improve and that this change would positively affect students' asthma health and re duce health care utilization cost. Methods :Asthma education for school nurses was provided online in a pretest/posttest format or in instructor-led groups. Students with persistent asthma were identified by using a checklist. Expert eval uators obtained student participants' preassessments/postassess-ments before and after the 3 asthma checkups by the school nurse, and the assessments were compared. Health care costs were as sessed using Medicaid administrative claims data. Results :A total of 54 school nurses and 178 students in Missouri particip ated in the TUAC evaluation from 2011 through 2014. Among school nurses who completed the online education (n = 42, 77.8%), knowledge scores significantly increased from pretest (49.1%) to posttest (90.7%, P < .001). Of school nurses who com pleted assessments on 3 children (n = 34), 91.2% met the ±6% equivalence for 1 or more assessments on forced expiratory volume in 1 second (FEVj) compared with the expert evaluator. At enrollment, 69.7% of students had "not well-controlled" or "very poorly controlled" asthma. Postintervention, FEVj signific antly improved (82.9% to 92.1% predicted), and self-reported impairment and tobacco smoke exposure significantly declined (P < .001). For TUAC students enrolled in Medicaid, there was an average 12-month health care cost difference (-$1,431) compared with controls. Conclusion :School nurses effectively assessed asthma status, students' out comes improved, and health care utilization costs declined. This evaluation contributed to program improvements to further im prove health outcomes among students with asthma.