Transcript Implementation of the New York State Asthma Plan 2000-2005

Implementing Interventions in
Diverse Communities:
The Asthma Partnership Of New York
New York State
Department of Health
Pediatric Pulmonary Center Meeting
March 1-3, 2007
Arlington, Virginia
New York’s Call to Action

“Despite some improvements in awareness, care
and management, asthma still remains an
epidemic in New York state with significant public
health and financial.

Disparities among high and low income groups
and variation in care processes, quality and cost
of care persist.
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More system level activity is necessary to
accelerate and spread improvements for all New
Yorkers.”
New York State Asthma Plan 2006-2011
Objectives
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Describe the Burden of Asthma In New York
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Define the role of the Asthma Partnership of
New York
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Highlight New York’s strategies to improve
asthma outcomes
BRFSS Prevalence of Asthma Among Adults by
Survey Year, New York State & Nationwide
Percent
10
9
8.9
7.9
8
7.7
7
7.0
7.5
7.6
7.6
7.8
8.3
7.5
7.3
6.3
6
5.4
5
4
3
2
1
0
1996
1997
1998
1999
2000
2001
Year
New York
Nationw ide
2002
2003
2004
National Asthma Survey – NY 2003
National Asthma Survey – NY 2003
National Asthma Survey – NY 2003
National Asthma Survey – NY 2003
National Asthma Survey – NY 2003
Healthy People 2010 Objectives for
Asthma Hospital Discharges per 10,000 population
New York State (1994-2004)
NY 94-96
NY 96-98
NY 98-00
NY 00-02
NY 02-04
HP 2010
0-4 Yrs
86.8
75.5
72.1
66.1
71.7
25.0
0-17 Yrs
28.0
43.3
35.7
31.2
34.9
17.3
5-64 Yrs
22.9
21.0
18.7
16.3
18.0
7.7
65+ Yrs
26.4
25.3
25.8
24.8
22.4
11.0
Age Group
Total Cost of Asthma Hospitalizations
New York State, 1993-2002
$600,000,000
The total cost of asthma
hospitalizations has
increased 44%, from
$322 million in 1993 to
$465 million in 2004.
The top 20% of asthma
hospitalizations
consumed ~ 55% of the
total cost for asthma
hospitalizations.
$500,000,000
$400,000,000
$300,000,000
The average cost per
asthma hospitalization
increased 106% from
$5,656 in 1993 to $11,634
in 2004.
$200,000,000
$100,000,000
$0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
This occurred despite
the average length of
stay for asthma
decreasing 24% from 4.9
days to 3.7 days during
the same time period.
Use of Appropriate Medications for Children with
Asthma, 1999-2003 Trends by Payer
Statewide Average
Commercial
Medicaid
CHPlus
80
75
70
65
60
55
50
45
40
1999
2000
2001
2002
2003
Measurement Year
5-17 Years: Commercial, Medicaid
5-18 Years: Child Health Plus
Source: QARR data
Use of Appropriate Medications for Adults with
Asthma, 1999 -2003 Trends by Payer
Statewide Average
Commercial
Medicaid
80
75
70
65
60
55
50
45
40
1999
2000
2001
2002
2003
Measurement Year
Source: QARR data
New York State Asthma Report Card –
Modified HEDIS Asthma Measures*
MODIFIED HEDIS MEASURE
STATEWIDE AVERAGE
CHILDREN (5-17)
STATEWIDE AVERAGE
ADULTS (18-56)
1 or More Controller Scripts in 2004**
69.8%
70.1%
3 or More Controller Scripts in 2004
47.4%
55.0%
5 or More Controller Scripts in 2004
32.9%
43.9%
*Cohort comprised of enrollees in HMOS and PHSPs who qualified for the denominator of the 2005
HEDIS Measure, ‘Use of Appropriate Medications for People with Asthma.’
**Standard 2005 HEDIS Measure.
NY Asthma BCAP Overall 2004 and 2005 Audit Results
Asthma Disease Severity Categories Documented: By NHLBI Category
(The exact terms (“Intermittent”, “Persistent”, “Persistent-mild”, etc.) must be recorded)
N=845 Reviewed Medical Charts
100%
87%
90%
All Records
80%
% of All Reviewed Charts
70%
Lowest
65%
Highest
60%
50%
40%
34%
30%
27%
26%
23%
20%
12%
11%
10%
11%
10%
9%
0%
2% 0%
0%
0%
Intermittent or
Mild Intermittent
Persistent
Persistent - mild
Persistent moderate
2%
5%
0%
1% 0%
0%
Not recorded
Response Categories
Persistent severe
Exerciseinduced asthma
NY Asthma BCAP Overall 2004 and 2005 Audit Results
Asthma Assessment Documentation Responses For Persons with Asthma
Assessed in the Review Period
N=845 Reviewed Medical Charts
98%
100%
94%
93%
90%
90%
82%
% of All Reviewed Charts
80%
75%
70%
60%
All Records
Lowest
56%
54%
Highest
50%
44%
40%
31%
30%
22%
20%
10%
7%
5%
0%
3%
0%
Daytime symptoms of
wheezing OR cough OR
shortness of breath (SOB)
recorded
Nocturnal symptoms of
wheezing OR cough OR
SOB
Activity-related symptoms of
wheezing OR cough OR
SOB
Response Categories
Frequency of prescribed
Frequency of use of quickquick-reliever (ß-agonist or reliever (ß-agonist or rescue)
rescue) medications
medications
NY Asthma BCAP Overall 2004 and 2005 Audit Results
Smoking Assessment Was Performed
N=845 Reviewed Medical Charts
100%
90%
80%
71%
% of All Reviewed Charts
70%
60%
50%
40%
39%
30%
20%
10%
4%
0%
All Records
Highest
Lowest
NY Asthma BCAP Overall 2004 and 2005 Audit Results
Member Has an Updated Asthma Action Plan Documented in the Medical Record
During the Review Period
N=845 Reviewed Medical Charts
100%
95%
90%
% of All Reviewed Charts
80%
70%
60%
50%
40%
30%
27%
20%
10%
0%
0%
All Records
Highest
Lowest
NY Asthma BCAP Overall 2004 and 2005 Audit Results
Patients with All Four NY Asthma Guideline Elements
(Documentation of Asthma Severity, Prescribed Controller Medications,
Asthma Triggers, and Asthma Action Plan)
N=433 Reviewed Medical Charts, 2005 Review Only
100%
90%
% of All Reviewed Charts
80%
70%
60%
50%
40%
29%
30%
20%
10%
10%
0%
0%
All Records
Highest
Lowest
What will it take to spread improvements and
reach New York’s diverse communities?

Change will not happen on the scale needed unless
there is collaboration and alignment of priorities across
stakeholder groups.

There must be some awareness that the stakeholders
are more likely to achieve the goal by working together
than individually.

“Americans are a peculiar people. If in a local community
a citizen becomes aware of a human need that is not
met…suddenly a committee comes into existence…and
a new community function is established. It is like
watching a miracle.”
de Tocqueville, 1840
Definition of Terms - NY

Partner: an associate or organization who works with other
partners, including the NYSDOH, toward a common goal
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Partnership: a cooperative relationship between Partners who
agree to share responsibility for achieving the goal of reducing the
burden of asthma
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Coalition: An organized group of partners within a specific region
who work together to achieve a shared goal through a population
based sustainable systems approach and some awareness that they
are more likely to meet their goal by working together than
individually.
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State Asthma Program: Implementation of coordinated asthma
activities based on the New York State Asthma Plan and led by
NYSDOH with statewide partners
Who are NY’s Partners?


Statewide Partnership (advisory, and
implementation role)
Regional Coalitions (advocacy, implementation role)

Local/Project Specific Partners (advisory,
implementation, sponsor role)
Statewide Partnership
NYSDOH Partners
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Center for Community Health
Center for Environmental Health
Child Health Plus
Department of Environmental
Conservation
Information Systems and Health
Statistics Group
Office of Health Systems Management
Office of Managed Care
Office of Medicaid Management
Office of Science and Public Health
Office of Rural Health
Public Affairs Group
Wadsworth Center for Labs and
Research
External Partners
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American Lung Association
Healthcare Association of New York State
Community Health Centers Association of NY
Pediatric, IM, Family Practice Professional
Societies
Medical Society of the State of New York
Health Plan Association of New York State
State Education Department
New York State Nurses Association
NYS Association of School Nurses
Pharmacy Society of the State of New York
NYS Regional Asthma Coalitions
Role: Shape, align, implement and monitor New York’s
action to reduce the burden of asthma
NYS Regional Asthma Coalitions
Coalition Partners
• Approximately 100 partners per coalition
such as:
•Health Care professionals/organizations
•Insurers
•Local Health Departments
•Schools/daycares
•Community groups/organizations (ALA)
•Pharmacists
•Faith based organizations
•Housing
•Environmental organizations
•Businesses
•Media
•Others
Role: Control asthma through a regional, population based, sustainable
systems approach.
Local or Specific Project Partners
Best Clinical and Administrative
Practices (BCAP): Improving Asthma
Outcomes in NYS (2004-2006)
Project Partners:
•NYSDOH Asthma Program
•NYSDOH Office of Managed Care
•Center For Health Care Strategies
(CHCS)
•Island Peer Review Organization
(IPRO)
•13 Medicaid Managed Care Plans
•Providers
•Regional coalitions
Role: Translate the Asthma Guideline into
practice, coordinate interventions and share
information among partners
How are all these partners connected?
Statewide
Partnership
NYSDOH
Guidance Team
Surveillance
Health Care
Community
NYSDOH
Leadership Team
Environment and
Occupational Health
Moving New York Forward:
“Re-Visioning Asthma”
Partners
Role
National Initiative for Children’s
Healthcare Quality (NICHQ):
Boston/Seattle
• Expert in system change and
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MacColl Institute for Chronic
Illness Improvement (Dr. Ed
Wagner, Mike Hindmarsh)
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Broad Representation across
DOH and NYCDOH&MH ,
including Executive Level buy in
and support)
•Expert in population based
chronic care improvement and
aligning system change aims at
multiple levels in the health
system and community systems.
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Statewide Partners: professional
societies, specialists, health
plans, advocacy organizations,
ALA, regional coalition reps,
patients/parents etc.
improving asthma care among
children
•Expert in Public Health, Medicaid,
Managed care, Epidemiology,
Environmental and Occupational
Health
•Expert in clinical, advocacy,
regional issues,
patient/community experience
New York State Asthma Plan 2006-2011
• July 2005 new strategic planning began
• Reviewed burden of asthma in NYS
• Emerging new evidence
• Result…
“Framework for Improving Asthma
Outcomes in NYS”
Framework for Improving Asthma Outcomes in New York State
Statewide
Public/Private Collaboration
•Leadership
•Shared Vision: Priorities  Goals
•Partners: People with Asthma, Providers, Plans, Purchasers, Legislators, Public Health …
Ongoing Surveillance, Data Integration, Evaluation, Performance Measurement & Research
Mobilizing Public
Health
Engaging Consumers/ Improving Healthcare
Communities
Delivery/Quality
•Asthma friendly communities,
schools, work and home
environments
•Public awareness and
knowledge of asthma
•Community support
and buy-in
•Public disclosure of
health system
performance
•Consumer education
•Consumer-directed
care decisions
Integrated Public
Health System
•Consensus Guidelines
•Medical Home
•Care Management
• IT connectivity & support
•QI models & activities
•Provider networks
•Provider education
Motivated,
Informed,
Integrated Health
Activated
Care Delivery
Consumers/
Communities
Aligning Finance/
Insurance
•Expanded access to health
insurance
•Model benefit package for asthma
services
•Administrative simplification
•Expanded funding for
services/benefits not adopted by
payers
•Performance Incentives
Supportive
Insurance &
Payment
Transformed Healthcare System
Improved Asthma Outcomes (Short Term/Long Term) and Optimized Value
NYSAP 2006-2011 Goals
1. Seamless, evidence- based,
patient/family centered asthma care
exists for all New Yorkers with asthma.
2. Disparities in asthma diagnosis,
treatment and outcomes are
eliminated.
3. "Asthma-Friendly" communities exist
in New York.
4. Policy makers, health care providers
and consumers have an increased
understanding of asthma and treat
and manage asthma effectively.
5. A Statewide Public/Private
Collaboration exists to shape,
implement and monitor New York’s
action which will improve asthma
outcomes in New York.
Prioritizing Strategies
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150
38 strategies (based on framework)
3 face to face meetings and 2 surveys
Each strategy rated based on a two by two matrix
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high or low impact – the degree to which this strategy is
supported by evidence and would improve health related
outcomes and quality of life and reduce symptom burden,
preventable hospitalizations and deaths;
high or low feasibility of implementation – the degree to
which the necessary resources, partners and political will
are available and can be conducted in the real world.
Goal 1: Seamless evidence-based
patient/family centered asthma care
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Update NYS Asthma Consensus Guideline pending
NAEPP updates
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Develop Asthma Guideline for patients
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Develop and establish the “NYS Center For
Innovation”
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Develop and implement a model benefit package for
that support good asthma care
Goal 2: Eliminate disparities in asthma
diagnosis, treatment, and outcomes
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Develop, implement and spread a multimodal asthma home environmental
intervention through a collaboration with NYS
Healthy Neighborhoods Program, Health
Plans and Providers in both urban and rural
communities

Pilot and expand an asthma quality
improvement collaborative within School
Based Health Centers located in
neighborhoods with high asthma morbidity
Goal 3: Create asthma-friendly
communities in NYS
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Develop and implement a comprehensive NYS
School Asthma Management Policy
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Implement tailored environmental trigger reduction
interventions in identified high risk elementary
schools
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Create and promote the NYS Asthma Coalition
Learning Network among state funded regional
asthma coalitions in order to identify and spread
best practices
Goal 4: Enhance awareness among
policy makers, providers, and
consumers
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Maintain and expand asthma surveillance
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Produce and disseminate NYS asthma surveillance
information
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Provide technical assistance for monitoring and
evaluation of asthma interventions
http://www.health.state.ny.us/diseases/asthma/index.htm
Goal 5: Foster a statewide public /
private collaboration to monitor
asthma outcomes
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Refine and expand the:
Asthma Partnership of New York
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Asthma Partnership of New York actively
works together to set priorities, monitor plan
implementation and results
Thank You!
Pat Waniewski, RN, MS
Asthma Coordinator, NYSDOH
Phone: (518)486-6065
Email: [email protected]
New York State Department of Health Asthma Web page:
http://www.health.state.ny.us/diseases/asthma/index.htm