Regional Asthma Disease Management Program

Mission Children's Hospital Regional Asthma Disease Management Program serves 21 counties in Western North Carolina. Through this program, children and families are given care and education in their local settings - homes, childcare centers, and schools. The program's ultimate goal is to subjectively improve a patient's quality of life, decrease school absenteeism, decrease ED utilization and hospitalizations. The Regional Asthma Disease Management Program embraces the holistic approach to patient care through compassion and patient advocacy.

In May of this year, MCH Regional Asthma Disease Management Program received the EPA 2012 National Environmental Leadership Award in Asthma Management, one of four awards given in the United States.

A unique feature of the RADMP is the positive impact the program has had across the State of North Carolina as well as nationally. In 2008, the Mission program was recognized as one of the top three Asthma Disease Management Programs in North Carolina by the Division of Public Health.

Environmental factors
Western North Carolina borders the 800 square mile Great Smoky National Park, home to the greatest concentration of biodiversity in any temperate climate with over 100 species of trees plus another 1600 species of flowering plants. There are a higher percentage of persons in North Carolina diagnosed with asthma than the U.S average.

Partnerships
The RADMP has a core network of community partners including 15 health departments in Western North Carolina, WNC Primary Care Providers, Cherokee Indian Hospital Authority, emergency departments of the 4 regional hospitals, sub-specialists, 15 Western North Carolina School Systems and Child Care Centers, school nurses, social workers, and many others.

Key collaborators include the North Carolina Asthma Program, Asthma Alliance of North Carolina, Community Care of North Carolina Networks, North Carolina Department of Health and Human Services, North Carolina Department of Environmental and Natural Resources, western North Carolina school systems and child care centers, Cherokee Indian Hospital Authority, faith-based organizations, non-profit organizations, physicians, school nurses, and social workers.

Management and Structure
Mission Hospital determined the need to confront the problem where it lives taking the clinical approach to asthma management and control into non-clinical settings such as homes, schools and other care facilities in outlying areas.

RADMP personnel serve on the board of the Asthma Alliance of North Carolina, which lobbies state-wide policy on behalf of asthma goals as identified by the North Carolina Asthma Program. Legislative results of the work of this board include smoke-free dining in all public restaurants. Other achievements include a state-mandated policy that asthmatic students may carry their rescue inhalers. Also, a "no-idling" school bus policy is now in place across the state.

Implementation of evidence-based guidelines
Mission Hospital's Regional Asthma Disease Management Program incorporates the six key messages of the GIP Report and the underlying EPR-3 Recommendations, which include: (1) assess asthma severity, (2) assess level of control, (3) use of inhaled corticosteroids, (4) written asthma action plans, (5) allergen and irritant exposure control, and (6) follow-up visits.

Asthma severity and level of control are determined through clinical assessments including lung spirometry, exhaled nitric oxide (eNO), peak flow meter monitoring, and symptom diary usage. Exercise challenge tests (pre- and post-spirometry) are administered as necessary.

Environmental assessments are conducted at child care sites, elementary schools as well as homes of children diagnosed with asthma. School assessments have proven to be an effective and informal way to introduce entire classrooms of children to asthma awareness.

RADMP staff is certified and expert in the tools from the EPA Indoor Air Quality Tools for Schools Program to educate school personnel on creating an "asthma friendly" environment for their students. School and child care centers are offered the opportunity to participate in environmental assessments through the North Carolina Department of Environmental and Natural Resources, Children's Environmental Health Branch.

Mission's RADMP distinguishes itself from other models because of its emphasis on the most vulnerable, at-risk children suffering from asthma. Mission Hospital is committed to addressing these issues in a community-based collaborative program that embraces the holistic approach to patient care through compassion and patient advocacy.

Program Contacts:
828-213-8254
Melinda Shuler - Regional Clinical Coordinator
Amy Trees - Respiratory Therapist
Helen Thingvoll - Office Specialist
Shawn Henderson - Practice Manager