Wee Wheezers Asthma Education Program

Implemented in Darnell Army Community Hospital, Ft. Hood, Texas by MAS Consultants Inc., P.O. Box 5130 Aiken, South Carolina 29804.

Wee Wheezers: Strengths/Challenges

Markers of success that have resulted from adoption of the asthma health-care system changes at Ft. Hood, of which Wee Wheezers is an integral part, are defined as 1) reductions in the number of hospital inpatient asthma dispositions; 2) reductions in the number of emergency department visits for asthma; 3) improvement in the affected child’s quality of life as reported by the family; 4) cost-savings to the hospital resulting from better asthma patient self-management.

The contribution of the educational program in improving health outcomes is impossible to isolate from the contributions of other improvement elements that were put into place in 1998 by the Asthma Process Action Team at DACH. Two phenomena, however, are clearly related to improving health care for Ft. Hood residents. First, the medical chiefs and their staff within the various departments of the hospital work together to improve patients’ health. The Asthma Process Action Team, composed of department representatives, the director, and coordinator of DACH-Air still meet regularly going into their fourth year. Second, this cooperative spirit--the sharing of information and consultation between DACH-Air, pediatrics, family care, and the emergency department--combined with better asthma diagnosis, treatment, and patient education have resulted in improving asthma care, as:

• Emergency department visits decreased 53% from 1997 to 2001
• Inpatient asthma dispositions decreased by 69% from 1997 to 2001
• Pediatric quality-of-life assessment index improved by 22% for children who completed Wee Wheezers
• Annual cost-avoidance to the hospital from reduced asthma treatment is estimated to be $650,000

Neither the health-care system changes nor the Wee Wheezers education alone would be likely to achieve benefits of the magnitude described above. Both are needed to attain the highest level of success with health-care improvement. Potential users of this asthma education program, or any other such program, should recognize that educating asthma patients in a vacuum, without the cognizance and the cooperation of the patients’ physicians, will probably result only in partial benefit to the patient. Care provided to patients or families who lack an understanding of the disease or its management results in poorer adherence to medical recommendations and poorer disease outcomes than care provided when patients are educated.

Strengths

Data collection capabilities that support asthma education intervention.
Wee Wheezers operates within a health-care system that supports the entire military base population and all its dependents. The medical records system can track emergency visits and inpatient dispositions, among a host of other medical parameters. Pre-tests and post-tests at the asthma education classes and the quality-of-life survey at class and at 6 months, along with the medical records, demonstrate that the educational program is increasing participant knowledge and that this asthma health-care system is improving the lives of children with asthma. This capability has been essential to acquiring continued senior management support and DACH-Air funding for asthma care. DACH recently received a commendation from the medical command for its leadership in implementing the military’s asthma management guidelines and presented the asthma program at the MEDCOM annual conference in San Antonio, Texas, in May 2002.

Outstanding people who promote the program.
DACH-Air staff are highly motivated; they believe in what they are doing, are committed to success and sell the program not only to the asthma patient population but also to the hospital and clinic staff in the form of provider education and resources. The DACH-Air director conducts provider asthma education classes for the Darnell medical staff based on the military guidelines for asthma diagnosis and treatment. Members of the DACH-Air staff often educate in their offices asthma patients who need more immediate help or who have not attended the scheduled class. They also respond to requests for help from providers throughout the network.

Full-time asthma education coordinator.
With the addition of the asthma coordinator in 2000, one-on-one communications with families scheduled for Wee Wheezers is now possible. Appointment slips are now mailed to all families referred for education along with a letter of explanation about the course and its value to the family. The coordinator makes a follow-up reminder phone call the day before the session. When a parent misses a scheduled session, she/he is routinely placed on another schedule and receives written notices and phone calls about attendance. Since hiring the coordinator, attendance at Wee Wheezers has improved by more than 40%.

Use of peak flow-based asthma management plans.
Before implementation of DACH-Air and the Wee Wheezers program, only 30% of asthma patients used an asthma action plan. The education classes emphasize the importance of following the asthma action plan. Currently, 68% of children old enough to perform peak flow have an approved asthma action plan from their physicians based on peak flow performance. Use of the asthma management plans and recognition of asthma triggers and the symptoms of asthma as taught in the classes have improved parents’ confidence that they can manage their child’s asthma. In February 2002, DACH-Air was awarded the GlaxoSmithKline 2001 Circle of Excellence Award for Total Patient Management. Parents interviewed for this case study commented on how their asthma action plans had helped them manage their children’s asthma.

Sibling attendance at asthma education classes.
All siblings of children with asthma who are themselves at least 6 years old are encouraged to attend the Wee Wheezer sessions. Experience has shown that older siblings – probable caregivers and role models – can be instrumental with compliance issues.

Challenges

Child-care for parents while in the education session.
Ft. Hood hospital accommodates parents bringing children to the hospital who are not there for health care. Some parents bring babies and younger children to their asthma education sessions at the hospital. Although the hospital has a quiet room for caring for these children, DACH-Air is not staffed to provide formal child-care during the 2-plus hours the parents or guardians are in class. Failure to provide child-care leads to some distractions and disruptions in class from these children.

Medical staff turnover.
Success improving asthma management depends on provider education in concert with patient education. The turnover of military medical staff is high. Providing asthma education for the large number of incoming medical staff requires constant leadership and ongoing delivery of instruction. The biggest single challenge is educating medical staff at the hospital and satellite clinics on the proper use of controller medications and application of the clinical guidelines for asthma diagnosis and management.

No formal follow-up of education for parents of young children.
Because parents of children aged less than 5 years only attend one Wee Wheezer session, no routine mechanism exists to receive feedback on how well these parents practice what they learned at the class. Parents are provided with the coordinator’s phone number and are encouraged to call with any questions or problems. The 6-month follow-up using Juniper’s quality-of-life questionnaire provides a window into the family’s success and prompts the coordinator to contact the primary-care providers of patients with any significant decreases.