The key to winning the National Environmental Leadership Award in Asthma Management is to demonstrate that your comprehensive asthma management program:

• Is consistent with the NIH Guidelines throughout the continuum of care;
• Includes a robust environmental component; and
• Achieves positive health and financial outcomes.

Your responses to the five areas in this application will be evaluated against criteria designed to discover and highlight national leaders. You may collaborate with your partnering organizations on an application and you are encouraged to highlight key roles that these organizations play in delivering quality care (e.g., services you obtain through outsourcing, such as contracting to provide home visitors or case management services; partnering with community asthma coalitions to provide school-based asthma education classes).

You may apply online or by mail and your responses must not exceed 5,000 words (ten pages) total. A counter is provided in the online application so you can keep track of the length of your application.

To print a PDF of the application, click here.

1. COMPREHENSIVE ASTHMA MANAGEMENT PROGRAM (20 points)

To see how this area will be evaluated, click here.

Please describe your comprehensive asthma management program and briefly discuss how your organization addresses the components of the NIH Guidelines EPR 3 throughout the continuum of care. To the extent such information is applicable and available, please discuss in your response:

Asthma management program overview. Discuss when and how your program came into existence. Describe your program's goals and framework. As appropriate, address who administers the program throughout the continuum of care, including community partnerships; established mechanisms to ensure consistent communication among health care professionals responsible for implementing the program; approaches to ensure that asthma practice guidelines are incorporated into clinical procedures (e.g., provider incentives); approaches to increase patient participation in your program (e.g., patient incentives, pharmacy programs); and, reimbursement polices. Discuss how you ensure the sustainability of your program. For example, if your program is currently funded using an outside funding source (e.g., grant), please describe your plans to ensure sustainability after this funding lapses.

Measures of assessment and monitoring. As applicable, discuss how your clinical practices address diagnosis of asthma and assessment and monitoring of asthma control through the continuum of care. Discuss the procedures you use and how the concepts of severity and control guide the delivery of care.

Education for a partnership in asthma care. Describe your patient education program. Discuss, as applicable, when, where, and how patient education is provided; who receives different types of education; involvement of different members of the asthma health care team; elements of your education program; development and use of tools to encourage and assess self-management; and how you address cultural or health literacy issues. Describe programs to educate clinicians, and other members of the health care team, and support clinical decisionmaking.

Control of environmental factors and comorbid conditions that affect asthma. Describe your program for controlling conditions that affect asthma, other than environmental factors. (These will be addressed in #2 below.) Factors to discuss here, as applicable, include immunotherapy; management of comorbidities; sensitivity to medications; and infections.

Medications. Describe your programs to promote appropriate use of asthma medications. Describe, as applicable, your approach to pharmacologic therapy including long-term control and quick relief medications. Describe your approach to managing medications for patients with differential asthma, pediatric versus adult patients, and patients in special situations (e.g., pregnancy).

Please reference and explain any supplemental materials that you submit in support of this area. Attachments that are not referenced, explained, and given a title will not be considered during the evaluation.

2. ENVIRONMENTAL MANAGEMENT OF ASTHMA (40 points)

To see how this area will be evaluated, click here.

Please describe in detail how your asthma program addresses management of indoor and outdoor environmental triggers. To the extent such information is applicable and available, please discuss in your response:

• When and how the environmental component of your comprehensive asthma program came into existence.
• The elements of your environmental management component (e.g., determining relevant inhalant sensitivities to allergens; multifaceted allergen control interventions such as home visits, durable equipment, and occupational asthma counseling; social service referrals; patient and provider incentives to participate).
• Who delivers the environmental management component of your program (e.g., specialists, primary care providers, case managers, community members).
• Established mechanisms to ensure that health care professionals receive feedback regarding measures taken to manage indoor and outdoor environmental triggers.
• Funding source and plans to ensure sustainability (if different than for overall asthma program).

Please reference and explain any supplemental materials that you submit in support of this area. Attachments that are not referenced, explained, and given a title will not be considered during the evaluation.

3. POSITIVE HEALTH OUTCOMES (20 points)

To see how this area will be evaluated, click here.

Please describe the positive health outcomes attributable to your organization's comprehensive asthma management program, how environmental management contributes to these results, and how evaluation efforts contribute to improved patient outcomes and program success. Examples of outcomes that could be described include:

• Use of appropriate medications for people with asthma (2007 HEDIS measure)
• Reduction in emergency room visits per 1,000 members
• Reduction in hospital admissions per 1,000 members
• Reduction in missed school or work days
• Increase in number of symptom-free days
• Improved quality of life (from patient surveys)
• Increase in written asthma action plans
• Appropriate changes in behavior
• Number of people with reduced exposure to environmental asthma triggers
• Number of patients implementing environmental controls

The following paragraphs provide abbreviated, illustrative examples of the types of information sought:

• Example 1

  Health Plan - Our plan tracks claims data to measure our performance in improving the health of our members with asthma. Between 2000 and 2006, hospitalizations for asthma decreased by 56 percent in our commercial health plans and 34 percent in the Medicaid plan. Emergency department visits decreased 20 percent in commercial plans and 35 percent for Medicaid members during the same time period. A review of those members who received home environmental assessments for asthma triggers shows an even better improvement: hospitalizations for asthma decreased by 65 percent in our commercial health plans and 40 percent in the Medicaid plan for those receiving home visits and home-based education.

  Health Care Provider - Our program's asthma education specialists began a program of home-based education and visits in 2005. A comparison of pre- and post-intervention outcomes shows a reduction in ED visits for patients in the home visit program from 79 percent to 22 percent. Hospital admissions decreased from 40 percent to 5 percent. At the beginning of enrollment, 67 percent of patients missed school due to asthma compared to only 7 percent at follow-up.

• Example 2

  Health Plan - Our plan's asthma education program conducts annual follow-up surveys of children and families participating in our programs. Respondents to a 2006 survey reported 97 percent fewer school absences, 100 percent increased participation in physical activities, and 100 percent improved overall well-being of the child. From nearly 2,000 school health professionals trained in 2006, more than 95 percent think they are better prepared to care for children with asthma, as demonstrated by a 22 percent average increase in asthma knowledge levels measured through pre- and post-tests. These results have translated to 85 percent fewer hospitalizations and 78 percent fewer emergency room visits in the children they serve.

  Health Care Provider - Our clinics conducted interventions to reduce exposure to environmental triggers in homes, daycare centers, and other community gathering places. In a survey of our asthma patients, 75 percent reported 10 symptom-free days in a 14-day period and 70 percent have documented self-management goals. A comparison of health outcomes reported in 2004 to those reported in 2000 showed a 37 percent decrease in hospitalizations and a decrease in school and work absences related to asthma.

Please reference and explain any supplemental materials that you submit in support of this area. Attachments that are not referenced, explained, and given a title will not be considered during the evaluation.

4. COST SAVINGS OR RETURN ON INVESTMENT (10 points)

To see how this area will be evaluated, click here.

Discuss how cost savings or return on investment affects your program strategy and direction as well as the methods or approach you use for collecting this information. Please describe any cost savings or return on investment attributable to your organization's comprehensive asthma management program and describe how environmental management contributes to this. Return on investment may include non-monetary returns, such as reduced health disparities, stronger community relationships, or public relations or competitive advantages.

The following paragraphs provide abbreviated, illustrative examples of the types of information sought:

• Example 1

  Health Plan - Our Plan experienced improved health outcomes and significant cost savings six months after enrolling members with asthma in a home visit program. Costs per member per month (PMPM) were $155.67 prior to the home visit program and $72.55 after the home visit program, yielding a savings of $83.12 PMPM.

  Health Care Provider - A study of our hospital's hospitalization and ED rates from 2001 to 2004 showed a decrease in admissions from 65 to 32 per 1,000 person years, respectively. This yielded a savings of $375,000, compared to a program cost of $252,000. Using the Johns Hopkins Standard Outcomes Metrics and Evaluation Methodology for Disease Management Programs to calculate return on investment (pre-program medical costs minus post-program medical costs divided by program costs) yielded a return on investment of 1.49.

• Example 2

  Health Plan - As a result of Our Plan's asthma interventions, participating members experienced reductions in hospitalizations and ED visits, and improved use of appropriate medication. This translated in to significant cost savings pre- and post-enrollment for patients participating in the program. Costs pre-enrollment for PCP visits, ED visits, home health services, inpatient admissions and specialist referrals for 500 members were $372,535. Post-enrollment costs were $240,250, yielding a savings of $132,285.

  Health Care Provider - In a cost-benefit analysis, we found significant cost savings for those patients attending our asthma clinic. We estimate that 200 patients participating in the clinic would cost $81,000 less than patients receiving usual care. We assumed the following costs for this analysis: $1,000 for an ED visit for acute asthma; $4,000 for a 48-hour hospitalization, and $600 for a six-month supply of controller medication. Estimated rates of utilization and compliance were based on analysis of our randomized clinical trial. As the patients referred to our clinic are socially and economically disadvantaged, the improved outcomes are also associated with reduced disparities in asthma morbidity.

Please reference and explain any supplemental materials that you submit in support of this area. Attachments that are not referenced, explained, and given a title will not be considered during the evaluation.

5. DISTINGUISHING PROGRAM FEATURES (10 points)

To see how this area will be evaluated, click here.

Please describe features of your program that are unique, innovative, creative, or otherwise distinguish your program from others. Specifically highlight any unique or exceptional element of the environmental management component of your program that you believe is worthy of recognition. Below are examples to consider when developing your response:

• A program that effectively targets disproportionately-impacted or underserved populations.
• Strong community partnerships that leverage or supplement your resources (e.g., local asthma coalition).
• A program design that ensures sustainability after the expiration of outside funding.
• An outreach program that effectively identifies members in need of asthma care and gains their full participation in your programs.
• Creative use of claims or pharmacy data to track and improve health outcomes.
• An education, reimbursement, and incentive program that effectively engages your providers in delivering environmental management of asthma and other aspects of the NIH Guidelines to their patients.
• Community outreach (e.g., to schools or employers) to raise awareness of how others can help reduce exposure to environmental asthma triggers.
• Advocacy efforts geared towards creating asthma-friendly environments (e.g., support for local laws limiting exposure to secondhand smoke).

Please reference and explain any supplemental materials that you submit in support of this area. Attachments that are not referenced, explained, and given a title will not be considered during the evaluation.