Comprehensive Services and Health Systems Approaches to Improve Asthma Control in New York State

Grants to New York nonprofits, government agencies, hospitals, and academic institutions for the implementation or expansion of asthma control services. Applicants are strongly encouraged to submit an LOI by July 31. The purpose of this program is to enhance health outcomes and address the asthma burden in designated high-risk counties.

The aim of this Request for Applications (RFA) is to fund organizations serving high-risk areas to expand the availability and quality of evidence-based comprehensive asthma control services by improving the quality of
guidelines-based health care, ensuring the provision of appropriate asthma self-management education, and promoting policies supportive of asthma control. Improved asthma control will be achieved through a population-based, sustainable systems approach designed to deliver seamless, guidelines-based comprehensive asthma control services across public health, community and health care sectors. The RFA seeks organizations that will work to reduce the racial/ethnic and community disparities in the burden of asthma, with a primary focus on children ages 0 to 17 years.

Comprehensive Services and Health Systems Approaches to Improve Asthma Control in NYS aims to align with statewide NYSDOH community and health system initiatives, such as the NYS Prevention Agenda, Delivery System Reform Incentive Payment Program (DSRIP), Population Heath Improvement Program (PHIP), the State Health Innovation Plan, Healthy Neighborhoods Program contractors and Advancing Tobacco-Free Communities and Health Systems for a Tobacco-Free New York contractors.

Description of Program:

Funding awarded through this RFA is anticipated to support five contractors in high asthma burden geographic areas to expand the availability and quality of comprehensive asthma control services to reduce the burden of asthma in NYS, as demonstrated by a decrease in asthma-related emergency department visits and hospitalizations. This will be accomplished by identifying children and adults with poorly controlled asthma, linking them to quality guidelines-based care, providing and referring to asthma self-management education, and either referring to or providing home-based asthma services. Contractors will implement and support strategies in health systems, community and home- based settings aimed at reducing the burden of asthma among priority populations and improving the quality of care and quality of life for people and families with asthma in each region. The Project Logic Model (Attachment 1) illustrates the strategies, activities, milestones and expected outcomes of the initiative.

The work under this RFA will center on translating current national asthma guidelines into practice in awarded regions. The National Asthma Education Prevention Program, Expert Panel Report 3, 2007: Guidelines for the Diagnosis and Management of Asthma (NAEPP Guidelines) provides “recommendations for the diagnosis and management of adults and children with asthma to help clinicians and patients make appropriate decisions about asthma care”.

The NAEPP Guidelines provide four key components of asthma care:
1. Assessment and monitoring of asthma severity and control;
2. Patient education for a partnership in care;
3. Control of environmental factors that affect asthma; and
4. Pharmacologic treatment.

The 2008 Guidelines Implementation Panel (GIP) Report was published to provide recommendations and strategies for overcoming barriers to implementing the recommendations of the NAEPP Guidelines to improve acceptance and use of the asthma guidelines. The GIP provides six priority messages for the broader asthma community that, when acted upon, would most likely result in improvement in asthma care processes and outcomes.

These six priority messages are:
1. Assess asthma severity to determine type and level of initial asthma therapy;
2. Assess asthma control to guide asthma therapy;
3. Review allergen and irritant exposure to provide a multipronged strategy for reduction;
4. Use inhaled corticosteroid for long-term management of persistent asthma control;
5. Complete Asthma Action Plans for all people who have asthma to guide self-management; and Plan follow-up visits at periodic intervals to assess control and treatment.
6. The following strategies should be implemented in the same geographic locations to ensure access to comprehensive NAEPP Guidelines-based asthma control services.

Asthma Services:

Asthma Services interventions targeting priority populations will address all of the following strategies:

1) Asthma Self-Management Education: Ensure the delivery of evidence-based asthma self- management education in a variety of settings. Asthma self-management education should address key elements from the NAEPP Guidelines (basic pathophysiology of asthma, correct usage of medications and improved medication adherence, monitoring symptoms, and avoiding triggers). Home-based services (taking place in the home) will be provided to individuals whose asthma is not well controlled. Home-based services should be multicomponent interventions that include, at a minimum, asthma self-management education, a home environmental assessment, and multi-trigger reduction services.

2) Linkages to Care: Assure linkage to guidelines-based care for people with asthma including support for medication adherence and trigger reduction services.

3) Training of Caregivers: Coordinate and deliver asthma management training based on NAEPP Guidelines to caregivers (e.g. family members, community health workers, and home visitor staff).

4) Policies Supportive of Asthma Control: Support the adoption and implementation of evidence- based policies supportive of asthma control including trigger reduction, and improved air quality.

Health Systems:

Health systems interventions targeting priority populations will address all of the following strategies:

1) Quality Improvement: Implement quality improvement processes in health care settings. Quality improvement strategies may include practice facilitation, academic detailing, and health system redesign. Intensive quality improvement efforts will focus specifically on pediatric primary health care settings by employing proven improvement methods, such as those described by the Institute for Health Care Improvement (IHI), for making and sustaining system change interventions. Participating practices will set project team aims, establish measures and report data, and select, test, implement and spread evidence-based interventions aimed at improving asthma outcomes.

2) Team-Based Care: Promote the use of team-based care and other health care delivery models with health care organizations and partners to improve coordination of asthma care.

3) Coverage and Reimbursement: Promote coverage for and utilization of comprehensive asthma control services including medicine, devices, self-management education, and home visits.

4) Community-Clinical Linkages: Support the development of connections between public health programs and the clinical setting to coordinate delivery of comprehensive asthma control services.

Awardees will be required to work across both Asthma Services and Health Systems to implement all of the strategies outlined above simultaneously.

Geographic Area:

Eligible Service Areas have a total population greater than 700,000 and include one or a contiguous group of eligible counties identified as being among the 25 highest asthma burden counties in NYS. Asthma burden is defined using the following asthma indicators: asthma-related hospitalization rates and asthma-related emergency department visit rates for adults and children

Eligible Counties:

-Region 1, Service Area 1: Albany, Fulton, Montgomery, Rensselaer, and Schenectady Counties

-Region 1, Service Area 2: Dutchess, Orange, Sullivan, Ulster, and Westchester Counties

-Region 2, Service Area 3: Erie and Niagara Counties

-Region 2, Service Area 4: Monroe County

-Region 3, Service Area 5: Nassau and Suffolk Counties

-Region 4, Service Area 6: Bronx County

-Region 5, Service Area 7: New York, Queens, Kings, and Richmond Counties