State-wide Legislation Positively Impacts Attendance for ...

State-wide Legislation Positively Impacts Attendance for Students with Asthma

Joy Krieger, MA, RN (AAFA-STL); Hamsa Subramanian, MD (Signature Medical Group, Allergy & Immunology); Hua Pan, PhD (Washington University School of Medicine) Reagan Nelson, MPA, AE-C (AAFA-STL); Emily Vandas, BA (AAFA-STL); Manoj Warrier, MD (Allergy, Asthma & Sinus Care Center of St. Louis and Saint Louis University)

INTRODUCTION

Asthma disproportionately affects students from lower-income areas. This study evaluates the outcomes for students in the two years following the passage of Missouri House Bill 1188 (allows trained school employees to administer bronchodilator to students) and the implementation of the St. Louis Chapter of the Asthma & Allergy Foundation of America's (AAFA-STL) school nurse RESCUE (Resources for Every School Confronting Unexpected Emergencies) program, which provides schools with equipment and access to medications to treat asthma.

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MO House Bill 1188 1

Allows a school nurse or other trained employee to administer asthma-related rescue medication to any student experiencing an asthma attack. Sponsored in Missouri by Representative Sue Allen and Senator Eric Schmitt.

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AAFA-STL's RESCUE program 2 provides equipment used for asthma emergencies to school nurses at no cost. Qualifying schools typically have a free and reduced lunch percentage of 25% or greater for their population.

METHODS

AAFA-STL's RESCUE program mainly supports schools with lower-income populations. Participating schools were provided with a nebulizer, spacers, and supplies along with access to free albuterol. When RESCUE supplies were used, school nurses logged outcomes? return to classroom, sent home, sent to emergency department (ED) or other.

86.07% 84.48% 85.69%

RESULTS

In the 2013-2014 school year, 103 of the 105 schools receiving equipment from RESCUE returned logs. Equipment was used 1357 individual times, with students going back to class 86.07%, sent home 10.83%, and sent to ED 1.33% of the time. In the 2014-2015 school year, 126 of the 207 schools returned logs. Equipment was used 1720 individual times, with students going back to class 84.48%, sent home 10.81%, and sent to ED 3.14% of the time.

1-Return to Class

Month of Usage Equipment Used

Outcome Reason for Use Known Asthmatic?

1. Spacer 2. Nebulizer/Tubing 3. PFM 4. Stock Albuterol

1. Return to Classroom 2. Sent Home (or other Non-ED Care) 3. Emergency Department 4. Other

1. Emergency Use 2. Pre-Treatment for Exercise 3. Monitoring (PFM)

Having Symptoms (URI/Non-Emergency) 4. Other

105 103

207 126 37%

2013-2014 2014-2015 2015-2016

10.83% 10.81% 9.48% 2-Sent Home

1.33% 3.14% 2.39% 3-Went to ER

1.77% 1.57% 2.44% 4-Other

Average cost to area schools per student, per day across the 4 counties

AAFA serves in MO 3

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If access to these materials prevented an emergency situation just 25% of the 4,520

times a student was reported

returning to the classroom over

the past three years

Schools saved $73,359

CONCLUSION

The RESCUE program ensures schools have access to the necessary equipment to treat acute asthma symptoms, thereby decreasing the need for ED visits and sending students home. HB1188 1 ensures schools are allowed to stock asthma rescue medicine . This comprehensive approach decreases the economic costs to parents and society and improves student health as well as academic performance, especially in schools serving lower-income populations.

$80

per school

Average amount AAFA-STL invests per school, working out to a $30,000 investment across the 375 schools

providing data

$64.92

per day

$433

per ED visit

National average cost per ED visit for pediatric asthma for Medicaid/CHIP enrollees was $433 in 2010 4. An estimated 41.6% of children were enrolled in MO Medicaid in FY 2015 5, 6

Conversely, if the school nurse had not had access to stock

meds/equipment just 25% of the 4,520 times a student returned

to class, estimated ED costs Incurred under Medicaid are $489,290 across 1,130 incidents

268 146

52%

REFERENCES

1. Missouri House Bill 1188 (L. 2012). RSMo 167.635.1. Retrieved from

6. United States Census Bureau. (2015). Annual Estimates of the Resident



Population for Selected Age Groups by Sex for the United States, States,

2. Asthma and Allergy Foundation of America, St. Louis Chapter. (2016).

Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010

Resources for Every School Confronting Unexpected Emergencies

to July 1, 2015 [Data file]. Retrieved from

(RESCUE). Retrieved from

.

xhtml?src=bkmk

3.

Missouri Department of Elementary Education & Secondary Education. (2015). Finance Data and Statistics Summary for All Districts [Data File].

7.

Retrieved from

School-Information.aspx

Missouri Department of Health and Senior Services. (2014). Issue Brief: Evaluation Project Results Report School District Adoption of Policy to Maintain Stock Supply of Asthma-related Rescue Medication [Data File]. Retrieved from

4. Pearson W.S., Goates S.A., Harrykissoon S.D., & Miller S.A. (2014). State-



Based Medicaid Costs for Pediatric Asthma Emergency Department Visits.

tions.php *Spring 2016 data is still being collected; preliminary analysis

Preventing Chronic Disease, 11:14013.

based on sample size of 205 responding school districts; by comparison,

DOI:

Spring 2014 based on n = 434 (or 83.3% response rate of all public

5. Centers for Medicare and Medicaid Services. (2015). FFY 2015 Number of

school districts in Missouri)

Children Ever-Enrolled in Medicaid and CHIP [Data file]. Retrieved from



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