Attempting to Use a District-Wide Asthma Case Identification System for Asthma Prevalence

By Wheeler, Lani S.; Boyle, Susanne | Journal of School Health, August 2006 | Go to article overview

Attempting to Use a District-Wide Asthma Case Identification System for Asthma Prevalence


Wheeler, Lani S., Boyle, Susanne, Journal of School Health


CASE STUDY OBJECTIVES

* To improve our case identification system for use in an annual asthma prevalence count for Anne Arundel County public schools

* To simplify the system for school nurses

* To increase the system's accuracy

SCHOOL DISTRICT DEMOGRAPHICS

In Maryland, county and school district boundaries are the same. Anne Arundel County, Maryland, home to Annapolis, the state capital, and near Baltimore and Washington, DC, includes urban, suburban, and rural areas. The Anne Arundel County public school system serves 75,000 students in grades pre-K to 12, 17% of whom qualify for free and reduced-price lunch, and includes 116 schools--77 elementary schools, 19 middle schools, 12 high schools, 2 centers of applied technology, 3 special education centers, 1 alternative high school, 1 middle school learning center, and 1 center for emotionally impaired students.

PROGRAM CONTEXT

The Anne Arundel County Department of Health provides all school health services (nursing, occupational and physical therapy, and audiology) for Anne Arundel County public schools. The county school nursing program has a program manager, 8 supervisory nurses, 2 training nurses, 77 school nurses (registered nurses) (1:974 students), and 129 health assistants (27 of whom are licensed practical nurses). School health program staff work to improve the health of students with asthma by identifying students with asthma and ensuring that they receive the care they need in school. Anne Arundel County school nurses serve every public school in the county and are organized in 12 clusters, each consisting of a high school and its feeder schools. The nurses (1) supervise medication administration and peakflow monitoring carried out by trained health assistants, (2) teach about asthma and preventing symptoms at school, (3) provide case management as needed, (4) perform annual asthma health appraisals for all students with current asthma, and (5) educate students by leading Open Airways for Schools groups in elementary schools and using Quest for the Code and Power Breathing in secondary schools.

CASE STUDY

The Anne Arundel County School Health Program, provided by the county's Department of Health, is committed to improving the health of students with asthma. Since 1998, our program has used a case identification system to develop an annual asthma prevalence count. The case identification system uses information from annual emergency cards, school entry physical examination forms, medication administration forms, and health room visits to identify students with health needs in schools. (1) Our school nurses use the system to identify students who need school health services and asthma education, but the system's implementation varies across schools.

We wanted to be able to compare the prevalence of asthma across schools to identify areas of higher prevalence, target our efforts, assess differences among racial groups, and monitor asthma rates over time. To do so, we chose to determine a point prevalence rate on September 30 of each year, coinciding with the date of our schools' annual population count. We decided against counting all students with asthma over an entire school year because of substantial and variable turnover in the student population.

When we began in 1998, we decided to determine current asthma prevalence instead of lifetime asthma prevalence because it has more relevance for school nurses. Our definition included all students with asthma who would be likely to require monitoring or treatment at school. Specifically, we defined students with current asthma as those with one of the following:

* A health-care provider diagnosis of asthma (including exercise-induced asthma) and current asthma medication prescription

* A provider diagnosis and symptoms in the past 12 months (as reported by parents or directly by older students)

* A parent report of asthma or wheezing and provider-prescribed asthma medication for recurrent symptoms in the past 12 months

During the first year, in response to school nurses' requests for clarifications, we added the following to the definition:

* Students with diagnoses of reactive airway disease, wheezy bronchitis, or similar diagnoses for which an authorized prescriber has prescribed albuterol or a controller medication treatment

* Students who have albuterol or controller medications or medication orders sent to school

The definition does not include:

* Students taking over-the-counter asthma medications who do not have a provider diagnosis

* Students with a past history of asthma whose asthma has been either resolved or totally asymptomatic (without treatment) for a year or more

Developing confidential lists of students with health concerns was not new to our school nurses. …

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