Strategic plan for addressing asthma in Georgia, 2013-2018;Asthma in Georgia

Strategic Plan for Addressing Asthma in Georgia 2013-2018
environment

family support

schools and childcare

healthcare delivery system

Facilitated by the Georgia Department of Public Health

Strategic Plan for Addressing Asthma in Georgia 2013-2018
TABLE OF CONTENTS Letter from the Commissioner ..............................................................3 Letters of Support.......................................................................................4 Executive Summary....................................................................................6 Background................................................................................................ 10 Plan Revision Process.............................................................................. 20 Strategic Plan............................................................................................. 25
n Environment.................................................................................... 26 n Family Support............................................................................... 29 n Healthcare Delivery System....................................................... 30 n Schools and Childcare.................................................................. 35 Alignment with National Agenda...................................................... 38 Acronyms.................................................................................................... 40 References................................................................................................... 41
Funding for this effort was provided by Centers for Disease Control and Prevention Cooperative Agreement Addressing Asthma from a Public Health Perspective (5U59/EH000520-3). This plan was prepared by the Georgia Health Policy Center for the Georgia Department of Public Health.

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LETTER FROM COMMISSIONER

LETTERS OF SUPPORT

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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LETTER FROM THE PEDIATRIC HEALTHCARE IMPROVEMENT COALITION

LETTERS OF SUPPORT

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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LETTER FROM CHAIR OF GEORGA ASTHMA ADVISORY COALITION

LETTERS OF SUPPORT

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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EEXXEECCUUTTIIVVEESSUUMMMMAARRYY

Mission
To improve asthma control and reduce its burden in Georgia by a focused commitment to policy and environmental change, education, and an integrated care delivery system.

Asthma affects an estimated 23 million people in the United States. In Georgia approximately 568,658 adults and 259,198 children are living with asthma. This equates to 7.8% and 10.4% of the adult and child populations respectively. In 2010, uncontrolled asthma among Georgians contributed to more than 52,791 emergency room visits and more than 10,401 hospitalizations. Asthma related hospitalization costs topped $174 million in 2010 alone. More than 100 Georgians die each year from complications resulting from uncontrolled asthma.
Recognizing the impact that asthma continues to have on Georgia's citizens and institutions, the Georgia Asthma Control Program (GACP) in collaboration with the Georgia Asthma Advisory Coalition (GAAC) embarked on a revision of the state's asthma control strategic plan in late 2011. The plan revision was driven by the desire to focus asthma control efforts on policy, system, and environmental change (PSE) approaches, designed to positively impact population level behaviors and outcomes.
The objectives and strategies in this plan will serve as a blue print for a statewide comprehensive and coordinated response to address asthma management and control strategies. Over the next five years, this plan will act as a platform to mobilized partners and collaborative efforts aimed at reducing the burden of asthma throughout the state.

Mission To improve asthma control and reduce its burden in Georgia by a focused commitment to policy and environmental change, education, and an integrated care delivery system.
Five Year Focus 2013-2018: Children with Pediatric Asthma ages 0-17.
Georgia Asthma Control Program The Georgia Asthma Control Program (GACP) was established in 2001 through a cooperative agreement originally awarded to the Georgia Department of Human Resources by the Centers for Disease Control and Prevention (CDC). GACP has maintained funding through the CDC and is now a program within the Georgia Department of Public Health which was formed via legislative action in 2011.
GACP serves as the premier source of population based surveillance data on asthma morbidity and mortality for the state. Its role is to lead the development of the state's strategic plan for asthma through the statewide coalition; provide intervention and programmatic resources for asthma through Georgia's public health districts; and mobilize strategic collaboration between private and governmental sectors to advance asthma care in Georgia.

Executive Summary

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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Focus Areas, Goals and Objectives The plan addresses four focus areas (Environment, Family Support, Healthcare Delivery System, Schools and Childcare settings) and includes 22 time-bound objectives supported by strategic actions.
FOCUS AREA: Environment
GOAL1: Decrease exposure to environmental triggers for people with asthma.*
OBJECTIVE 1.1By 2018, establish statewide healthy homes standard to reduce the level of asthma triggers in home and indoor environments.
OBJECTIVE 1.2 By 2018, enact new tobacco free ordinances in at least 5 Georgia cities/counties. OBJECTIVE 1.3By 2018, ensure that all county health departments in non-attainment areas host smog
safety information on their websites. (Areas of the country where air pollution levels persistently exceed the national ambient air quality standards may be designated by the Environmental Protection Agency (EPA) as "non-attainment.") OBJECTIVE 1.4By 2018, increase by 50%, the number of libraries, recreation areas, and other public outlets in non-attainment areas that display smog safety information. OBJECTIVE 1.5By 2018, implement an educational campaign promoting the healthy homes standard in 5 Georgia cities/counties. OBJECTIVE 1.6By 2018, increase by 2 the number of housing authorities or administrative entities that adopt the healthy homes standard for non-owner occupied and multifamily housing. OBJECTIVE 1.7 (Developmental) By 2018, increase by 2, the number of Georgia cities/counties that have integrated code enforcement regulations to include healthy homes standards.

FOCUS AREA: Family Support
GOAL2: Promote/Support self-management in children ages 0-17 diagnosed with asthma and their families.*
OBJECTIVE 2.1By 2018, increase by 5% the number of youth focused Community Based Organizations (CBO) that conduct training on asthma self-management.

* Related to Healthy People 2020 objectives.
Executive Summary

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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FOCUS AREA: Healthcare Delivery System
GOAL3: Increase access to services and resources.
OBJECTIVE 3.1By 2018, increase the number of certified asthma educators (CAE) in GA by 50%. Focus on increasing CAEs operating within primary care teams or co-located at primary care sites. (baseline 79 total CAEs, 2012 National Asthma Educators Certification Board baseline)
OBJECTIVE 3.2 (Developmental) By 2018, increase the number of sites utilizing telemedicine for the diagnosis and treatment of asthma.
OBJECTIVE 3.3( Developmental) By 2018, increase by 5% the number of Community Health Workers (CHW) certified as asthma educators.

GOAL4: Promote and increase implementation of National Asthma Education and Prevention Program (NAEPP) guidelines in standards of care for the diagnosis, treatment, and management of asthma.*
Objective 4.1 By 2018, educate at least 500 providers on current NAEPP guidelines.
Objective 4.2By 2018, increase the number of children ever receiving an asthma action plan from their providers from 43% to 50%.
Objective 4.3By 2018, increase by 10% the number of parents/guardians of children with asthma reporting having received asthma management education.

GOAL5: Improve coverage and reimbursement rates for comprehensive asthma care.

OBJECTIVE 5.1

By 2018, increase the number of Care Management Organizations (CMO) and/or health plans providing reimbursement for comprehensive asthma care based on NAEPP guidelines from 0 to 1.

GOAL6: Improve asthma health information exchange
OBJECTIVE 6.1( Developmental) By 2018, Pilot asthma related rapid-cycle data sharing via health information exchange between hospitals, emergency departments, Medicaid claims data, primary and specialty care providers.

This objective can also be found in the Schools and Childcare focus area. A Developmental Objective is one for which there is no current baseline or where there would be a need for new data collection methods. * Related to Healthy People 2020 objectives.

EXECUTIVE SUMMARY

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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FOCUS AREA: Schools and Childcare
GOAL7: Reduce the impact of asthma on the development and academic success of Georgia's children.*
OBJECTIVE 7.1By 2018, among school districts that have adopted tobacco-free school policies increase by 50% the number of school districts that adopt Georgia's model "asthma-friendly school" policy.
OBJECTIVE 7.2By 2018, among childcare centers that have participated in Georgia Asthma Management Education for Childcare Centers (GAME-CS) training, increase by 50% the number of childcare centers that adopt Georgia's model "asthma-friendly childcare center" policy.
OBJECTIVE 7.3By 2018, provide an online "one-stop shop" that provides resources for implementing asthma-friendly schools and childcare policies in Georgia (Georgia Department of Public Health website).
OBJECTIVE 7.4By 2018, increase by 150 the number of childcare centers that achieve the Georgia Asthma Friendly Childcare Center recognition.
GOAL 8:Improve the integration of care management between health care providers, schools and childcare settings.
OBJECTIVE 8.1By 2018, increase by 10% the number of schools and childcare settings that report receiving asthma action plans from primary care providers from the 2012 baseline.
OBJECTIVE 8.2By 2018, increase the number of certified asthma educators (CAE) in GA by 50%. Focus on increasing CAEs among school nurses. (baseline 79 total CAEs, 2012 National Asthma Educators Certification Board baseline)

* Related to Healthy People 2020 objectives. This objective can also be found in the Healthcare Systems focus area.
EXECUTIVE SUMMARY

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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BACKGROUND

What is Asthma?

Asthma is a chronic disease of the lungs and airways that causes breathing problems that can be reversed if properly managed. The affects of asthma can cause airways that are inflamed or swollen, production of excess mucus and tightening of the muscles that surround the airway. These affects often cause symptoms of recurrent episodes of wheezing, coughing, shortness of breath, and chest pain or tightness. Asthma symptoms can be triggered or worsened by many things such as allergens (dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers), irritants (tobacco smoke, air pollution, chemicals or dust in the workplace), and exercise. Asthma affects people of all ages. Its causes are not well understood and likely differ among individuals. Factors such as genetics, environmental exposures, and viral and respiratory infections all play a role in asthma. There is no cure for asthma however it can be managed by avoiding triggers and taking appropriate medications.

Factors such as genetics,

environmental exposures,

Asthma in the United States

and viral and respiratory

Currently, more than 23 million people have asthma in the United States. Estimates from the 2011 National Health Interview Survey suggests that 13% of adults have been diagnosed with asthma at some point in their life and 8% currently have asthma. The burden of asthma is significant for individuals and society. It translates to substantial reduction in quality of life--missed days of work/school, unplanned need for childcare, emergency room visits, sleep disturbances, fatigue, physical limitations, and depression. Some of the economic impacts of asthma are higher insurance rates, lost productivity and lost wages due to missed days of work. Annual health care expenditures for asthma are estimated at $20.7 billion. In an ongoing effort to reduce the burden of asthma nationally, the U.S. Department of Health and Human Services has established national objectives for improving the health of Americans. These objectives are found in the Healthy People 2020 report found on the www.healthlypeople.gov website. Below are the Healthy People 2020 national objectives for asthma.

infections all play a role in asthma. There is no cure for asthma however it can be managed by avoiding triggers and taking appropriate medications.

OBJECTIVE: Reduce annual asthma deaths
AGE GROUP/SUB-OBJECTIVE Children and adults under age 35 years
Adults aged 35 to 64 years old Adults aged 65 years and older

TARGET
This measure is being tracked for information purposes. A target will be set during the decade. 6.0 deaths per million 22.9 deaths per million

OBJECTIVE: Reduce annual hospitalizations for asthma
AGE GROUP/SUB-OBJECTIVE Children under age 5 years Children and adults aged 5 to 64 years Adults aged 65 years and older

TARGET
18.1 hospitalizations per 10,000 8.6 hospitalizations per 10,000 20.3 hospitalizations per 10,000

BACKGROUND

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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OBJECTIVE: Reduce annual hospital emergency department visits for asthma

AGE GROUP/SUB-OBJECTIVE Children under age 5 years Children and adults aged 5 to 64 years Adults aged 65 years and older

TARGET 95.6 emergency department visits per 10,000 49.7 emergency department visits per 10,000 13.8 emergency department visits per 10,000

OBJECTIVE: Reduce activity limitations among persons with current asthma
AGE GROUP/SUB-OBJECTIVE All persons with asthma

TARGET 10.2 percent

OBJECTIVE: Reduce the proportion of persons with asthma who miss school or work days

AGE GROUP/SUB-OBJECTIVE
Reduce the proportion of children aged 5 to 17 years with asthma who miss school days in the past 12 months due to asthma
Reduce the proportion of adults aged 18 to 64 years with asthma who miss work days in the past 12 months due to asthma

TARGET 48.7 percent
26.8 percent

OBJECTIVE: Increase the proportion of persons with current asthma who receive formal patient education

AGE GROUP/SUB-OBJECTIVE All persons with asthma

TARGET 14.4 percent

OBJECTIVE: Increase the proportion of persons with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines

AGE GROUP/SUB-OBJECTIVE
Persons with current asthma who receive written asthma from their health care provider
Persons with current asthma with prescribed inhalers who receive instruction on their use
Persons with current asthma who receive education about appropriate response to an asthma episodwe, including recognizing early signs and symptoms or monitoring peak flow results
Increase the proportion of persons with current asthma who do not use more than one canister of short-acting inhaled beta agonist per month
Persons with current asthma who have been advised by a health professional to change things in their home, school, and work environments to reduce exposure to irritants or allergens to which they are sensitive
(Developmental) Persons with current asthma who have had at least one routine follow-up visit in the past 12 months
(Developmental) Persons with current asthma whose doctor assessed their asthma control in the past 12 months
(Developmental) Adults with current asthma who have discussed with a doctor or other health professional whether their asthma was work related

TARGET 36.8 percent
This measure is being tracked for information purposes. A target will be set during the decade. 68.5 percent
90.2 percent
54.5 percent

OBJECTIVE: Increase the numbers of States, Territories, and the District of Columbia with a comprehensive asthma surveillance system for tracking asthma cases, illness, and disability at the State level

AGE GROUP/SUB-OBJECTIVE Number of states and or territories

TARGET 47 areas

BACKGROUND

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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Collection of Asthma Statistics in Georgia
Asthma surveillance at the state level includes adult and child data on asthma prevalence, risk factors, mortality, morbidity, and hospital expenditures from the Behavioral Risk Factor Surveillance System (BRFSS), BRFSS Asthma Call-back Survey (ACBS), and Georgia's Online Analytical Statistical Information System (OASIS).

Conducted throughout

Conducted throughout the year by telephone, the BRFSS is a state-based survey that collects information on health conditions, health risk behaviors, preventive health

the year by telephone, the BRFSS is a state-

practices, and health care access primarily related to chronic disease and injury. The BRFSS was established by the CDC in 1984 and is conducted in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam.

based survey that collects The Asthma Call-back Survey (ACBS) is an in-depth asthma survey developed and funded

information on health

by the Air Pollution and Respiratory Health Branch (APRHB) in the National Center for

conditions, health risk behaviors, preventive

Environmental Health (NCEH). It is conducted with BRFSS respondents who report an asthma diagnosis or report having a child within the household with an asthma diagnosis. The ACBS collects information on patient self management education,

health practices, and

medication adherence and proper use, quality of life impacts, and

health care access primarily asthma control.

related to chronic disease and injury.

The Online Analytical Statistical Information System (OASIS) is Georgia's standardized health data repository for Vital Statistics (births and deaths, including fetal deaths), Hospital Discharge, Emergency Room Visit, Arboviral Surveillance, Youth Risk Behavior

Survey (YRBS), Behavioral Risk Factor Surveillance Survey (BRFSS), STD, Motor Vehicle

Crash, and Population demographic data.

Further information on the Georgia asthma statistics presented in this strategic plan will be available in the 2012 Georgia Asthma Surveillance Report. The 2012 Georgia Asthma Surveillance Report presents asthma prevalence, morbidity, and death rates among adults and children in Georgia during the years 2006-2010. Information on self management, environmental triggers, symptoms, primary care utilization, hospital costs, prescription medication use, and work-related asthma are also presented in the report.

BACKGROUND

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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Asthma in Georgia
Georgia Prevalence
In 2010, among Georgia adults 18 years and older the overall prevalence of current asthma was 7.8% (568,658). The prevalence of asthma among adult males 5.8% (208,913) was significantly lower than adult females 9.5% (359,745). This data also shows that prevalence is higher among black, non-Hispanic adults (8.1%) when compared to white non-Hispanic adults (7.7%), and Hispanic adults (5.5%). Note that prevalence estimates for Hispanics should be interpreted with caution since national surveillance data shows that prevalence is relatively high among Hispanics of Puerto Rican descent and relatively low among Hispanics of Mexican descent. The prevalence of asthma is more than twice as high among adults with an annual household income of less than $15,000 as compared to other income levels.
Childhood asthma prevalence in Georgia between the years 2006-2010 indicates that approximately 10.4% (259,198) of children 0-17 years have current asthma. Among children, the prevalence was higher among males 12% than females 9% and higher among black non-Hispanics 14% when compared to white non-Hispanics 8% .
When compared to National statistics, Georgia ranks 45th in lifetime asthma prevalence among adults (Table 1) and 37th in current asthma prevalence (Table 2). The burden is more significant in Georgia's children where the state ranks 7th in lifetime asthma prevalence (Table 3) and 16th in current asthma prevalence of (Table 4).
Georgia's Asthma Morbidity
Asthma is a chronic lifelong disease, however with appropriate management asthma can be controlled so that people are able to lead active and healthy lives. Results from 2006-2010 surveillance data indicate that the burden of asthma morbidity remains high in Georgia due to uncontrolled asthma.
n T hirty-eight percent of adults and 29% of children with asthma did not use any prescription medications in the past 12 months.
n A sthma caused more than 52,000 emergency room (ER) visits annually between 2006 and 2010.
n S ixty-two percent of adults and 71% of children with asthma used prescription medication in the past 3 months.
n In 2010, asthma limited usual activities in 50% of children with asthma. n In 2010, 54% of adults report having asthma-related symptoms at least once during
the last 30 days. n M ore than half of children with asthma and more than three-quarters of adults with
asthma have never received an asthma action plan from a primary care provider. n O ne of 4 Georgia adults with current asthma had asthma symptoms every day in the
past 30 days. n T wenty-five percent of adults and 37% of children with current asthma reported loss
of sleep for 1-5 nights in the past 30 days. n F orty-five percent of Georgia adults with current asthma reported at least one or more
days of lost work or usual activities in the past year due to asthma.

BACKGROUND

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Table 1: Adult Self-Reported Lifetime Asthma Prevalence Rate (Percent) and Prevalence (Number) by State or Territory: BRFSS 2010

STATE/ TERRITORY
U.S. Total** HI VT RI OR MI WA ME DC CT MA DE NH KY AZ CO NY WY NM PR NV AK UT IN MO OK FL OH PA AR ID IL NJ KS MT SC VA TX WI CA NC MD NE AL IA LA MS SD GA MN VI WV ND GU TN

SAMPLE SIZE
443,692 6,522 6,782 6,585 5,045 8,846
19,546 8,104 3,964 6,760
16,271 4,238 6,018 8,046 5,741
11,629 8,919 5,820 6,987 3,538 3,904 1,955
10,134 10,195
5,417 7,719 35,003 9,827 11,198 4,013 6,991 5,197 12,405 8,538 7,277 9,401 5,378 18,038 4,772 17,763 12,107 9,161 16,343 7,648 6,086 7,013 8,068 6,702 5,779 8,943 1,819 4,394 4,743
779 5,757

PREVALENCE (PERCENT)
13.5 17.6 17.2 16.7 16.2 15.8 15.8 15.7 15.5 15.3 15.3 15.1 15.0 14.9 14.8 14.7 14.7 14.7 14.6 14.6 14.5 14.4 14.3 14.2 14.2 14.2 13.8 13.8 13.8 13.6 13.6 13.6 13.3 13.2 12.9 12.9 12.9 12.8 12.8 12.6 12.6 12.4 12.2 11.8 11.6 11.6 11.6 11.6 11.5 10.9 10.8 10.7 10.6 10.5
9.3

95% CI (PERCENT)
(13.3 - 13.7) (16.1 - 19.0) (15.8 - 18.6) (15.1 - 18.2) (14.6 - 17.8) (14.6 - 16.9) (15.0 - 16.6) (14.5 - 16.8) (14.2 - 16.9) (13.9 - 16.7) (14.4 - 16.3) (13.4 - 16.7) (13.7 - 16.2) (13.6 - 16.2) (13.3 - 16.2) (13.7 - 15.8) (13.7 - 15.8) (13.3 - 16.0) (13.2 - 16.0) (13.0 - 16.2) (12.5 - 16.5) (11.8 - 17.0) (13.1 - 15.5) (13.2 - 15.3) (12.6 - 15.8) (13.1 - 15.3) (12.9 - 14.7) (12.7 - 15.0) (12.9 - 14.8) (11.8 - 15.5) (12.4 - 14.8) (12.2 - 15.0) (12.4 - 14.3) (12.1 - 14.2) (11.7 - 14.2) (11.6 - 14.3) (11.3 - 14.6) (11.6 - 13.9) (11.2 - 14.3) (12.0 - 13.3) (11.6 - 13.6) (11.4 - 13.5) (11.1 - 13.4) (10.7 - 12.9) (10.5 - 12.8) (10.4 - 12.8) (10.5 - 12.6) (10.3 - 12.9) (10.3 - 12.8)
(9.5 - 12.3) (8.8 - 12.8) (9.4 - 12.0) (9.1 - 12.1) (7.6 - 13.3) (8.0 - 10.7)

BACKGROUND

Table 2: Adult Self-Reported Current Asthma Prevalence Rate (Percent) and Prevalence (Number) by State or Territory: BRFSS 2010

STATE/ TERRITORY
U.S. Total** VT RI MI KY MA NH AK AZ DE ME DC PA NY WY NM OH WA IN OK OR HI CO CT IL NV MT UT ID MO NJ KS MD VA FL SC WI AL AR GA IA NE CA MN NC SD PR ND TX WV MS LA TN VI GU

SAMPLE SIZE
441,955 6,754 6,560 8,821 7,995
16,215 5,997 1,941 5,711 4,225 8,069 3,940
11,149 8,870 5,796 6,960 9,781
19,444 10,156
7,694 5,013 6,497 11,571 6,727 5,190 3,882 7,256 10,090 6,954 5,400 12,370 8,509 9,137 5,354 34,814 9,352 4,759 7,623 3,994 5,762 6,071 16,304 17,741 8,925 12,072 6,667 3,537 4,720 17,948 4,385 8,045 6,993 5,752 1,813
779

PREVALENCE (PERCENT)
8.6 11.1 10.9 10.5 10.4 10.4 10.4 10.0 10.0 10.0 10.0
9.9 9.9 9.8 9.8 9.7 9.6 9.6 9.5 9.5 9.5 9.4 9.2 9.2 9.2 9.2 9.1 9.1 8.8 8.8 8.7 8.6 8.4 8.4 8.3 8.3 8.3 8.0 7.8 7.8 7.8 7.8 7.7 7.6 7.5 7.5 7.5 7.4 7.4 7.3 7.2 6.7 6.0 5.9 5.2

95% CI (PERCENT)
(8.5 - 8.8) (10.1 - 12.2)
(9.7 - 12.1) (9.5 - 11.4) (9.3 - 11.5) (9.6 - 11.1) (9.3 - 11.4) (7.7 - 12.3) (8.8 - 11.2) (8.7 - 11.3) (9.1 - 10.9) (8.8 - 11.0) (9.1 - 10.7) (9.0 - 10.7) (8.7 - 10.9) (8.5 - 10.9) (8.7 - 10.6) (9.0 - 10.2) (8.7 - 10.4) (8.6 - 10.4) (8.3 - 10.8) (8.3 - 10.4) (8.3 - 10.0) (8.1 - 10.2) (8.0 - 10.4) (7.6 - 10.9) (8.0 - 10.3) (8.1 - 10.0)
(7.8 - 9.7) (7.6 - 10.0)
(8.0 - 9.5) (7.7 - 9.5) (7.4 - 9.3) (7.0 - 9.8) (7.6 - 9.0) (7.1 - 9.5) (7.1 - 9.5) (7.1 - 8.8) (6.5 - 9.1) (6.7 - 8.8) (6.9 - 8.8) (6.9 - 8.7) (7.1 - 8.2) (6.4 - 8.8) (6.7 - 8.2) (6.5 - 8.6) (6.3 - 8.7) (6.3 - 8.6) (6.6 - 8.2) (6.3 - 8.2) (6.5 - 8.0) (5.7 - 7.6) (4.9 - 7.0) (4.4 - 7.5) (3.1 - 7.3)

Strategic Plan for Addressing Asthma in Georgia 2013-2018

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Table 3: Child Lifetime Asthma Prevalence Rate (Percent) and Prevalence (Number) by State or Territory: BRFSS 2010

STATE/ TERRITORY
Total ** DC PR HI MD CT RI KY AL GA MO MI PA NJ VT OK IL MA IN ME MS OH NY AZ NM OR WI LA TX CA NV WV TN KS WA ND MT UT WY IA NE

SAMPLE SIZE
71,645 725 784
1,671 2,461 1,747 1,566 1,893 1,775 1,535 1,266 2,012 2,483 3,409 1,578 2,019 1,350 1,407 2,343
899 1,952
795 702 1,224 1,708 950 1,127 1,890 5,057 1,644 909 907 396 2,233 4,597 1,167 1,756 3,812 1,277 1,522 3,881

PREVALENCE (PERCENT)
12.6 22.4 22.4 16.9 16.5 15.3 15.1 14.7 14.5 14.5 14.5 14.4 14.3 14.2 14.2 14.0 13.6 13.5 13.4 13.2 13.2 13.2 13.1 12.4 12.3 11.8 11.7 11.6 11.6 11.0 10.6 10.6 10.5 10.4 10.4
9.8 9.6 9.5 9.3 8.8 8.6

95% CI (PERCENT)
(12.1 - 13.2) (18.4 - 26.9) (19.2 - 25.9) (14.7 - 19.3) (14.5 - 18.6) (13.2 - 17.7) (13.1 - 17.4) (12.5 - 17.3) (12.4 - 16.8) (12.4 - 16.8) (11.9 - 17.7) (12.4 - 16.6) (12.6 - 16.3) (12.7 - 15.9) (12.2 - 16.3) (12.3 - 16.0) (11.2 - 16.3) (11.1 - 16.2) (11.7 - 15.4) (10.9 - 15.8) (11.4 - 15.3) (10.1 - 17.0) (10.1 - 16.9)
(9.8 - 15.5) (10.5 - 14.3)
(9.7 - 14.2) (9.5 - 14.4) (10.0 - 13.4) (10.0 - 13.4) (9.4 - 13.0) (7.9 - 14.0) (8.5 - 13.2) (7.3 - 14.8) (9.0 - 11.9) (9.3 - 11.5) (8.0 - 11.9) (7.9 - 11.7) (8.4 - 10.8) (7.7 - 11.1) (7.2 - 10.7) (7.1 - 10.3)

Table 4: Child Current Asthma Prevalence Rate (Percent) and Prevalence (Number) by State or Territory: BRFSS 2010

STATE/ TERRITORY
Total ** DC PR MD RI AL CT HI MI MO KY OK VT IL PA MA AZ OH GA NJ WI IN MS NV ME LA NM OR TX KS NY MT UT WY WV ND TN IA NE WA CA

SAMPLE SIZE
71,394 725 784
2,450 1,554 1,772 1,741 1,664 2,006 1,261 1,884 2,012 1,574 1,348 2,463 1,403 1,220
792 1,533 3,397 1,126 2,338 1,947
909 891 1,882 1,701 944 5,036 2,226 699 1,748 3,799 1,274 907 1,162 395 1,520 3,879 4,573 1,639

PREVALENCE (PERCENT)
8.4 18.0 12.2 11.9 11.8 11.5 11.3 11.1 11.1 10.9 10.7 10.2 10.0
9.8 9.6 9.5 9.4 9.2 9.0 9.0 8.9 8.8 8.6 8.6 8.5 8.3 8.0 7.6 7.6 7.5 7.4 6.9 6.9 6.6 6.5 6.4 6.4 6.2 6.1 6.0 5.9

95% CI (PERCENT)
(8.0 - 8.8) (14.3 - 22.3)
(9.7 - 15.3) (10.2 - 13.9)
(9.9 - 13.9) (9.6 - 13.7) (9.4 - 13.4) (9.3 - 13.1) (9.4 - 13.1) (8.6 - 13.8) (8.8 - 12.9) (8.7 - 12.0) (8.3 - 12.0) (7.7 - 12.4) (8.1 - 11.4) (7.6 - 11.9) (7.3 - 12.1) (6.7 - 12.6) (7.4 - 11.0) (7.8 - 10.4) (6.9 - 11.3) (7.4 - 10.5) (7.2 - 10.3) (6.1 - 12.0) (6.6 - 10.8) (6.9 - 10.0)
(6.6 - 9.7) (5.9 - 9.7) (6.3 - 9.2) (6.4 - 8.9) (5.2 - 10.3) (5.5 - 8.8) (5.9 - 8.0) (5.3 - 8.2) (5.0 - 8.5) (5.0 - 8.3) (4.0 - 9.9) (4.9 - 8.0) (4.8 - 7.7) (5.3 - 6.9) (4.7 - 7.3)

Asthma is a chronic lifelong disease, however with appropriate management asthma can be controlled so that people are able to lead active and healthy lives.

BACKGROUND

Strategic Plan for Addressing Asthma in Georgia 2013-2018

16

Between 2006-2010, more than 52,000 emergency room visits in Georgia were linked to asthma, as were more than 10,000 hospitalizations. Asthma-related hospitalization costs topped $174 million in 2010 alone. Each year, approximately 100 Georgians die from complications related to asthma.
n C hildren 0 to 4 years old and older adults (65+ years) have higher asthma-related hospitalization rates than other age groups (Figure 1).
n B lack males and females with current asthma have significantly higher ER visit and hospitalization rates than white males and females with current asthma.
n E R visit rates are highest among Georgia children with current asthma who are 0 to 4 years old. ER visit rates decrease as age increases (Figure 2).
n T he highest risk of ER visits due to asthma are among the black non-Hispanic population.

Figure 1: Age-Specific Asthma Hospitalization Rates per Year, Georgia 2006-2010

400 400

Rate per 100,000 Rate per 100,000

300 300

223 200
100
0 0-4

223

223

223

149

200

70 100 30

149

30

48

81 70

133

150

30

30

48

133

150

81

5-9 10-14 150-17 18-24 25-34 35-44 45-54 55-64 65+

0-4

5-9 10-14 15-17 18-24 25-34 35-44 45-54 55-64 65+

Age group (years)

Age group (years)

Source: Georgia Hospital Discharge Data, accessed through Online Analytical Statistical Information

System (OASIS) Georgia Department of Public Health, Office of Health Indicators for Planning

(OHIP). (May 2012) http://oasis.state.ga.us/

Rate per 100,000 Rate per 100,000

3000 2500 2000 1500 1000
500 0 0-4

Figure 2: Annual Asthma Emergency Room Rates by Race and Age Group, Georgia 2006-2010

3000 2500

black

white

black

white

2000

1500

1000

500

5-9 10-14 105-17 18-24 25-34 35-44 45-54 55-64 65+

A0g-e4 group 5(y-9ears) 10-14 15-17 18-24 25-34 35-44 45-54 55-64

65+

Age group (years)

BACKGROUND
100 100

Strategic Plan for Addressing Asthma in Georgia 2013-2018

17

Asthma Mortality
According to the National Asthma Education and Prevention Program (NAEPP), the national mortality rate for asthma has risen over the past 20 years, especially in Blacks and individuals aged 85 years and older. In Georgia, an average of 104 asthma-related deaths occurred per year (1.3 deaths per 100,000 population) from 2000 to 2008. The mortality rate disproportionately affected Blacks (2.6 deaths per 100,000 population) and older adults (5.2 deaths per 100,000).
Asthma Management
The National Heart, Lung and Blood Institute (NHLBI) Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma suggests that most asthma symptoms are controllable with appropriate medical care, medication, avoidance of triggers and self-management. The EPR3 recommendations for gaining control of asthma are; 1) asthma self-management; 2) the direct involvement of patients and their caregivers in strategies to control their disease; and 3) the creation an asthma management plan (Asthma Action Plan). An Asthma Action Plan is a form with instruction on how to recognize early signs and symptoms of an attack, determine which medicines to take and when to take them, and recognize when to seek medical attention. (Table 5), includes Georgia indicators of asthma self management for adults and children.

Table 5: Percent of adults and children with current asthma who received asthma management strategies from a doctor or health care provider, Georgia, 2006-2009

ADULTS (%)

CHILDREN (%)

Taught what to do during asthma episode or attack

74

78

Taught to recognize early asthma sign or symptoms

67

78

Taught how to use a peak flow meter

44

44

Given asthma action plan

25

44

Taken a course to manage asthma

9

18

Source: Georgia Behavioral Risk Factor Surveillance System Asthma Call Back Survey

BACKGROUND

Strategic Plan for Addressing Asthma in Georgia 2013-2018

400

18 300

Rate per 100,000

Asthma in Schools

223 200
149

223

133

150

A study conducted by Moonie, et1a00l. showed that childr7e0n with persistent asthma 81

miss more school days than children without asthma. It was sho30wn tha3t 0excessi4v8e

absenteeism is related to lower stud0ent grades and lower psychological, social, and

Gaining control over

educational adjustment. In Georgia, 580%-4of sch5o-9ol ag1e0d-1c4hild1re5-n17miss1e8d-214 or m25o-3r4e of school because of their asthma (Figure 3). Gaining control overAagsetghrmouap t(yheraorus)gh

da3y5s-44 self

ast4h5m-54a

thr5o5-u6g4h

sel6f5+

management can have a positive impact on decreasing absenteeism and improving

management can have

quality of life. An integral part of asthma self management is the use of prescribed

a positive impact on

medications to prevent asthma symptoms (controller medications) and relieve sudden

asthma episodes (reliever medications). Georgia data from 2006-2009 (Figure 4) suggest decreasing absenteeism

that 29% of children with current asthma reported not using any prescribed medications to control their asthma over the past 12 months and only 44% children are using both control and reliever (rescue) medications.
3000

and improving quality of life.

School and childcare settings can support asthma self management in children by providing asthma education for s2t5u0d0 ents and staff, communicating asthma emergency

black

white

Rate per 100,000

procedures, adopting asthma-fri2e0n0d0ly policies and procedures; and coordinating services with physicians. An example of an asthma friendly policy is the Kellen Edwin

Bolden Act that was approved in12500004 by the Georgia legislature. The Kellen Edwin

Bolden Act is legislation that addresses the rights of students to self-administer asthma medication and carry inhalers in1s0c0h0ools (Georgia (OCGA 20-2-774 (2004). A statute

authorizing students to self admini5st0e0r asthma medication, pursuant to local adopted school policies). Though this act was passed in 2004, only 64% of parents of children with

asthma were aware that their schoo0l aged child is allowed to carry asthma medicine on

their person at school (Figure 5).

0-4

5-9 10-14 15-17 18-24 25-34 35-44 45-54 55-64 65+

Age group (years)

Figure 3: Number of Missed School Days Due to Asthma During the Past 12 Months, School-aged Children with Current Asthma, Georgia 20062009
100

80
58 60
42 40

Percent

20

0

None

1 or more Days

Number of days

Source: Georgia Behavioral Risk Factor Surveillance System Asthma Call Back Survey

100
80
BACKGROUND
60

Strategic Plan for Addressing Asthma in Georgia 2013-2018

2080

19

Percent

58 060

None

1 or more Days

42

Number of days

40

Figure 4: Medication Types Used by Adults and Children with Current Asthma, Georg2ia0 2006-2009*

100 0
80

None

Number of days

1 or more Days

60

Percent

41000

38

29

2080

060

No Presciption

Medication

40

38

29

20

10 7 Control
Only
10 7

24 19
Rescue Only 24
19

44 28
Control and Rescue44 28

Percent

0
No Presciption Medication
Child has written asthma action plan on le at school

Control Only

Rescue Only

Control and Rescue

Figure 5: Asthma Action Plan and Medication at School, School-aged Children with

Current Asthma, Georgia 2006-2009

The Kellen Edwin Bolden Act is legislation that addresses the rights of students to selfadminister asthma medication and carry inhalers in schools.

Awareness that child is allowed to carry asthma medicine at school Child has written asthma action plan on le at school

0
Awareness that child is allowed to carry asthma medicine at school

20

40

60

Percent

80

100

0

20

40

60

80

100

Percent

Source: Georgia Behavioral Risk Factor Surveillance System Asthma Call Back Survey

BACKGROUND

Strategic Plan for Addressing Asthma in Georgia 2013-2018

20

PLAN REVISION PROCESS
Out of a realization for the need to refocus the program to achieve system level impact, the Georgia Asthma Control program (GACP) along with the Georgia Asthma Advisory Coalition (GAAC) developed the 2013-2018 Strategic Plan for Addressing Asthma in Georgia. This plan represents a statewide comprehensive and coordinated response to address asthma management and control strategies within the following systems; Healthcare Delivery System, School and Childcare Settings, Indoor/Outdoor Environment and Family Support Systems.
In late 2011, encouraged by a renewed CDC program-wide emphasis and focus on policy, systems, and environmental change (PSE) approaches to disease control, the Georgia Asthma Control program convened the Georgia Asthma Advisory Coalition (GAAC) over an 8 month period to establish the 2013-2018 Strategic Plan for Addressing Asthma in Georgia. GAAC was established in 2003 by GACP, it is comprised of statewide stakeholders brought together to inform the development of Georgia's Asthma Strategic Plan, guide GACP's programmatic direction and contribute to the accomplishment of the strategic plan activities and objectives.
In support of the strategic plan revision the Georgia Health Policy Center (GHPC) was contracted for facilitation and documentation support during the plan revision process. (Figure 6) provides a visual model for the planning process and GAAC strategic planning structure.
Figure 6: Georgia Asthma Advisory Coalition 20132018, Strategic Planning Structure

STAKEHOLDER STEERING
COMMITTEE
Georgia Asthma Control Program Management
TEAM

Environment Work Group

EVALUATION

EVALUATION

Schools and Childcare
Work Group

EPIDEMOLOGY

Family Support Work Group

EVALUATION
Healthcare Delivery System
Work Group

EPIDEMOLOGY

EPIDEMOLOGY

PLAN REVISION PROCESS

Strategic Plan for Addressing Asthma in Georgia 2013-2018

21

Steering Committee
An eighteen member Steering Team provided oversight to the process and is expected to play a significant role in leading the implementation over the next five years. The group was made up of Work Group Co-Chairs and other representatives from partnering agencies and organizations.

Work Groups
Four Work Groups, were established to develop goal area recommendations, objectives and strategic activities for the next five years. They are:
n Environment n Family Support n Healthcare Delivery System n Schools and Childcare
Each group examined current context, critical issues and rationale for action before developing priorities and identifying key stakeholders whose participation would be critical to the process. Work Groups described objectives as being "developmental" in instances where baselines were not known or where there would be a need for new data collection methods.

This plan is truly a representation of our collective efforts and passion around making asthma a winnable battle in Georgia.

A cross-cutting Surveillance and Evaluation Work Group was also established. They were charged with the responsibility of drafting the evaluation plan to track progress and measure outcomes following ratification of the work group recommendations by the Coalition.

Acknowledgements:
A number of people and organizations were instrumental in providing input for this report and assisting in the development of its parts. Appreciation is expressed to the members of the Georgia Asthma Advisory Coalition, colleagues and other stakeholders who gave selflessly of their time, energy, expert guidance and direction in crafting this strategic plan document. This plan is truly a representation of our collective efforts and passion around making asthma a winnable battle in Georgia.

PLAN REVISION PROCESS

Strategic Plan for Addressing Asthma in Georgia 2013-2018

22

Each group examined current context, critical issues and rationale for action before developing priorities and identifying key stakeholders whose participation would be critical to the process.

Steering Team
NAME Carol Darsey Dr. Leroy Graham Phyllis Johnson Dr. Joshua Murphree Susan Bertonaschi Robert Lawrence Dorothy Mabry Janice Haker Lashon Blakely Matt Caseman Andrea Kellum Heidi LaSane Rebecca Watts-Hull Ateya Wilson Kathy English Michelle Brown Dr. Martha Tingen Francesca Lopez

ORGANIZATION Georgia Association of School Nurses/Liberty County Schools Not One More Life Healthcare Sciences, Georgia Department of Education Dougherty County Schools Annie E. Casey Foundation - Atlanta Civic Site Georgia Head Start Association DHHS Admin. for Children and Families Department of Early Care and Learning Bright from the Start Environmental Protection Agency (Region IV) Georgia Georgia Rural Health Association Healthcare Georgia Foundation Environmental Protection Agency (Region IV) Georgia Mother's & Others for Clean Air American Lung Association, Georgia Three Rivers Area Health Education Center Choice Health Care (ACO)/Southside Medical/West End Medical Pediatric Health Improvement Coalition (PHIC) DPH Georgia Asthma Control Program

Environment Work Group

NAME Columbus Ward Vietdoan Cheng Kenny Ray Michael Jackson Corby Hannah John Armour Forest Staley Heidi LeSane Rebecca Watts-Hull Christy Kuriatnyk

ORGANIZATION Accountable Communities: Health Together DPH Georgia Asthma Control Program DPH Georgia Tobacco Use Prevention Program DPH Georgia Tobacco Use Prevention Program Center For Working Families/ Healthy Homes City of Atlanta Office of Housing DPH Georgia Childhood Lead Prevention Program/ Healthy Homes Environmental Protection Agency (Region IV) Asthma Program Mother's & Others for Clean Air DPH Georgia Lead and Healthy Homes Program

PLAN REVISION PROCESS

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23

Family Support Work Group

NAME

ORGANIZATION

Tamica Moon

HEART Coalition - Asthma Initiative

Stephanie Hall

DPH Georgia Asthma Control Program

Estrella Callwood

SWAH Empowerment

Udo Obiechefu

Americorps Health Corp

Catherine Prather WilliamsAccountable Communities: Healthy Together/Georgia State University

A'Keti Avila

Self -Wealth and Health Empowerment (SWAH)

Felix Lawson

Fulton Department of Health

Ateya Wilson

American Lung Association Georgia

Danella Abdul-Barr

Rite Aide & Zap Asthma Inc.

Healthcare Delivery System Work Group

NAME

ORGANIZATION

Andrea Kellum

Healthcare Georgia Foundation

Kathy English

Three Rivers Area Health Education Center

Jon A Ramsey

Allergy & Asthma Clinics of Georgia/ Georgia Asthma Coalition

Lisa Jean Charles

Hughes Spalding Asthma Center- Children's Healthcare of Atlanta (CHOA)

Jennifer Forstner

Merck Inc.

Tracy Bridges, MD

Allergy & Asthma Clinics of Georgia/ Georgia Asthma Coalition

Doug Masini, MD

Department of Respiratory Therapy, Armstrong State University

James Freeman

Southside Medical Center

Deanna Keene

Georgia Southern University

Michelle Brown

Choice Health Care (ACO)/Southside Med/West End Med

Matt Caseman

Georgia Rural Health Association

Dewan McCarty Georgia Department of Public Health - Health Promotion Disease Prevention

Susan McCallum

Georgia Department of Public Health - Maternal & Child Health

Felix Lawson

Fulton County Department of Health and Wellness

Yvette Payton

Three Rivers AHEC

PLAN REVISION PROCESS

Strategic Plan for Addressing Asthma in Georgia 2013-2018

24

Schools and Childcare Work Group

NAME

ORGANIZATION

Carol Darsey

Georgia Association of School Nurses/Liberty County Schools

Anna Proctor

Network of Trust/ Phoebe Putney Memorial Hospital

Sherri Davis

Network of Trust/ Phoebe Putney Memorial Hospital

Ambi Bohannon

Southeast Health District Office of Health Promotions

Samuel Reynolds

Central GA Asthma Initiative/ SWAH Empowerment

Anne Coleman

Cobb-Douglas Health District

Cathy Wendholt-McDade

Cobb-Douglas Health District

Sadie Stockton

East Central (Augusta) Public Health District

Traci Gosier

South (Valdosta) Public Health District

Janet Lamar

Central GA Asthma Initiative / SWAH Empowerment

Marsha Pierce

Coastal (Savannah) Health District

Nazeera Dawood

Fulton County Department of Health and Wellness

Johnnie Thomas

Children's Healthcare of Atlanta (CHOA)/Sheltering Arms

Lashon Blakely

Environmental Protection Agency (Region IV) Georgia

MaryAnn MorrisGwinnett County Cluster Nurse/ Georgia Association of School Nurses - Asthma Task Force

PLAN REVISION PROCESS

Strategic Plan for Addressing Asthma in Georgia 2013-2018

25
STRATEGIC PLAN
Mission To improve asthma control and reduce its burden in Georgia by a focused commitment to policy and environmental change, education and an integrated care delivery system.
Target Population Plan activities will focus on reducing the impact of asthma on all Georgians with a special emphasis on children aged 0-17 years.
Principles and Values n A system-based planning and implementation process that is transparent and
collaborative n A wholly mission focused plan that is practical, simple and values accountability
for action and outcomes n R igorous evidence based objectives that are specific, measurable, attainable, relevant,
and time bound.
Areas of Focus and Emphasis n Environment n Family Support n Healthcare Delivery System n Schools and Childcare

STRATEGIC PLAN

Strategic Plan for Addressing Asthma in Georgia 2013-2018

26

ENVIRONMENT

Rationale: The following considerations were important in the development of Work Group goals and objectives:
n Home-based multi-trigger, multicomponent interventions with an environmental focus aimed at reducing exposure of persons with asthma to multiple indoor asthma triggers (allergens and irritants). These interventions involve home visits by trained personnel to conduct two or more activities. (CDC Recommended)
n Combining education and home environment strategies n Integrated pest management n Clear Air policies n Public and private insurers covering costs of evidence-based environmental home interventions n To maximize impact, targeted regions of the state will align with the strategic focus of the Georgia Tobacco Use
Prevention Program, Georgia Lead and Healthy Homes Program and Georgia Asthma Control Program.

Goal 1: Decrease exposure to environmental triggers for people with asthma.

OBJECTIVE1.1: B y 2018, establish statewide healthy homes standard to reduce the level of asthma triggers in home and indoor environments.

KEY ACTIVITIES
Research generally accepted principles for healthy homes.

KEY PARTNERS AND STAKEHOLDERS
GA Lead and Healthy Homes Program (GHHP), GA Childhood Lead Poisoning Prevention Program (GLPPP), Centers for Working Families, GA Asthma Control Program (GACP), Atlanta Housing and Urban Development

Develop a draft tool for the Georgia healthy homes standard.

GA Lead and Healthy Homes Program (GHHP), GA Childhood Lead Poisoning Prevention Program (GLPPP)

Develop an assessment tool based on the Georgia healthy homes standard.

GA Lead and Healthy Homes Program (GHHP), GA Lead Poisoning Prevention Program (GLPPP)

Collect and analyze data from the assessment tool.
Produce final standard and present to the Commissioner.

GA Dept. of Public Health Division of Health Protection Injury Epidemiology Program
Div. Directors of Division of Health Protection Injury Epidemiology Program and Health Promotion and Disease Prevention

OBJECTIVE1.2: By 2018, enact new tobacco free ordinances in at least 5 Georgia cities/counties.

KEY ACTIVITIES
Focus efforts in Savannah, Macon, Columbus, Augusta, and Atlanta.

KEY PARTNERS AND STAKEHOLDERS
Georgia Tobacco Use Prevention Program (TUPP), American Lung Association, Americans for Non Smoker's Rights , local public health districts

Align tobacco control program efforts with asthma program areas.

TUPP, Georgia Asthma Control Program (GACP), American Lung Association

Engage the EPA, the CDC, and local

Environmental Protection Agency (EPA) Region 4, TUPP, GACP

coalitions to provide additional resources.

STRATEGIC PLAN

Strategic Plan for Addressing Asthma in Georgia 2013-2018

27

OBJECTIVE1.3: B y 2018, ensure that all county health departments in non-attainment areas host smog safety information on their websites. (Areas of the country where air pollution levels persistently exceed the national ambient air quality standards may be designated by the Environmental Protection Agency (EPA) as "non-attainment".)

KEY ACTIVITIES Establish list of non-attainment counties.

KEY PARTNERS AND STAKEHOLDERS Mothers & Others for Clean Air (M&O)

Assemble contact information for environmental health point person in each non-attainment county and provide to M&O.

GA Asthma Control Program

Distribute smog safety materials and links to relevant web sites to every Mothers & Others for Clean Air (M&O) non-attainment health department environmental health officer.

Post materials and links to all health departments falling in a non-attainment area.

DPH (Environmental Health Section), local health department Public Information Officers

OBJECTIVE1.4: B y 2018, increase by 50% the number of libraries, recreation areas, and other public outlets in non-attainment areas that display smog safety information.

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Compile a list of each non-attainment county's libraries Mothers & Others for Clean Air (M&O), Georgia Asthma

and recreation centers.

Control Program, Georgia Tobacco Use Prevention Program

Survey (in person or by phone) libraries and recreation centers to identify those already displaying smog safety materials and those that are not.

Mothers & Others for Clean Air (M&O), Georgia Asthma Control Program, Georgia Southern University Public Health program, GA Parent Teacher Association

Provide copies of Guidance for Georgia Families: Outdoor Air Pollution & Physical Activity to key stakeholders, libraries and recreation centers that did not previously display them.

Mothers & Others for Clean Air (M&O) , Georgia Asthma Advisory Coalition (GAAC),Georgia Asthma Control Program

STRATEGIC PLAN

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28

OBJECTIVE1.5: B y 2018, implement an educational campaign promoting the healthy homes standard in 5 Georgia cities/counties.

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Use state databases to identify the 5 cities/counties and to inform outreach trainings.

Dept. of Public Health Division of Health Protection Injury Epidemiology, GA Lead and Healthy Homes Program (GHHP), GA Lead Poisoning Prevention Program (GLPPP)

Engage Georgia Head Start to integrate the healthy homes standard as part of their home visits.

Region 4 EPA, GA Lead and Healthy Homes Program (GHHP), GA Lead Poisoning Prevention Program (GLPPP), Georgia Asthma Control Program (GACP), GA Dept. of Early Care and Learning, GA Head Start, Region 4 HHS Administration for Children and Families

Develop appropriate media and other promotional campaigns.

Learn to Grow, Not One More Life, Choice Health Care, Region 4 EPA, GA Lead and Healthy Homes Program (GHHP), GA Lead Poisoning Prevention Program (GLPPP), Georgia Asthma Control Program (GACP), GA Dept. of Early Care and Learning, GA Head Start, Region 4 HHS Administration for Children and Families

OBJECTIVE1.6: B y 2018, increase by 2 the number of housing authorities or administrative entities that adopt the healthy homes standard for non-owner occupied and multifamily housing.

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Target efforts to Atlanta and Savannah HUD project grantees.

Atlanta HUD, Savannah HUD, Center for Working Families, GA Childhood Lead Hazard Control Program, GA Lead and Healthy Homes Program

Engage the Department of Community Affairs to adopt the Healthy Homes standard.

Georgia Dept. of Community Affairs, Georgia Dept. of Public Health, GA Childhood Lead Hazard Control Program, GA Lead and Healthy Homes Program, Georgia Asthma Control Program, local Alliance of HUD Tenants

OBJECTIVE1.7: By 2018, increase by 2, the number of Georgia cities/counties that have integrated code enforcement regulations to include healthy homes standards. (Developmental Objective)

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Focus implementation efforts in Savannah and Atlanta.

GA Childhood Lead Hazard Control Program, GA Lead and Healthy Homes Program, Center for Working Families, City of Atlanta Housing Bureau

STRATEGIC PLAN

Strategic Plan for Addressing Asthma in Georgia 2013-2018

29

FAMILY SUPPORT
Rationale: The following considerations were important in the development of Work Group goals and objectives:
n H ome-based multi-trigger, multicomponent interventions with an environmental focus aimed at reducing exposure of persons with asthma to multiple indoor asthma triggers (allergens and irritants). These interventions involve home visits by trained personnel to conduct two or more activities (CDC Recommended)
n The Yes We Can Urban Asthma Partnership: A Medical/Social Model for Childhood Asthma Management
n L everaging community based organizations for the delivery of asthma management messages n C ombining asthma management education and home environment strategies n U se of NAEPP guidelines for asthma management

Goal 2: Promote/Support self- management in children ages 0-17 years diagnosed with asthma, and their families.

OBJECTIVE2.1: B y 2018, increase by 5% the number of Community Based Organizations that conduct trainings on asthma self-management.

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Foster partnerships between community organizations and health care providers to improve self- management by: Promoting Asthma management messages Conducting Asthma Management workshops Conduct Training for Trainers in Chronic Disease Self-Management

American Lung Association, YMCAs, Boys and Girls Club, Zap Asthma, Faith-Based Organizations, H.E.A.R.T Coalition

STRATEGIC PLAN

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30

HEALTHCARE DELIVERY SYSTEM
Rationale: The following considerations were important in the development of Work Group goals and objectives:
n Development and implementation of comprehensive standards of care for the diagnosis and management of asthma based on guidelines developed by the National Asthma Education and Prevention Program's (NAEPP) Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma. (NHLBI Recommended)
n The patient-centered medical home (PCMH) model as an approach for managing asthma, improving outcomes, and reducing costs
n Health care provider education and training based on NAEPP guidelines and best practices with focus on FQHCs and Medicaid providers
n Utilization of care team that includes certified asthma educators (CAE's), community health workers (CHW), pharmacists, and other non-physician health care providers in the delivery of comprehensive asthma care
n Home-based multi-trigger, multicomponent interventions with an environmental focus aimed at reducing exposure of persons with asthma to multiple indoor asthma triggers (allergens and irritants). These interventions involve home visits by trained personnel to conduct two or more activities (CDC Recommended)
n Coverage and reimbursement improvements among CMOs and 3rd party payers supporting a comprehensive asthma management approach
n Development and/or incorporation of asthma management within telemedicine sites in schools and rural settings

Goal 3: Increase access to services and resources.

OBJECTIVE3.1: B y 2018, increase the number of certified asthma educators (CAE) in GA by 50%. Focusing on increasing CAEs operating within primary care teams or co-located at primary care sites. (baseline 79 total CAE's, 2012 National Asthma Education Certification Board)

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Assess and identify the gaps in CAEs by county.

Georgia Asthma Control Program (GACP), National Asthma Education Certification Board

Identify staff and safety net providers within appropriate state agencies and professional associations who will complete CAE certification.

Georgia Rural Health Association, State Office of Rural Health (SORH), GA Association of Primary Health Care, GA Dept. of Public Health (DPH), GA Dept. of Community Health (DCH)

Provide education support for Certified Asthma Educator (AE-C) certification preparation.

GACP, Three Rivers Area Health Education Center, Association of Asthma Educators(AAE)

Determine cost, seek and identify funds available to provide incentives to those who successfully pass certification.

GACP, GA Tobacco Use Prevention Program, Health Care Georgia Foundation, ALA, Georgia Association of Respiratory Therapists

STRATEGIC PLAN

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31

OBJECTIVE3.2: B y 2018, increase the number of sites utilizing telemedicine for the diagnosis and treatment of asthma. (Developmental Objective)

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Recruit representative from GA Partnership Georgia Asthma Control Program (GACP), Allergy & Asthma Clinics for Telehealth (GPT) as a member of GAAC. of GA, Georgia Asthma Coalition, GA Dept. of Public Health, Georgia
Partnership for Telehealth (GPT)

Identify specialty sites for use of telemedi- GACP, Allergy & Asthma Clinics of GA, Georgia Asthma Coalition, GPT, cine for asthma diagnosis and treatment. Georgia Department of Education, Local School Districts

Develop and promote toolkit for utilizing telemedicine in the treatment and management of asthma, with emphasis on the GPT school-based initiative.

GACP, Allergy & Asthma Clinics of GA, GA Asthma Coalition, GPT, Georgia Department of Education, Local School Districts

OBJECTIVE3.3: B y 2018, increase by 5% the number of Community Health Workers (CHWs) certified as asthma educators. (Developmental Objective)

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Identify following baselines: Total number of currently trained CHWs Current schools (higher education) offering programs in CHW training Organizations who currently utilize CHWs

Self Wealth and Health Empowerment (SWAH), Zap Asthma, Center for Working Families, Morehouse School of Medicine

Partner with community and technical colleges to offer CHW certification program Create a comprehensive asthma training curriculum Train current CHWs in asthma management
Considerations: Define the role of a CHW/ outreach worker under the asthma management spectrum that fits among the health continuum. Who employs CHW? Is this person in the ER? Opportunity to reimburse?

AmeriCorps- Atlanta Health Corp., Zap Asthma, CMOs (Peach Care & Well Care), Georgia's community colleges and Technical Schools, Center for Working Families, Morehouse School of Medicine

A Developmental Objective is one for which there is no current baseline or where there would be a need for new data collection methods.

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32

Goal 4: Promote and increase implementation of National Asthma Education and Prevention Program (NAEPP) guidelines in standards of care for the diagnosis, treatment, and management of asthma.*

OBJECTIVE4.1: By 2018, educate at least 500 providers on current NAEPP guidelines.

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Identify and engage Georgia stakeholders who have prioritized asthma education for patient care.
Develop and/or deliver web-based trainings on current NAEPP guidelines, providing CE/CME credits.

Three Rivers (AHEC), Georgia AHEC network, GACP, Georgia Rural Health Association, GA Chapter of the American Academy of Pediatrics, GA Academy of Family Physicians, GA Primary Care Association, Children's Healthcare of Atlanta, Pediatric Health Improvement Coalition (PHIC)
Three Rivers (AHEC), Georgia AHEC network, GACP, Georgia Rural Health Association, GA Chapter of the American Academy of Pediatrics, GA Academy of Family Physicians, Not One More Life, Pediatric Health Improvement Coalition (PHIC)

Research current asthma-based reporting measures that align with NAEPP guidelines.

Choice Healthcare, Merck, Health Information Exchange, National Center for Primary Health Care, Pediatric Health Improvement Coalition (PHIC)

Create an objective protocol that can be used to assess and strengthen implementation of NAEPP guidelines into clinical practice based on that research.

Choice Healthcare, Merck, Health Information Exchange, Morehouse School of Medicine National Center for Primary Health Care, GA Dept. of Community Health, Pediatric Health Improvement Coalition (PHIC), Not One More Life

OBJECTIVE4.2: B y 2018, increase the number of children ever receiving an asthma action plan from their providers from 43% to 50%.

KEY ACTIVITIES
Provide training to promote the adoption of best practices in asthma care linking providers, schools, and other recreational outlets on the asthma action plan (children 0-17yrs.).

KEY PARTNERS AND STAKEHOLDERS
Georgia Asthma Control Program, Georgia Asthma Advisory Coalition, Three Rivers AHEC, GA Association of School Nurses, Dept. of Early Care and Learning, GA Head Start Association, GA Chapter of the American Academy of Pedicatrics, Pediatric Health Improvement Coalition

Develop a standardized asthma action plan for Georgia and train providers on its use.

Georgia Asthma Advisory Coalition Schools/childcare and Healthcare Systems work groups, Three Rivers AHEC, GA Chapter of the American Academy of Pedicatrics, Pediatric Health Improvement Coalition

*Related to Healthy People 2020 objectives.
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Goal 5: Improve coverage and reimbursement rates for comprehensive asthma care.

OBJECTIVE5.1: B y 2018, increase the number of Care Management Organizations (CMOs) and/or health plans providing reimbursement for comprehensive asthma care based on NAEPP guidelines from 0 to 1.

KEY ACTIVITIES
Survey and evaluate health plans on current coding practices and procedures for asthma NAEPP guidelines.

KEY PARTNERS AND STAKEHOLDERS
Choice Healthcare, Allergy & Asthma Clinics of GA, GA Asthma Coalition, GA Association of Health Plans, GA Dept. of Community Health, GA Office of Insurance and Safety, GA Chapter of the American Academy of Pediatrics, Pediatric Health Improvement Coalition

Educate, through DCH, Georgia's health plans, including their subcontracted care management organizations, on comprehensive asthma care based on NAEPP guidelines.

Pediatric Health Improvement Coalition, GA Chapter of the American Academy of Pediatrics, Georgia Asthma Control Program, GA Dept. of Community Health , GA Dept. of Public Health, GA Office of Insurance and Safety

Develop educational presentation on comprehensive asthma care including payment and clinical reform to use with house and senate health committees, Governor's health care liaison, Dept. of Community Health, Pediatric Health Care Alliance, and others.

Georgia Asthma Control Program, GA Dept. of Public Health, Georgia Asthma Advisory Coalition, Georgia Asthma Coalition, GA Chapter of the American Academy of Pediatrics, Pediatric Health Improvement Coalition

Craft, based on information gathered from first three strategies, a legislative proposal and/or DCH regulatory change that provides for full reimbursement by health plans for comprehensive asthma care.

GA Dept. of Public Health, GA Rural Health Association (GRHA), Georgia Asthma Coalition, Merck, DCH Community Health, Large Primary Care and Specialty (Asthma, Pulmonology) Provider Groups, GA Association of Primary Health Care, Children's Healthcare of Atlanta, Area Health Education Centers, Association of Respiratory Health Workers, American Lung Assoc., Georgia Asthma Advisory Coalition, Environmental and Healthcare Systems Work Groups, Center for Working Families, School-Based Health Center Associates, Medical Association of GA, GA Hospital Association, Department of Education, grassroots stakeholders/families, GA Office of Insurance and Safety, GA Chapter of the American Academy of Pediatrics, Pediatric Health Improvement Coalition

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Goal 6: Improve asthma health information exchange.

OBJECTIVE6.1: B y 2018, Pilot asthma related rapid-cycle data sharing via health information exchange from hospitals, emergency departments, Medicaid claims data, primary and specialty care providers. (Developmental)

KEY ACTIVITIES
Convene a task force to explore the development of rapid health information exchange platform.
Updated and/or develop system tools
Indentify participating sites identified; Develop and implement site training plan

KEY PARTNERS AND STAKEHOLDERS
GA Dept. of Public Health, GA Dept. of Community Health, Pediatric Health Improvement Coalition (PHIC) Choice Healthcare, Merck, Health Information Exchange, Morehouse School of Medicine National Center for Primary Health Care, Children's Healthcare of Atlanta, GAAC, Health Care Georgia Foundation, Regional Extension Center, CMOs

A Developmental Objective is one for which there is no current baseline or where there would be a need for new data collection methods.

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SCHOOLS AND CHILDCARE SETTINGS
Rationale: The following considerations were important in the development of Work Group goals and objectives:
n Establishing management and support systems for asthma-friendly schools. n Providing appropriate school health and mental health services for students with
asthma. n Providing asthma education and awareness programs for students and school staff. n Providing safe and healthy school environments to reduce asthma triggers. n Providing safe, enjoyable physical education and activity opportunities for students with asthma. n Coordinating school, family, and community efforts to better manage asthma symptoms and reduce school
absences among students with asthma. n Establishing strong links to asthma care clinicians n Targeting students who are most affected by asthma at school n Choosing the right mix of resources n Using a coordinated multicomponent and collaborative approach n Supporting evaluation of school-based programs

Goal 7: Reduce the impact of asthma on the development and academic success of Georgia's children.

OBJECTIVE7.1: By 2018, among school districts that have adopted tobacco-free school policies increase by 50% the number of school districts that adopt Georgia's model "asthma friendly school" policy.

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Convene a committee for the development of Georgia's model asthma-friendly school policy. (Assess existing policies)
Convene a committee that creates the model implementation plan (including marketing of training).
Develop tool kit (including marketing package) and conduct training for school staff and local health promotion teams/coalitions that will promote and enforce this policy.
Create and provide policy advocacy training for local health promotion groups including school wellness teams.
Provide cost/benefit analysis (including cost-savings, materials, staff time for education, training on policy, protocols, list of small grant sources, etc.) to school wellness committee and local health promotion groups.

Department of Education, Health and Physical Education Directors, Georgia Asthma Advisory Coalition Schools and Child Care Work Group, GA Assoc. of School Nurses- Asthma Task Force, Mothers & Others For Clean Air, Annie E. Casey Foundation-Atlanta Civic Site, and Children's Healthcare of Atlanta, EPA Region 4 Asthma Program, Children's Medicaid Services, A Dept. of Public Health Div. of Maternal and Child Health, GA Dept. of Public Health Division of Environmental Health, Georgia Lead and Healthy Homes Program, US Green Building Council Georgia Chapter

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OBJECTIVE7.2: B y 2018, among childcare centers that have participated in Georgia Asthma Management Education for Childcare Settings (GAME-CS) training, increase by 50% the number of childcare centers that adopt Georgia's model "asthma-friendly childcare center" policy.

KEY ACTIVITIES
Convene a committee to develop model policy for asthma-friendly early childcare centers in Georgia.
Convene a committee that creates the model implementation plan (including marketing of training).
Develop a tool kit (including marketing package) and conduct training for center staff and local health promotion teams/coalitions that will promote and enforce this policy.
Create and provide policy advocacy training for local health promotion groups including school wellness teams.
Provide cost analysis (including cost-savings, materials, staff time for education, training on policy, protocols, etc.) to school wellness committee and local health promotion groups.

KEY PARTNERS AND STAKEHOLDERS
Georgia Head Start Association, DHHS - Administration for Children and Families, Department of Education, Health and Physical Education Directors, Georgia Asthma Advisory Coalition Schools and Child Care Work Group, GA Assoc. of School Nurses- Asthma Task Force, Mothers & Others For Clean Air, Easter Seals of North Georgia, Annie E. Casey Foundation-Atlanta Civic Site, and Children's Healthcare of Atlanta, EPA Region 4 Asthma Program Children's Medicaid Services, GA Dept. of Public Health Div. of Maternal and Child Health, GA Dept. of Public Health Division of Environmental Health, Georgia Lead and Healthy Homes Program, US Green Building Council Georgia Chapter, Georgia Early Childhood Professional Development System

OBJECTIVE7.3: B y 2018, provide an online "one-stop-shop" that provides resources for implementing asthma friendly schools and childcare policies in Georgia. (Georgia Department of Public Health website)

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Provide support for state-level policies. n Increase awareness of state-level policy using Georgia Department of
Public Health website
n Research education resources and promising curricula that will foster uniform asthma-based education and Asthma Action Plans across the state
n Develop multilingual resources for school-based asthma education.

GA Dept. of Public Health Communications, Georgia Asthma Control Program, Georgia Asthma Advisory Coalition, Georgia Association of School Nurses-Asthma Task Force

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OBJECTIVE7.4: B y 2018, increase by 150 early childcare centers that achieve the Georgia Asthma Friendly Childcare Center recognition.

KEY ACTIVITIES
n Implement marketing and awareness plan targeting parents of young children and childcare organizations/associations
n Gain buy-in from DECAL to include GAME-CS in core required courses for licensed centers
n Train staff from public health districts and early childcare centers on the GAME-CS Curriculum
n Assist and support early childcare centers throughout training and implementation

KEY PARTNERS AND STAKEHOLDERS
Georgia Asthma Control Program, GA Dept. of Early Care and Learning, GA Head Start Association, DHHS Administration for Children and Families Region 4, Annie E Casey Foundation Atlanta Civic Site, Children's Healthcare of Atlanta, American Lung Association, Georgia Training Institute, local schools of public health and respiratory therapy

Goal 8: I mprove the integration of care management between health care providers and schools and childcare settings.

OBJECTIVE8.1: B y 2018, increase by 10% the number of schools and childcare settings that report receiving asthma action plans from primary care providers from the 2012 baseline.

KEY ACTIVITIES

KEY PARTNERS AND STAKEHOLDERS

Identify information exchange mechanism between health providers and school/childcare settings for AAPs.
Conduct awareness and education campaign for key audiences of GA Dept. of Education, Local School Boards, Dept. of Early Care and Learning on the NAEPP guidelines and the importance of requiring AAPs at school/childcare for all children with asthma.

Dept. of Community Health, GA Allergy and Asthma Physicians Associations, Georgia Academy of Family Physicians, Georgia Association of School nurses, Georgia Regional Extension Center, GA Chapter AAP, GA Dept. of Public Health Div. of Maternal and Child Health, CSRA Asthma Coalition, Georgia Asthma Control Program

Authorize provider reimbursement for Asthma Action Plan creation and distribution by providers to patients.

Georgia Office of Insurance and Fire Safety commissioner, GA Dept. of Community Health

OBJECTIVE8.2: B y 2018, increase the number of certified asthma educators (CAE) in GA by 50%. Focus on increasing CAEs among school nurses. (79 total CAEs in GA, 2012 National Asthma Educators Certification Board baseline)

KEY ACTIVITIES
Facilitate training opportunities for school nurses on NAEPP guidelines. (i.e. Becoming and Asthma Educator and Care Manager)

KEY PARTNERS AND STAKEHOLDERS
Georgia Association of School Nurses, Three Rivers AHEC, Georgia Asthma Control Program, Local School Boards

Identify school nurses for CAE certification (K-12) through each district lead nurse.

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ALIGNMENT WITH NATIONAL AGENDA TO ADDRESS ASTHMA DISPARITIES
In May 2012, the President's Task Force on Environmental Health Risks and Safety Risks to Children released the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities to address the following current observations:
n P oor and minority children are more likely to have asthma and their health outcomes are worse.
n B lack children are twice as likely to be hospitalized and four times as likely to die from asthma as white children.
n A nnually, 10.5 million school days are missed because of asthma. n C hildren with asthma are more likely to be overweight and obese compared to other
children without asthma.
Under the Task Force, a broad range of federal organizations have committed to advancing the following strategies:
n R educing barriers to the implementation of guidelines-based asthma management; n E nhancing capacity to deliver integrated, comprehensive asthma care to children in
communities with racial and ethnic disparities; n Improving capacity to identify the children most impacted by asthma disparities; and n A ccelerating efforts to identify and test interventions that may prevent the onset of
asthma among ethnic and minority children.
The following table highlights the alignment of the GACP 2013-2018 strategic objectives with Strategies 1 and 2 of the Federal Action Plan.

STRATEGY1: Reducing barriers to the implementation of guidelines-based asthma management.

FEDERAL PRIORITY ACTION Explore strategies to expand access to asthma care services
In health care settings, coordinate existing federal programs in underserved communities to improve the quality of asthma care

GACP 2013-2018 STRATEGIC OBJECTIVE
(Healthcare) By 2018, increase the number of Care Management Organizations (CMO) and/or health plans providing reimbursement for comprehensive asthma care based on NAEPP guidelines from 0 to 1
(Healthcare) By 2018, increase the number of certified asthma educators (CAE) in GA by 50%. (79 total CAE's, 2012 NAECB)
(Healthcare) By 2018, increase by 5% the number of CHWs certified as asthma educators.
(Healthcare) Over the next 5 years, educate at least 500 providers on current NAEPP guidelines.
(Healthcare) By 2018, increase the number of children ever receiving an asthma action plan from their providers from 43% to 50%

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STRATEGY1: (continued)
FEDERAL PRIORITY ACTION In homes, reduce environmental exposures
In schools and childcare settings, implement asthma care services and reduce environmental exposures, using existing federal programs in collaboration with private sector partners

GACP 2013-2018 STRATEGIC OBJECTIVE
(Environmental) By 2018, establish a statewide healthy homes standard to reduce the level of asthma triggers in home and indoor environments.
(Environmental) By 2018, increase by 2 the number of housing authorities or administrative entities that adopt the healthy homes standard for non-owner occupied and multifamily housing.
(Schools/childcare) By 2018, 50% of school districts that have adopted tobacco-free school policies will have adopted the model "asthma-friendly school" policy
(Schools/childcare) By 2018, among childcare centers that have participated in Georgia Asthma Management Education for Childcare Settings (GAME-CS) training, increase by 50% the number of childcare centers that adopt Georgia's model "asthma-friendly childcare center" policy.
(Schools/childcare) By 2018, increase by 150 early childcare centers that achieve the Georgia Asthma Friendly Childcare Center recognition.

STRATEGY2: Enhancing capacity to deliver integrated, comprehensive asthma care to children in communities with racial and ethnic disparities.

FEDERAL PRIORITY ACTION

GACP 2013-2018 STRATEGIC OBJECTIVE

Promote cross-sector partnerships among federally supported, community-based programs targeting children who experience a high burden of asthma

(Schools/childcare) By 2018, increase by 10% the number of schools and childcare settings that report receiving asthma action plans from primary care providers from the 2012 baseline.

In communities that experience a high burden of asthma, protect children from health risks caused by short- and longterm exposure to air pollutants

(Environment) By 2018, enact new tobacco free ordinances in at least 5 Georgia cities/counties.
(Environment) By 2018, increase by 50% the number of libraries, recreation areas, and other public outlets in non-attainment areas that display smog safety information.

ALIGNMENT WITH NATIONAL AGENDA TO ADDRESS ASTHMA DISPARITIES

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ACRONYMS

AAE

Association of Asthma Educators

AAP

American Academy of Pediatricians

AHEC Area Health Education Centers

ACF

Administration of Children and Families

ALA

American Lung Association

CAE

Certified Asthma Educators

CBO

Community based organization

CHOA Children's Health Care of Atlanta

CHW

Community health worker(s)

CMO

Care management organization

CMS

Centers for Medicare and Medicaid Services

CSRA Central Savannah River Area

DCH

Department of Community Health

DECAL Department of Early Care and Learning

DHHS Department of Health and Human Services

DOE

Department of Education

DPH

Department of Public Health

EPA

Environmental Protection Agency

GAAC Georgia Asthma Advisory Coalition

GACP Georgia Asthma Control Program

GASN Georgia Association of School Nurses

GHA

Georgia Hospital Association

GLPPP Georgia Childhood Lead Poisoning Prevention Programs

GRHA Georgia Rural Health Association

GPT

Georgia Partnership for Telehealth

GAME-CS Georgia Asthma Management Education in Childcare Settings

HUD

Housing and Urban Development

NAECB National Asthma Education Certification Board

NAEPP National Asthma Education and Prevention Program

NHLBI National Heart, Lung and Blood Institute

OASIS Online Analytical Statistical Information System

PTA

Parent Teachers Association

SMC

Southside Medical Center

SWAH Self Wealth and Health empowerment

TUPP Georgia Tobacco Use Prevention Program

YMCA Young Men's Christian Association

YRBS

Youth Risk Behavioral Survey

ACRONYMS

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REFERENCES
Behavioral Risk Factor Surveillance System (BRFSS) Prevalence Data, http://www.cdc.gov/asthma/brfss/default.htm.
Georgia Hospital Inpatient Discharge Data, 2006-2008
Georgia Youth Risk Behavior Survey, 2007, 2009, 2010
Georgia Youth Tobacco Survey, 2009
Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP), http://oasis.state.ga.us/
Crocker DD, Kinyota S, Dumitru GG, Ligon CB, Herman EJ, Ferdinands JM, Hopkins DP, Lawrence, BM, Sipe TA, Task Force on Community Preventive Services. Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a Community Guide systematic review. Am J Prev Med 2011;41(2S1):S5-32.
Task Force on Community Preventive Services. Recommendations from the Task Force on Community Preventive Services to decrease asthma morbidity through home-based, multi-trigger, multicomponent interventions. Am J Prev Med 2011;41(2S1):S1-4.
Thyne, S. et al. "The Yes We Can Urban Asthma Partnership: A Medical/Social Model for Childhood Asthma Management." Journal of Asthma. 2006;43: 667-673
Brett, M. and Stillman, L. (2009). "The Role of Pest Control in Effective Asthma Management: A Business Case." http://asthmaregionalcouncil.org/uploads/IPM/IPM_FINAL_2009.pdf
Jowers JR, et al. "Disease Management Program Improves Asthma Outcomes," The American Journal of Managed Care. 2000;6(5):585-59.
Krieger J, et al. "A Randomized Controlled Trial of Asthma Self-Management Support Comparing Clinic-based Nurses and In-home Community Health Workers," Archives of Pediatric and Adolescent Medicine. 2009;163(2):141-149.
"Guidelines for Asthma Management" http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf
Hoppin, P., Jacobs, M., Stillman, L.( June 2010). "Investing in Best Practices for Asthma: A Business Case for Education and Environmental Interventions." Asthma Regional Council of New England, http://www.chicagoasthma.org/site/files/410/12588/173113/484251/PayerBusiness_Case_2010finalHRiA.pdf
High Quality Care for Children with Asthma: The Medical Home Foundation http://www.medicalhomeinfo.org/downloads/pdfs/Lail-Meurer_Quality_Care_for_Asthma.pdf
Lutfiyya MN, Scott N, Hurliman B, McCullough JE, Zeitz HJ, Lipsky MS. Determining an association between having a medical home and uncontrolled asthma in US school-aged children: a population-based study using data from the National Survey of Children's Health. Postgrad Med. 2010 Mar;122(2):94-101.
Physician Asthma Care Education (PACE) program http://rover.nhlbi.nih.gov/health/prof/lung/asthma/pace/
Michael D. Cabana, Kathryn K. Slish, David Evans, Robert B. Mellins, Randall W. Brown, Xihong Lin, Niko Kaciroti and Noreen M. Clark. Impact of Physician Asthma Care Education on Patient Outcomes. Pediatrics 2006;117;2149.
U.S. Department of Health and Human Services, National Heart, Lung and Blood Institute, National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. 2007. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
Guidelines Implementation Report (GIP): EPR-3, Partners Putting Guidelines Into Action (National Asthma Education and Prevention Program, 2008). http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf
Cloutier, M., Hall, C., Wakefield, D., & Bailit, H. (2005). Use of asthma guidelines by primary care providers to reduce hospitalizations and emergency department visits in poor, minority, urban children. The Journal of Pediatrics, 146(5), 591-597.

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REFERENCES (continued)
The CDC Community Guide. Community Preventive Services Task Force on Asthma. http://www.thecommunityguide.org/asthma/index.html
Nurse Asthma Care Education (NACE) Program, National Respiratory Training Center (NRTC). http://www.nrtc-usa.org/
Wisnivesky, J. P., Lorenzo, J., Lyn-Cook, R., Newman, T., Aponte, A., Kiefer, E., . Ethan, H. (2008). Barriers to adherence to asthma management guidelines among inner-city primary care providers. Annals of Allergy, Asthma and Immunology, 101(3), 264-270.
Hemnes, A. R., Bertram, A., & Sisson, S. D. (2009). Impact of Medical Residency on Knowledge of Asthma. Journal Of Asthma, 46(1), 36-40.
Cabana, M. D., Abu-Isa, H., Thyne, S. M., & Yawn, B. (2007). Specialty differences in prescribing inhaled corticosteroids for children. Clinical Pediatrics, 46(8), 698.
Watts B. Outpatient management of asthma in children age 5-11 years: guidelines for practice. Journal of the American Academy of Nurse Practitioners 2009 May;21(5):261-9.
Bunting, B., & Cranor, C. (2006). The Asheville Project: long-term clinical, humanistic, and economic outcomes of a communitybased medication therapy management program for asthma. Journal Of The American Pharmacists Association, 46(2), 133-147.
Benavides S, Rodriguez JC, Maniscalco-Feichtl M. Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present. The Annals of Pharmacotherapy. 2009 Jan;43(1):85-97. Epub 2008 Dec 23.
Improving Asthma Care for Children: Best Practices in Medicaid Managed Care (Center for Health Care Strategies, July 2006) http://www.chcs.org/usr_doc/IACC_Toolkit.pdf
Wheeler, L., Merkle, S., Gerald, L., and Taggart, V. (2006) Managing Asthma in Schools: Lessons Learned and Recommendations. Journal of School Health, Vol. 76, No. 6.
Centers for Disease Control and Prevention. Strategies for Addressing Asthma within a coordinated School Health Program, With Updated Resources. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2006. www.cdc.gov/HealthyYouth/asthma/pdf/strategies.pdf.
The Indoor Air Quality Tools for Schools Approach: Providing a Framework for Success http://www.epa.gov/iaq/schools/pdfs/framework.pdf
Foscue, K. and Harvey, M. (2011) Statewide Multi-Agency Intervention Model for Empowering Schools to Improve Indoor Air Quality. Journal of Environmental Health.
"How Asthma Friendly is Your School" Questionnaire. National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program School Asthma Subcommittee
"How does indoor air quality impact student health and academic performance? The case for IAQ management in schools." (April 2010). http://www.epa.gov/iaq/schools/pdfs/student_performance_findings.pdf
U.S. Department of Health and Human Services, Healthy People 2020, www.healthypeople.gov
"President's Task Force on Environmental Health Risks and Safety Risks to Children: Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities" http://www.epa.gov/asthma/childrenstaskforce
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Vital Health Statistics
Moonie, S, et al. The Relationship Between School Absence, Academic Performance, and Asthma Status. Journal of Sc hool Health: 78(3):140-148, 20

REFERENCES

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Strategic Plan for Addressing Asthma in Georgia 2013-2018
Funding for this effort was provided by Centers for Disease Control and Prevention Cooperative Agreement Addressing Asthma from a Public Health Perspective (5U59/EH000520-3). This plan was prepared by the Georgia Health Policy Center for the Georgia Department of Public Health.