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AIM Summer 2011 Newsletter

Summer 2011
In This Issue
FLARE Evaluation
CEU Opportunity – Disabilities
AIM Partnership Forum Presentations
Michigan Asthma Calendar

FLARE Evaluation Highlights by Michelle L. Macy, MD, MS

emergency vehicleMany people have heard that emergency department (ED) visits for asthma signal a problem and that there are some patients who just keep coming back to the ED for asthma exacerbations. Have you ever considered ED asthma discharge instructions could play a part in breaking this cycle? ED Discharge instructions provide an opportunity 1) to reinforce asthma education, 2) to encourage a follow-up medical appointment, and 3) to emphasize the proper use of asthma medications, including inhaled corticosteroids when appropriate.


In 2006, the state of Michigan Asthma Mortality Review Project identified that asthma deaths were associated with a high number of ED visits in the preceding months and that under prescribing of controller medications such as inhaled corticosteroids was common. In response to these statistics, a statewide group of asthma and emergency care experts developed the FLARE plan to provide ED with a model for asthma discharge instructions. The FLARE plan provides patients with a simple, short-term asthma action plan to use from the time they leave the ED until they can follow-up with their primary care provider. The FLARE plan also includes basic information about asthma, highlighting the following asthma care concepts:

Follow up with your doctor
Learn your medications
Asthma is a chronic disease
Respond to these warning signs
Emergency care may be needed

FLARE plans were sent to all Michigan EDs with a letter requesting ED leaders review and update their asthma discharge instructions. To evaluate the impact of the FLARE project, we compared the content of ED asthma discharge instructions before and after distribution of the FLARE plan. Sixty-one Michigan hospital EDs voluntarily sent their current discharge instructions and identifying information was removed. Instructions were reviewed by 3 experts who checked for the presence of 4 criteria:

  1. Advises patient to follow up with primary doctor.
  2. Advises patient to take prescribed medications as the doctor has directed.
  3. Informs patients that asthma is a chronic (life-long) disease.
  4. Informs patients that most people with asthma do not get so sick that they need emergency care and/or emergency asthma care may indicate treatment or management failure.

Key findings from this FLARE evaluation include:

  • 38% of EDs were not awarded maximum points for instructing patients to follow-up with their primary care physician after the ED visit (with 24% receiving zero points for its discussion)
  • More than one in ten EDs did not advise asthma patients to take prescribed medications as directed
  • More than half of discharge instructions did not state that asthma is a chronic disease
  • Just 1 of 5 ED asthma discharge instructions informed patients that emergency care for asthma may indicate treatment or management failure
  • After the FLARE plan, asthma discharge instruction scores were most improved on Criterion 4, with Criterion 2 a close second

In addition to numeric scoring, expert reviewers also made written notes about key asthma information that was missing from each set of instructions. Asthma discharge instructions provided after the FLARE plan were more likely to be written using simple language and to include information that the pathophysiology of asthma includes both inflammation and narrowing of the airways. There was a 28% increase in the number of ED asthma discharge instructions that included a discussion of how to avoid or control triggers for asthma.

Adoption and implementation of the instructions continues in Michigan EDs; most implementing hospitals have a staff champion, and many have worked with local asthma coalitions and other partners to assist in this process. Read a more detailed account of the FLARE evaluation project and the FLARE plan. Contact Tisa Vorce or 517.335.9463 with any questions.

Dr. Michelle Macy is a pediatric emergency physician at the University of Michigan C.S. Mott Children's Hospital and a faculty member in the Departments of Emergency Medicine and Pediatrics. She conducts research in the Child Health Evaluation and Research (CHEAR) Unit with an interest in improving the quality of asthma care in the emergency department.



Health Professionals: Looking for CEUs?

The Partnership for Health & Disability (PHD) offers online training for healthcare and public health professionals of all kinds in understanding and treating patients with disabilities.

PHD is supported by the Centers for Disease Control & Prevention, and the Michigan Department of Community Health. The partnership's goals include reducing health disparities, preventing secondary conditions, and promoting healthy lifestyles among people with disabilities

The two one-hour online training sessions can help you gain a better understanding of the access and wellness issues that affect people with disabilities, and how you can mitigate barriers to appropriate care. One course centers on people with developmental disabilities; the other, on people with physical and sensory disabilities.

Upon completion of the training, CEUs are available through the Centers for Disease Control and Prevention. The courses are free; one CEU for each course will be offered for a $15 fee.
2011  AIM Partnership Forum Presentations Available
  • Asthma and Air Pollution: Health Effects and Prevention
    Dr. Fuyuen Yip, Centers for Disease Control and Prevention
  • Recent and Ongoing Studies of Air Pollution & Asthma Among Children in Detroit
    Dr. Stuart Batterman, University of Michigan
  • Michigan's Near Real-Time Air Quality Services
    Laura DeGuire, Michigan Department of Environmental Quality
  • Smoke-Free Multi-Unit Housing: Protecting Health
    Jim Bergman, The Center for Social Gerontology, Inc.
  • Healthy Homes: Past, Present & Future
    Courtney L. Wisinski, Michigan Dept. of Community Health, Healthy Homes University
kids playing music
Quick Links

Michigan Asthma Calendar 
9-15   Camp Michi-MAC, YMCA Storer Camp, 6941 North Stoney Lake Rd., Jackson.
For more info: Mary Hagen, 586.493.9879

23-24    Freedom From Smoking® Facilitator Training, American Lung Association, 25900 Greenfield Rd, Oak Park. For more info: Patty Inman, 810.931.1425  
17    Health & Community Fair, health screenings including asthma, Our Savior Lutheran Church, 6901 N. Saginaw, Flint. For more info: Jan Roberts, 810.262.9591  
20    Asthma 1-2-3 Facilitator Training, American Lung Association, 25900 Greenfield Rd, Oak Park. For more info: Patty Inman, 810.931.1425  

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