Except obesity, asthma affects more children than any other chronic disease. It is one of the most frequent reasons for school absence, hospital emergency visits and hospital admissions. For children with asthma SHS staff help to obtain physician-directed asthma action plans (AAPs). SHS works with parents and providers to obtain a copy of the most current Asthma Action Plan to provide continuity of care. SHS collaborates with Dell Children’s Medical Center in a continuum of care that looks at how many students take their AAPs to school following hospital discharge.
The Texas Department of State Health Services (DSHS) estimates 9.1% of children in Texas have asthma (TX DSHS Asthma Burden 2014). The prevalence rate for Central Texas children, as represented by Health Service Region 7, is 9.2%. Asthma prevalence in Texas among African American children is estimated at 19.2%, more than twice the rate for white or Hispanic children. Applying the 9.1% prevalence rate (for all ethnicities) to AISD, this would predict that about 7700 students have the condition. The prevalence rate varies by ethnicity and age of the child. School RNs managed 1577 students for asthma during SY 2014-15, of whom 362 had physician-generated Asthma Action Plans and 1215 had RN-generated Individualized Health Care Plans (IHCPs). Nurses identified 7312 asthmatic students in their acuity survey (95% of the estimated prevalence for AISD based on DSHS information). Students being actively managed for asthma tend to be younger students. Older students with asthma may be successfully self-managing their condition, consequently those older students case managed by SHS tend to have more severe asthma. SHS seeks to identify as many students with asthma as possible prior to any asthma exacerbation. When a student is seen in ED or admitted to the hospital for asthma, SHS works with Dell Children’s Medical Center to obtain AAPs for in-school management of the condition.
There were 4280 breathing difficulty episodes during SY 2014-15. Of the total episodes, 1068 were among students for whom there was no previously known diagnosis of asthma, and therefore no care plan. School nurses are dependent on parents to notify them of their student’s health conditions. For students who lack access to care, and who experience breathing difficulty in school, school nurses help link families to care.
There has been a multiyear effort to identify students with asthma and get care plans in place. Students without a known diagnosis/care plan that experience breathing difficulty are more likely to be absent than their counterparts whose asthma is actively managed in school, they are also less likely to return to class following an asthma exacerbation during school hours.
Of students experiencing a breathing difficulty episode in SY 2014-15, 89.5% of those with a care plan remained in school and returned to the classroom, while only 64.2% of those without a plan remained in school. This stable pattern over several years reiterates the importance of targeting previously undiagnosed students and implementing care plans as a means to increase educational time and reduce a health barrier to learning.
In SY 2014-15, 0.8% of students with a care plan who experienced breathing difficulty required a medical referral, 0.1% involved EMS contact, and 0.1% were transported via EMS.
In contrast, 5.5% of students without a care plan required a medical referral following breathing difficulty, 1.3% required EMS contact and 0.9% were transported via EMS. These findings were significantly different from the prior year and coincide with a 16.7% increase in number of breathing difficulty episodes (from 3666 to 4280, regardless of diagnosis/plan status) over the two year period.