Medical Professional Publications

School-Based Asthma Therapy Program Improves Health Indicators and Utilization

Columbus, OH — January 2018

A real-world asthma control effort has been successfully implemented in urban schools in Columbus, Ohio and surrounding areas. The program, called the School-Based Asthma Therapy (SBAT) Program, demonstrates the potential success of asthma control programs outside of efforts funded by research grants.

A recent retrospective review of the program’s data, published in the Journal of Asthma, reported the program’s success in reducing health care utilization and achieving substantial organic growth and high program acceptance by school staff, parents and providers.

“Many programs implemented as part of a study die out once the funding goes away,” says Elizabeth Allen, MD, a pulmonologist at Nationwide Children’s Hospital and lead author of the recent publication. “We adopted a program that was originally started as a research endeavor elsewhere, but took it a step further to get a local school system working with us so we could orchestrate it in a way that was sustainable — something that people would be eager to keep doing.”

The resulting SBAT Program is funded by Partners for Kids, an accountable care organization (ACO) that functions as a partnership between Nationwide Children’s Hospital and 1,000 doctors in 34 Ohio counties. The ACO’s funding enables SBAT Program staff to coordinate services and communication with insurers, families, schools and physicians to get at-risk children the asthma medication they need.

Participating school nurses and physicians identify children who are struggling with poorly controlled asthma that may be corrected by better adherence to inhaled corticosteroid controller medications. When families enroll, children receive at least one daily preventative dose at school via a duplicate prescription sent directly to the school.

This simple step toward ensuring at least one daily dose of controller medicine for the most high-risk children with asthma has resulted in significant improvement in mean Asthma Control Test scores among participants, from 16 to 21. Further, there were reductions in emergency department visits and inpatient hospitalization days from a one-year period preceding program enrollment to a one-year period of participation in the program (based on data from 98 children who were enrolled in the program for a full year). There was also a reduction in pediatric intensive care unit days, but the difference was not statistically significant.

“School nurses very enthusiastically received the program, because they saw the kids they had been trying to help were actually getting better in front of their eyes — for example, kids who previously couldn’t go out to recess because their symptoms were so bad,” says Dr. Allen, who is also the physician lead for Nationwide Children’s Keep Me Well Asthma Quality Improvement Initiative. “Providers also tell me their toughest patients are doing a lot better now that there’s a sure method of getting them the therapy they need. We’ve shown that with ACO funding, it’s a highly acceptable program to all of the players.”

Based on the reduction in emergency department visits and inpatient days, the SBAT Program largely pays for itself within the Partners for Kids ACO model. Its popularity with schools, parents, and providers is self-evident as well; initially provided to just 38 students in 17 schools in the 2013-2014 school year, the program grew to 268 students in 131 schools by 2015-2016. Dr. Allen says enrollment is now nearly 500 children in more than 200 schools.

Dr. Allen believes the ACO model and the support Nationwide Children’s provides is a key factor to program sustainability. In this setting, sponsoring a program to reduce asthma-related emergency department visits and inpatient days improves patient outcomes and is financially feasible. Different sponsorship models may be needed to duplicate SBAT in communities with more traditional payment systems.

Going forward, the Nationwide Children’s SBAT Program will continue to operate under its current funding structure with the goal of serving even more children with poorly controlled asthma. The staff is currently applying for grants to help fund analysis of program impact on school absence, caregiver work absence, broader asthma symptoms and quality of life. They also want to develop an instruction manual to provide guidance to other localities interested in implementing the SBAT Program.

“It is our hope that this real-world effort will demonstrate that these programs can be affordable, convenient, and effective. When a program like this exists, asthma specialists and primary care providers can use it as another tool to make sure kids are getting their medication,” says Dr. Allen. “It’s surprising how often symptoms improve markedly once kids are in the program, even when families believed they were being adherent.”


Allen ED, Arcoleo K, Rowe C, Long WW. Implementation of a ‘real world’ School-Based Asthma Therapy program targeting urban children with poorly controlled asthma. Journal of Asthma. 2017 Nov 30:1-9. [E-pub ahead of print.]

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