The San Diego city schools tested the feasibility of a non-computerized method for tracking students with asthma and examined case management activities conducted by school nurses over a three-year period (beginning with the 1999-2000 school year). Students whose parent reported physician-diagnosed asthma were identified and the nurse noted if the child had medication and a peak flow meter at school. The nurses used professional judgment but no single standard to indicate asthma severity. For this project 920 students with mild asthma and 174 with moderate or severe asthma were tracked for the entire period. The prevalence of asthma was 5.1% (year 1) to 6.2% (year 3) district-wide.

Each school had a peak flow meter and metered dose inhalers (albuterol) for students with a medical order, but no specific asthma intervention nor additional resources were included in this project. Nurses recorded specific case management activities, i.e., education, parent or doctor calls, and home visits, for these students. These activities were examined with respect to student changes (potential outcomes) in the subsequent year. 

Students who received at least one case management activity were more likely to have medication at school and to use a peak flow meter in the following year.  Students with asthma were absent for an illness more often (half to 1.25 day) each year than those without known asthma. There were no differences in absenteeism related to nurse activities for students with asthma.

In the third year, over 75% of the students with moderate/severe asthma who had received case management service(s) had medication at school compared to 46% who did not receive at least one service in the previous year. Student tracking was considered feasible and school nurse case management showed promise for improving adherence to standards of care for children with asthma.

(Taras H et al. J Schl Health 2004;74(6):213-219)

Comment:  This forms a foundation for identifying additional activities that qualify as ‘case management’ and determining which might be appropriate for third-party reimbursement, particularly in conjunction with reducing emergency department utilization.  --J.O.