Breathmobile Provides Needed Treatment to Students Nationwide

As one of the largest school districts in the country, the Los Angeles Unified School District serves more than 600,000 students on a daily basis. With so many children come a wide variety of health issues and individual health insurance complications that also must be addressed.

One of the most serious health concerns for these children has been asthma and allergies, which can affect not only their quality of life but also their ability to maintain a consistent educational schedule. For close to 20 years, one organization has worked to bring regular health care and health education to students across the expansive school system.

When the LA Breathmobile began working with the district it serviced just 18 schools. They now take their 4 vehicles to 94 schools around the county. Co-director Lyne Scott, MD, said that schedule allows the mobile clinics to hit each school every 4 to 6 weeks. Children who are covered under a health insurance plan are billed through that particular system, while those without insurance are seen free of charge. The teams working with the vehicles also have the ability to get the children treated at their local schools or at other locations or hospitals, depending on their medical needs.

Scott said the key to the program is not only helping the children, but also helping educate the parents about their child’s condition and working with the schools themselves to ensure everyone is as safe as possible.

“We work with everyone,” she said. “The principals are usually our greatest ally.”

In addition to the schools, Scott said the parents also play an important role in treatment. “The parents are very involved. You’ve got to have a family buy in for the treatment plan and helping the kids engage in their own care.”

The Breathmobile team and others like it have been seen as a way to bolster a district with around 540 school nurses for all the students. “That’s what we’re seeing nationwide in our sister programs,” Scott added. “School staffs are often helping with the asthma plans in the school.”

Scott said the biggest challenge facing not only the Breathmobile program in Los Angeles but across the country is funding. Even still, she said the work they do has long since shown a benefit to the children who need their efforts most.

“Often, reimbursements are higher for emergency visits and hospitalizations than they are for preventative care,” she said. “We know that by doing preventative care we’re not just cost shifting, but we’re also cost saving.” Scott estimated for every dollar invested in the program there was an overall savings to the healthcare community of $7.

According to the organization’s website, close to 80% of the patients seen by the Breathmobiles reach “well-controlled” levels of their asthma by the third visit, with 96% reaching that level by their sixth visit. Emergency room visits also reportedly drop by 68% for those who take part in the program for more than a year. For that same group, hospitalizations drop 87% and missed school days drop a reported 82%.

Scott said one of the keys to their success is the Astramax electronic health record system. “The technology for how we track outcomes has evolved from a simple program to a more complex clinical outcome program.” The website notes that with Astramax the teams can track each visit and monitor symptoms, impairment, and prescribed medications among other items. A team that includes a “specialty-trained asthma provider,” as well as either two registered nurses or a registered nurse and a respiratory therapist operates the vehicles themselves. There is also a patient financial service resource worker who can work with them when needed.

In addition to Los Angeles, there are currently similar programs operating in other parts of California, as well as in Baltimore, Phoenix, and southern Alabama. The Los Angeles unit is a combined effort between Los Angeles County and the University of Southern California, where Scott is an assistant professor of pediatrics along with fellow co-director Marilyn Li, MD.