Chronically-Sick Kids Helped by Electronic School-Based Monitoring Systems 

by Francis P. Koster, Ed.D.

In national rankings, North Carolina ranks high for our number of sick school children, and low for our number of school nurses.

The numbers are amazing - 1 in 5 school kids has a medical diagnosis that must be managed to facilitate maximum learning_[1].

1) One in three North Carolina kids aged 10 - 17 are "Obese"._[2] Obese children have their life shortened between four and ten years, and for citizens of all ages obesity accounts for one dollar of every ten spent on healthcare in the United States._[3]

2) Diabetes is now the seventh leading cause of death in North Carolina, and skyrocketing. As a nation we are headed toward a future where 1 in 3 adults will have it, and live 15 years less than the rest of us.[4] Diabetes among children is really scary - if not kept under control, it can lead to blindness, paralysis, amputation, and death.

3) One in ten students in North Carolina suffer from asthma[5] -. It is the leading chronic health condition reported by the school system and the leading cause of absenteeism.[6] It is the leading cause of hospitalization of children under 15._[7]

4) Food allergies are skyrocketing in children - now impacting one in 12.   These allergies call for careful monitoring and training in the use of epi-pens by both the child and adults nearby. _[8]

Chronic diseases like obesity, diabetes, and asthma are different than a broken arm, or tooth ache - managing the disease is primarily the duty of the patient.   A broken arm, once set, will heal on its own. The tooth will stop hurting once the dentist does their magic. A chronic disease is like a thief in the neighborhood - unless you are constantly on guard, it will sneak in and surface again.

Here is the big issue: once a patient has a diagnosis of a chronic disease, the only way to optimize health is to change behavior - you must eat differently, exercise differently, take medicine differently, and/or avoid certain allergens   In other words, you cannot just take a pill for it.

 

The problem is that few patients - even adults - change their behavior.

 

Take adult diabetics for example. Once disease management coaching begins, two thirds of them eat better, but only one in five do the required exercise, and just a few prick their finger and check their blood, which they are supposed to do several times a day. One in four do not check even monthly!_[9] They literally put themselves in an early grave.

When you mix chronic diseases and kids, the situation gets even more challenging. Kids are often too immature to take full responsibility in managing their illness.   A school nurse can be a big help.

This leads us to the rapidly expanding use of electronics in healthcare. To be clear, the following discussion does not refer to a doctor making a diagnosis - it is about how to manage a child after the doctor's visit, and a diagnosis is received.

The key to chronic disease management is training the child over and over about the steps they must take to stay healthy - just like we train them to wash their hands after using the toilet, and train them to look both ways when crossing the street. When training a chronically ill child, they keep logs of things like what they ate, when they take their pills, and when they worked out, for how long, what their blood sugar count was, or how well their lungs are working when measured by a simple plastic thing they blow in.   In order to ensure that these logs are timely and accurate, supervision in maintaining them is essential.

A school nurse can be a big help. In one county near where I live, there are only 12 school nurses - or about one for every 1,700 students.Each one is responsible for three schools._[10]The national standard is one nurse to every 750 kids.[11] So we have high number of sick kids needing close oversight, and too few trained people to provide it.  

That county has 20,000 students in 35 schools._[12] According to their parents, 1,600 of those 20,000 have a diagnosis of chronic illness that can seriously impact the quality of their current and future life. Many parents to not inform the school system, so the real number is higher.

In an adjacent county, over 10,000 students have one or more chronic illnesses._[13] 500 of them have to take long term daily medications while at school._[14] Another 1,800 have special medications stored at school for use by the nurse if known problems erupt.[15]

Those numbers lead us to think about the potential for electronic help via laptops and ever-present cell phones.

So here are the puzzle pieces laid out on the kitchen table:

The number of chronically ill Americans is projected to rise 40% over the next 20 years[16];

• chronically ill kids either have, or could have, low cost small laptops that include the ability to have a video call to their school nurse;
• Most seriously ill school kids have portable monitors such blood sugar monitors, or devices that measure lung function, and can share the results simply by holding the monitor up to the camera;
• Existing school nurses know their seriously ill children, and know how to help - but when needed are often at one of the other two schools they are responsible for;
• Major computer manufacturers are getting ready to release new health monitoring devices;
• Some school systems have an emerging electronic record keeping system that these "apps" could feed into. Those that don't could get one rather cheaply, compared to the cost of not having one, and paying an ambulance run(s), follow up time spent with parents, and impact on the learning process of the rest of the student body of flashing lights as a friend is rushed off.

It is important to note that the technology is not the answer. It is a facilitator - enabling the nurse to monitor the child, the child to capture information, and alerts to be sent when these steps break down.

Successful programs already in place around the country that have demonstrated dramatic student health improvement when children and adolescents are trained and held accountable for managing their disease.   Take the recipe above, throw in some widely available electronics, and leadership, and life is good - literally.

And good for taxpayers. Children who do not learn to manage their disease grow into adults with impressively higher unemployment rates, [17] require much more taxpayer funded healthcare costs, and tend to raise children who look like themselves. Moving a child from being a victim of a chronic disease to a victor over it moves many of them from taxpayer dependency to contributing members of society. [18]

Research school based chronic disease management programs. You don't need to re-invent the wheel. Just like using your cookbook, success comes from selecting from tried and true recipes.

These programs can be imitated in your town - but your schools need your help getting started. Please call them.

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[1] http://www.schs.state.nc.us/schs/pdf/HealthProfile2011_WEB.pdf

[2] http://stateofobesity.org/states/

[3] http://www.forbes.com/sites/scottatlas/2013/01/09/obesity-the-new-just-say-no-for-2013/

[4]Joseph Konen and Joyce Page., The State of Diabetes in North Carolina, 375 (2011); National Diabetes

   Statistics, National Diabetes Information Clearinghouse (NDIC) (2011).

[5] Calculation based on total population of school kids in N.C. from http://legislative.ncpublicschools.gov/20110318-fastfacts.pdf and Asthma Factsheets (see footnote #5)

[6] http://www.asthma.ncdhhs.gov/docs/factsheets/ChildrenAndAsthmaInNorthCarolina.pdf

[7] http://www.medpagetoday.com/resource-center/anaphylaxis-advances/Food-Allergy-Trends-2014/v/47261?xid=nl_mpt_DHE_2014-09-18&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=ST&eun=g699450d0r&userid=699450&email=futuristfran%40aol.com&mu_id=5862084&utm_term=Daily

[8] http://www.medpagetoday.com/resource-center/anaphylaxis-advances/Food-Allergy-Trends-2014/v/47261?xid=nl_mpt_DHE_2014-09-18&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=ST&eun=g699450d0r&userid=699450&email=futuristfran%40aol.com&mu_id=5862084&utm_term=Daily

[9] http://clinical.diabetesjournals.org/content/24/2/71.full

[10] email communication from Dr. Lynn Moody, Rowan County School Superintendant 9/17/2014

[11] http://www.nationalguidelines.org/guideline.cfm?guideNum=4-03

[12] http://www.rss.k12.nc.us/index.php/Main/2nd_Page/about_sup

[13] http://www.cabarrushealth.org/documentcenter/view/227

[14] Ibid

[15] Ibid

[16] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136976/

[17] http://onlinelibrary.wiley.com/doi/10.1038/oby.2006.188/full

[18] http://cjp.sagepub.com/content/21/4/391.short