school district. School-based grantees also brought about a number of practice changes regarding asthma education and training, mostly involving regularly scheduled annual asthma training for clinic staff, school staff, athletic coaches, and school bus drivers.
Many of the changes enacted by the hospitalbased grantees were practice changes involving asthma education and/or training. Examples of these practice changes include:
1. Training of school nurses by hospital-based asthma educator regarding the use of peak flow meters and assessment of asthma severity—while not included in formal job responsibilities, it is an ongoing practice.
2. Hospital-based asthma educator is provided regular time by school administration to implement asthma education with youth at high risk of having poorly controlled asthma.
3. Hospital-based asthma educator provides annual asthma education to school staff, with active support of school administration. Grantees, in addition to reporting actual changes, reported ways in which changes helped enable sustainability of their efforts. Common themes which emerged across policy and practice changes reported by grantees included:
1. Improving awareness, knowledge, and skills related to asthma.
2. Continuation of high level of care for students with asthma.
3. Building capacity within the schools to better manage asthma.
4. Improving communication with caregivers and health care providers.
5. Increasing standardization of care for children with asthma, especially surrounding EPR-3 guidelines.