It takes a village: Improving Pediatric Asthma Care through Local, Community and Nation-wide Efforts

From the 2019 HVPAA National Conference

Dr. Melissa Grageda (Richmond University Medical Center), Dr. Melissa Guillermo (Richmond University Medical Center), Dr. Fabiola Paul (Richmond University Medical Center), Dr. Ana Mendez (Richmond University Medical Center), Dr. Ginny Mantello (Office of the Staten Island Borough President), Ms. Kim Wagner (Richmond University Medical Center), Ms. Nancy Taranto (Richmond University Medical Center), Dr. Brian McMahon (Richmond University Medical Center)

Background

Asthma affects 10% of children in the US, with an estimated cost of treatment of more than $3 billion per year.

Clinical Implications and Objective

Over the last four years, our academic community hospital has actively advocated and collaborated with local, community and national leaders to improve the quality of life of children with asthma by reducing emergency department(ED) visits, hospitalizations, and absences from school, thereby also effectively reducing the associated health care burden.

Methods

During the first year, the focus was standardizing asthma care and education of hospitalized patients, and ensuring seamless transition of care with timely follow up and appropriate health home visits. Outcomes of resident-led quality improvement projects were presented at hospital board meetings, local patient safety conferences, and a national academic conference.

During the second year, pediatric leaders from our patient-centered medical home (PCMH) worked alongside community partners and local government to establish the local asthma coalition, while maintaining internal QI measures (Table1). Community outreach efforts included asthma education at schools and community centers by resident physicians and child health care coordinators. For patients frequently seen in the emergency department but not cared for in our PCMH, next-day phone calls by a care coordinator ensured follow-up with their pediatrician or pulmonologist. The care coordinator re-emphasized the importance of action plans, medication administration forms and influenza vaccination. Finally, monthly coalition meetings provided the opportunity to continually engage all partners, while aligning improvement efforts.

During the third year, the hospital became an accredited pediatric asthma center. The hospital joined a national QI collaborative led by the American Academy of Pediatrics VIP Network to standardize the care of asthma patients in the emergency department and inpatient pediatric unit using clinical pathways (Pathways to Improve Pediatric Asthma). The interdisciplinary team of leaders involved in this project included physicians, the respiratory director, nurses and quality improvement directors.

The fourth year encompassed the entire action period for the national collaborative. Process and balancing measures were collected monthly, and PDSA meetings held to discuss local and nation-wide results. The next phase of the national collaborative will assess sustainability of inpatient outcomes.

Preliminary Results

Community outreach efforts are positively received by schools and community centers. The percentage of asthma patients from our patient centered medical home seen in the ED remains below ten percent (Table 1). Peak flow measurement and home plan discussion rates are improving (Figure 1). There was a decrease in transfers to a higher level of care, 7-day return to ED/inpatient unit, 30-day return to ED/inpatient unit and 120-day return (Table 2 & Figure 1).

Conclusion

Working with community and national key stakeholders to address the medical and social determinants of asthma health care inequity amplifies the care initiated in health care settings

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