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Patient identification, coordinator implementation improve childhood asthma care regardless of setting

An analysis of four research sites coordinating care for children with asthma showed that the unique solutions for identifying participants in the program, as well as how the sites implemented asthma care coordinators into the clinical pathway, influenced the successful implementation of the program regardless of setting.

“While at a high level, care coordination across these settings could be described as somewhat similar, factors such as the ability to use data sources, leverage infrastructure, readily communicate with health care providers and integrate new components of care into practice played a key role in instituting improvements in coordinated care,” R. Patrick Kelly, MPH, of the University of Michigan Center for Managing Chronic Disease in Ann Arbor, Michigan, and colleagues wrote.

The researchers used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to identify the strengths and challenges of implementing specific care coordination programs in four different research sites — a school district, a health system, a clinical-based program and a community-based program. The sites were the Los Angeles Unified School District Asthma Program, Children’s Hospital of Philadelphia Asthma Care Navigator Program, La Red de Asma Infantil de Puerto Rico and the Addressing Asthma in Englewood Project.

Care coordination activities were similar among the sites, researchers wrote. The activities included asthma education, a home assessment and follow-up visits, with flexibility in the care pathway for patients with additional needs. Care coordination was influenced by the identification of participants and integration of asthma care coordinators (ACCs).

Each site used a unique solution to implement its care coordinator program.

Participants were identified at the Los Angeles site by connecting ACCs with school nurses to identify children with poor asthma control. At the Philadelphia site, the health system’s electronic medical records were used to identify serious cases of asthma in children. San Juan’s clinic site used outreach and recruitment to screen patients and identify potential program participants, whereas the Addressing Asthma in Englewood Project site — located in Chicago — recruited potential participants from community events and clinics.

The integration and acceptance of ACCs within a clinical care team was a key component to successful implementation, according to the researchers.

Communication through the student electronic health record helped integrate ACCs at the Los Angeles site, whereas being in the same institution at the Philadelphia site helped ACCs to better coordinate with health care providers. ACCs in San Juan held patient education seminars and worked with health care staff to coordinate communication between the clinicians and the family, and the Chicago program implemented a series of in-person, home-based and phone-based education initiatives.

“The analysis also uncovered the importance of the lead implementing unit’s organizational relationships to partners providing access to participants and clinical care,” researchers wrote. “Regardless of setting, successful program implementation requires considerable resources, time, and buy-in from key stakeholders.” – by Jeff Craven

Disclosure: This study was funded by the Merck Childhood Asthma Network.