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Community-based pediatric asthma management program reduces ED admissions, hospitalizations

ATLANTA — An asthma management program consisting of an asthma registry, community-based education in homes and schools and collaboration with community partners significantly reduced ED visits and hospitalizations among children with high-risk asthma, according to data presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

Pediatric asthma affects approximately 13.5% of children in the Memphis, Tennesse area, and comprises nearly 40% of the admissions into Le Bonheur Children’s Hospital. In 2010, pediatric asthma hospitalizations reportedly cost the Tennessee Medicaid system $2.1 million in avoidable hospitalizations, as well as an additional $2.6 million for ED visits.

In an effort to curtail hospitalizations and the use of ED for asthma exacerbations, Le Bonheur Children’s Hospital created the Changing High Risk Asthma in Memphis through Partnership (CHAMP) program to treat children at risk for severe asthma exacerbations that would lead to unplanned medical encounters.

Christie F. Michael

“Through CHAMP, we have identified process and system changes that improve the care of children with high-risk asthma,” Christie F. Michael, MD, from the Le Bonheur Children’s Hospital, told Infectious Diseases in Children. “By having a strong community team that is closely connected to our dedicated medical team, we effectively take down the walls of the clinic so there is a true partnership amongst providers, patients and families, school nurses and payors.”

The researchers enrolled 479 children on government insurance with poorly controlled asthma into the CHAMP program, which brought support services into patients’ homes and school settings using a community-based care coordination team; this team was able to deliver more accessible care when needed to patients who did not regularly have access to a provider. Following treatment, insurance claims data were stored in a high-risk asthma registry that also enhanced data sharing to all points of care.

In addition to these services, CHAMP also set up a 24–hour asthma call line in case patients became ill or needed care after the allotted hours.

“An asthma registry houses insurance claims data and team activity and enhances guideline-based care and case management,” Michael said. “In addition, patients have 24-hour access to advice and prescriptions for asthma while community navigators provide education and medication reconciliation in the home.”

The researchers measured the outcomes of inquiries to the call line as well as drops in ED and hospitalization visits, analyzing data to compare each patient one year before and one year after enrollment into the program.

According to study findings, there was a 55% decrease in ED visits when pre- and post-enrollment data were compared; likewise, hospitalizations had also significantly decreased, with 68% less admissions. Additionally, the researchers found that the majority of respiratory problems presented to the 24-hour asthma call line (72%) were able to be resolved without hospitalization.

“Critical gaps in the current health care system that we have addressed include fragmented care with poor information sharing, the reality of access to medical care and the importance of having the means to address the conditions in which people live,” Michael said. “As we identify more successful innovations in healthcare delivery, innovations in reimbursement will be necessary for sustainability.”– by Katherine Bortz

Reference:

Michael CF, et al. Abstract 265. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; March 3-6, 2017; Atlanta.