UCAN Community Asthma Program

Asthma is the #1 reason children have to stay in the hospital. Richmond has been named the #1 "most challenging place to live with asthma" 3 of the past 5 years. Children with asthma can have difficulty breathing leading to hospital stays, missed school, missed work for parents, and worry for parents who are watching for the next asthma attack.

How we are improving our community asthma program

The UCAN team is working hard to improve asthma education and care for children in Central Virginia. The doctors, nurses and social workers help families through...

• Excellent care: The team uses the best evidence to treat each child with the medications they need to stay healthy and out of the hospital
• Education: teaching families in the hospital and asthma clinic about their medications, avoiding triggers that can lead to asthma attacks, and sending "text tips" with important information about asthma
• Coordinating care: helping families with scheduling and transportation so that children can make it to their appointments
• Community outreach: helping connect families to community resources to keep their children healthy in their homes by identifying asthma triggers in the home and helping to remove the triggers.

Why it matters to our patients

Many children with asthma miss school and their parents miss work because of visits to the emergency room, hospital, and urgent care. All of those visits can be very expensive for families. Improving asthma care through UCAN means fewer hospital visits, fewer missed days of school and work, and fewer unexpected medical bills. Children are able to continue the activities they enjoy without worrying about an asthma attack.

How we measure

The charts below show the percentage of families who experience no missed days of school/work (higher is better) and the percentage of families who experience an excessive number of missed days of school/work (lower is better). Since the UCAN program began, fewer families miss school/work and they rarely miss many days.

Children with good control of asthma do not need to use a lot of albuterol or prednisone, two medicines used to treat asthma attacks. The charts below show the number of children who rarely need prescriptions for albuterol and prednisone (lower is better) and the percentage of children who need frequent prescriptions for albuterol and prednisone (higher is better).

Children with good control of asthma need only occasional unscheduled visits with their primary care physician and should rarely need to go to the emergency room or urgent care center, or be hospitalized. The charts below show the percentage of children who do not have unscheduled visits or hospitalizations (lower is better) and the percentage who have frequent unscheduled visits (lower is better).

More details

Background

• Asthma is the #1 reason for hospitalization in children.
• Poor chronic asthma control leads to limitations in activities for children, missed work for parents, and lost education days for students.  It can increase feelings of worry for parents who are watching for the next attack.
• Urban African American children have asthma morbidity and mortality  approximately twice that of whites
• Richmond has been named the #1 "most Challenging Place to Live with Asthma" for 3 out of the last 5 years.
• In 2015 the CHOR Foundation provided funding to implement a program to address outcome disparities for low income children with asthma who live in the Richmond, VA area.

Mission 

• Medical treatment
• Education to improve disease self-management
• Environmental factors and social determinants that undermine care

Target population

The program identifies candidate children and families through:

• Hospital admission
• Emergency department (ED) visit records
• Specialty and primary care provider referrals

The majority of these children are low-income African American and/or Latino, and show evidence of poor chronic asthma control.

Identification of needs

Challenges presented by our target population were found to include:

• Lack of understanding of asthma and its management
• Low expectations for asthma control
• Feelings of disenfranchisement from medical providers
• Complexities in dealing with the challenges of poverty

Our overall response focused on:            

• Engagement of families
• Frequent, regular follow-up (telephone and clinic)
• Asthma assessment of other family members 
• Provision of personalized and consistent medical treatment
• Education
• Social assessment
• Screening for mental health, food and housing needs, advocacy and legal assistance

Ongoing support and outreach, including:

• Weekly "texting tips"
• Assistance with scheduling and transportation
• Free environmental remediation tools (bedding dust covers, etc)
• Referral for home visits for environmental assessment and interventions

Outcomes

Comparisons of the 12 months prior to enrollment to the 12 months post-enrollment, 2016-2018:

1. Patient reported outcomes.

These figures compare the percentage of parents reporting no events (higher is better) and the percentage reporting an excessive number of events (lower is better)

Children missing school and parents missing work increases the burden that families carry when asthma is uncontrolled.  We ask parents and caregivers at each visit about missed school days and missed work days due to their child's asthma.

 

Children with good control of asthma don't need to use a lot of albuterol, the primary "rescue" medicine that helps relieve chest tightness associated with asthma attacks, and they rarely need to receive a prescription for prednisone, a steroid that that is given when asthma attacks are severe.

 

Children with good control of asthma need only occasional unscheduled visits with their primary care physician and should rarely need to go to the emergency room or urgent care center, or be hospitalized.

 

2. Hospital System outcomes

We looked at the number of Emergency Room visits, Observation Stays (24 hours or less), and Hospitalizations at the Children's Hospital of Richmond during 12 months before and the 12 months  after enrollment into UCAN.  The "Index" visit was the visit that prompted enrollment into UCAN – since counting that visit might magnify the effect of our program, we looked at the pre-enrollment numbers counting or not-counting the index visit. 

 

Since patients might go to another hospital for care, we checked with Virginia Premier, a Medicaid HMO provider that is associated with the VCU Health System, but would pay for and therefore know about their members that use other hospitals besides CHOR.  When they looked at their data, including the other hospitals, they found very similar results to what we found just limited to CHOR.

Future plans

We hope to expand our program to reach children with poorly controlled asthma who are currently receiving care from other hospitals and Emergency Rooms in Central Virginia.

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We're here to help with any quality-related questions. Please contact:

Kara Heird, MPH, RNC-OB
Interim Quality Manager, Performance Improvement Coordinator
Kara.Heird@vcuhealth.org