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:
Our overall response focused on:
- 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
- Engagement of families
- Frequent, regular follow-up (telephone and clinic)
- Asthma assessment of other family members
- Provision of personalized and consistent medical treatment
- 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
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.
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.
We're here to help with any quality-related questions. Please contact:
Michelande Ridoré, MS