Asthma is the most prevalent chronic disease in childhood. Healthcare disparities for minorities and low socioeconomic households are well documented. At Children’s Healthcare of Atlanta’s Asthma Center of Excellence, our patient population is 97% Medicaid, which means our patients are at greater risk for poor outcomes because of persistent trigger exposure, substandard housing and lack of understanding of asthma management. Because of this, patient engagement is an essential part of everything we do. Innovation, Collaboration, and Inspiration are areas in which we excel. Our high risk asthma program, community outreach, and asthma star board are excellent examples of how we engage our patients.
Asthma is the most prevalent chronic disease in childhood. Healthcare disparities for minorities and low socioeconomic households are well documented. At Children’s Healthcare of Atlanta’s Asthma Center of Excellence, our patient population is 97% Medicaid, which means our patients are at greater risk for poor outcomes because of persistent trigger exposure, substandard housing and lack of understanding of asthma management. Because of this, patient engagement is an essential part of everything we do. Innovation, Collaboration, and Inspiration are areas in which we excel.
Our high risk asthma program is an innovative program that gives the extra support and education that enrolled patients need to successfully manage their asthma. These patients meet specific criteria based on NIH guidelines, i.e. previous ICU admission for asthma, three or more emergency room visits in the past year for asthma. Starting at the time of enrollment, patients and caregivers are asked to define their goals; what do they want to be able to do that is harder due to asthma. A simple, concrete agreement, which includes their goals and the expectations of both the family and the Asthma Center, is reviewed and signed by the patient, caregiver, and staff member. We then work together to reach their goals through providing comprehensive, individualized education, medical care, including trigger assessment, and monthly phone calls. We also collaborate to create an asthma action plan and emphasize the need to contact us whenever they incur barriers. We also work with their primary care physician, pharmacy, and school to ensure all caregivers know the plan. Our goal is to help these patients and families learn to manage their asthma over the long term, instead of just crisis to crisis.
Our outreach program is comprehensive and far reaching. We offer an Asthma Care and Education, a conference for medical professionals to learn more about caring for asthmatic patients, twice a year in person, in addition to once a year by telehealth. We created a new Asthma Action Plan for community physicians that is easy to read and access online, along with a tip sheet so that physicians and their staff gain a better understanding of how to teach patients and families about their asthma action plan. We reach out to metro-Atlanta schools and child care centers for asthma education, assistance with supplies like nebulizers and spacers, and educational resources. As part of an Atlanta-based asthma project, we provided asthma education to primary care offices about the NIH guidelines for asthma care and management, asthma action plans, and asthma control tests. We also held an Asthma Care and Education conference specifically for the medical professionals working in the primary care offices of both the Atlanta project and the Georgia state asthma project. Our education reaches beyond metro-Atlanta through webinars. We believe that asthma is best managed not only on an individual basis, but when a community engages in a child’s care. Collaborating and educating community physicians, schools, child care centers, and other professionals is a hallmark of the Asthma Center’s mission.
The challenges to managing chronic illness are many. Inspiring our patients to engage in specific positive behaviors can help them better manage their asthma. One of our newest programs is the “Be an Asthma Star” board. Quarterly, a patient that best exemplifies an asthma star is chosen to be featured on our board, with their picture and a short story about their journey towards asthma control and advice for other patients. Included on the board are simple, concrete things you can do to be an asthma star i.e., take your controller medicine every day, recognize your early warning signs.
As of January 2014, the Asthma Center had 38 patients enrolled in the high risk program. One hundred percent of our high risk patients are contacted by phone each month. The Asthma Control Test (ACT) is administered both during that call and at appointments. ACT scores have increased by 15%, an indication that their asthma is better controlled. Although the program has not been in existence for long enough for extensive data analysis, we are tracking ED and inpatient admissions, ACT scores, missed school days, perceived barriers to control, and referrals to other services. One hundred percent of our high risk patients are contacted by phone each month. Anecdotal evidence implies that patients and families are benefitting from the increased support by missing less appointments and increased calls to us when they have concerns. Parents are also providing feedback that they are enjoying being a part of the high risk program.
From April 2013-January 2014, the Asthma Center provided asthma education to 1,071 Children’s employees, school nurses, school staff members, PCP office staff, providers, and after school program staff at 44 different in person and web-based sessions. One hundred percent of participants indicated on the evaluation that they feel better prepared to work with children with asthma (73% strongly agree, while 27% agree). For the Asthma Care and Education conferences, there was an 8% increase in knowledge based on pre- and post-tests. Our outreach efforts are always well received and appreciated.
Reaction to our asthma star board has been overwhelmingly positive. Patients of all ages are asking about it and reading the patient story and descriptions of how to be an asthma star. Although it is difficult to quantify its effects, many patients report wanting to be an asthma star and exhibiting more positive behaviors since the board was started in our center.