Disparities in asthma morbidity among underrepresented minorities and low socioeconomic households are well documented. The patient population for Children’s Healthcare of Atlanta’s Asthma Center of Excellence is 97% Medicaid and primarily urban, which places them at even greater risk for poor outcomes due to persistent trigger exposure, substandard housing and social stressors. We aim to maximize education, address barriers to self-management and build self-efficacy through consistent patient engagement and building relationships with families. Regular community outreach programming and education, our High-Risk Asthma Program, “Asthma Star” Board and Asthma Control Calendar are all excellent examples of how we engage our patients where they live, learn and play.
Nomination Narrative
Our goals are to educate and empower families and communities to improve asthma control. Our approach to managing chronic asthma was new to the Children’s Healthcare system and the first outpatient program to emphasize a need for active and consistent community outreach, involvement of all team members in patient support and education, and dedicated effort to initiate contact with patients outside of the traditional office visit.
Our High-Risk Asthma program is an innovative program that closely monitors patients with severe asthma. This is a team-based model that encourages all health professionals within the clinic (MA, RT, RN, LPN, PNP, MD) to provide educational opportunities, consistent messaging and support.
Patient and families identify a personal goal: what they want to be able to do that is harder due to asthma. An 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 by providing comprehensive, individualized education, medical care, trigger assessment and management, and monthly phone calls for support, reinforcement and health navigation.
As a team of providers and patients, we collaborate to create an asthma action plan and emphasize the need for close contact whenever they incur barriers. We provide frequent and bi-directional contact opportunities with their primary care physician, pharmacy, and school. Our goal is to help patients and families build self-efficacy for managing 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 three times during the year. Although anyone in the community is welcome, we target school nurses, respiratory therapists, medical providers, and coaches/trainers. 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 with asthma education, supplies (like nebulizers and spacers), and educational resources.
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. Recently we started an Asthma Champions program where healthcare professionals from within our organization are trained to attend and educate the public at health fairs and events. This not only increases opportunities to reach the public, but also engages our own staff in teaching the community about asthma. Collaborating and educating with the community, physicians, schools, child care centers, and other professionals is a hallmark of the Asthma Center’s mission. Inspiring our patients to engage in specific positive behaviors can help them better manage their asthma.
Our “Be an Asthma Star” board highlights a patient per quarter to model exemplary effort; it also provides positive feedback and visible rewards for achieving healthcare goals. The chosen patient is featured with their picture and a short story about their journey towards asthma control and advice for other patients.
Our new 2015 Asthma Calendar is given to each new patient and provides fun and engaging opportunities to learn about asthma. Each day on the calendar has places to indicate they took their medicine or indicate symptoms were present. Each month has different learning activities, sticker games or ways to engage us via social media (i.e., take a “flu shot selfie” and post to instagram with #choaflushotselfie).
Results
As of February 2015, the Asthma Center has 83 patients enrolled in the high risk program. For our patients who have completed a full year we have decreased emergency room visits by 46% and decreased hospitalizations by 59%. 100% of our high risk patients are contacted by phone each month to review symptoms and answer questions. Anecdotal evidence supports that patients and families are benefiting 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 missing significantly less amount of school and work
In 2014, the Asthma Center provided asthma education to 1,934 employees, school nurses and staff members, PCP offices, and after- school programs at 47 different sessions. 100% of participants indicated on the evaluation that they feel better prepared to work with children with asthma and 100% indicated they would recommend this program to other healthcare providers. Our outreach efforts are always well received and appreciated. Since beginning in July 2014, our Asthma Champion program has trained 23 employees and provided resources and information to approximately 915 people in six different health fair events.
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. Interaction to our calendar has also been very positive. Even as they wait for their appointment, the children and their parents begin working on the tasks and interacting together with the calendar. Although it is difficult to quantify its effects, many parents report that the Asthma Star Board and calendar help their children to learn about their asthma, engage in the process of asthma management and become hopeful that they can gain control of this disease.
