Reduced Asthma Visits
Category: Clinical Care Project, Primary Care Award
Nationwide Children's Hospital in Columbus, Ohio, wanted to reduce the number of asthma visits—a leading cause of pediatric emergency department (ED) visits—to improve overall patient health and reduce hospital spend. "We prioritized this project because of the effect it could have on our large patient population," says Dane Snyder, M.D., section chief of ambulatory pediatrics. "Poor asthma control is associated with an increase in missed school days and impaired academic performance."
The hospital's project followed several quality improvement (QI) steps, including changes in assessment and documentation, improving patient and family education, and providing high-risk patients with extended-length appointments. Snyder credits the success of the project to hospital leaders who provided support and resources, particularly the amount of dedicated time from physicians to work on the project.
Snyder says the biggest shift during the project was in the patient culture and how families responded to asthma symptoms. "Families started to think about their child's asthma in a preventable way, instead of simply reacting when their child was sick," he says. Parents were included in the treatment and prevention process through education, using take-home action plans for post-hospital care.
Easy-to-implement Process Changes
Nationwide Children's took an approach other hospitals can adopt. "These methods could easily be followed at other institutions, but they would take persistence," Snyder says. This step-wise approach could also be used for other pediatric conditions.
Identify asthma patients. Asthma alerts were added to the EMR in addition to developing an asthma patient registry. All asthma patients were screened using asthma control tests (ACT) and examined further. Providers were alerted to asthma patients quicker, leading to more ACTs and higher quality of care.
Outline a model patient visit. By developing an ideal asthma encounter, the team had goals to work toward, including providing step-up therapy for poorly controlled patients; monitoring pharmacy claims data and ensuring patients had influenza vaccinations.
Reinforce patient-centered care from home. Two asthma health coaches were added to the Nationwide Children's team in 2013, and they proactively contacted high-risk patients at home. Eventually, they became a team of eight who provided care teams with daily reports on asthma patient ED visits, hospital discharges and appointment no-shows.
Improve patient education. Health coaches and asthma specialty clinics bridged care between the hospital and home. Additionally, providers developed care action plans for patients to take home. The plans used the traditional green, yellow and red zones, with the addition of an orange zone to indicate when the patient's family should call the clinic and avoid a visit to the ED.
- $5.2 million in asthma ED costs avoided
- 24% drop in asthma-related ED visits