It's a concept children's hospitals are increasingly embracing as they address population health and social determinants of health: Meet people where they are.
Children's Hospital of Los Angeles (CHLA) is applying that approach to pediatric clinics in its health network to achieve dramatic improvements in asthma care by implementing an Asthma Action Plan.
"We understand it is a lot of work for clinic staff-they see a lot of patients during the day, and they have a lot going on," says Bhavana Arora, M.D., chief medical officer, CHLA Health System and the CHLA Health Network. "So, we're meeting them where they are and working with them so they can put it (the Asthma Action Plan) in place in a way that doesn't create additional workload."
Education, delegation vital to program success
The hospital rolled out the Asthma Action Plan to a handful of practices in its CHLA Health Network in 2018 and saw improvements in how patients controlled their asthma. The Asthma Action Plan has now expanded to nine practices with 33 pediatricians, and CHLA continues to see vastly improved metrics:
- Baseline testing in fiscal year 2019 found 38% of patients with their asthma well-controlled; in follow-up visits, 77% of patients had well-controlled asthma.
- Further analysis also showed more than half the patients achieved clinically significant improvements between their initial and follow-up visits.
Arora says the key to making those improvements is education. Parents and patients often don't fully understand asthma and how to properly administer the medications needed to keep it under control. Pediatricians may not have the resources-time being chief among them-to adequately educate families about asthma, according to Arora. Therefore, the Asthma Action Plan is designed to simplify family education across the CHLA network.
The educational materials are colorful and easy-to-read-and they come in English and Spanish versions. To address time scarcity for pediatricians, CHLA works with its network practices to understand their workflows and identify-as well as train-staff members to take the lead on the Asthma Action Plan.
"Pediatricians don't have to administer the asthma control tests and education, but they have to get comfortable training their staff to do some of that," Arora says. "It's about integrating within current workflows and understanding they need to give some of those tasks to their staff-and they will be done effectively."
Empowering patients and their families to control asthma
Arora says this collaborative, education-centric approach has also proven successful for CHLA's behavioral health and weight management programs. She adds family involvement is crucial to success-and it will be pivotal as the health network focuses more on behavioral health concerns in the wake of COVID-19.
"We think it's very important to be as clear as possible with families and explain the condition, what can help and what they can do about it with some concrete next steps,"Arora says. "Clearly, we're not in the home, so it's important we tell them what to do once they leave the office."