Children's Hospitals Today - Fall 2017 - 25

ASTHMA / FEATURE

hospital due to asthma. To shift these numbers, the goal was
to move upstream from the ED and meet the families where
they live, learn and play. Four areas of work began to emerge
at Children's Health.
Focus on high-risk asthma patients. Grant-funded activities helped the Children's Health team focus on a small
subset of the larger care management group. This group
involved 170 children who were considered at high risk for
asthma-related illness. The grant was used to mitigate environmental triggers for asthma discovered during individual
visits to patients' homes.
Expand care management. A care management team retrospectively reviewed cases of 3,614 patients who had a primary
or secondary diagnosis of asthma. In the six months prior to
becoming involved in the program, 516 children (14 percent)
had one or more visits to the ED. In the six months following
the care management encounter, 332 children had one or more
asthma-related visits, representing a 35 percent reduction in
overall unique patient visits.
Expand the primary care network. State-administered
federal health care reform incentives helped the hospital
grow its primary care network from six to 17 clinics covering underserved ZIP codes in the hospital's primary service
area. The team monitored the execution of best practices for
asthma, including action planning, severity assessment and
controller therapy. Additionally, physicians were incentivized to improve results. This work directly correlated with a
reduction in ED visits.
Engage the Health and Wellness Alliance for Children.
This group represents more than 70 community organizations
focused on measurably affecting health and wellness for children. With childhood asthma its first priority, the group serves
as a bridge between community and clinical partners, and
brings together several active but fragmented internal clinical
services at Children's Health. These clinical stakeholders are
now able to move alongside other local health care partners.

Community partnerships
Children's Health formed partnerships with community
groups, including joining efforts with Parkland Memorial
Hospital, the local adult safety-net hospital. The two organizations developed evidence-based clinical guidelines for asthma
and spread them across all the pediatric practitioners in Dallas.
Then the group turned its attention to working with the city of
Dallas to combat asthma-related environmental issues.
Knowing many asthma-related problems are caused by the
environment and where people live, combining forces with
the adult hospital helped Children's Health work with the city

to change housing code. "Children's health became a criterion
for the local housing inspectors to work with owners and
landlords to resolve those issues," says Peter Roberts, now
retired, who at the time this work got underway was executive vice president of population health and business development at Children's Health.
Nationally, the CDC estimates kids with asthma missed
13.8 million school days in 2013. To help keep kids in school,
Children's Health partnered with school nurses. The hospital
launched a telemedicine program in 60 schools and connected
those schools with the hospital's electronic medical record
system. With a parent or guardian's permission, the nurse can
access the child's medical record and asthma action plan.
Roberts says the strategy for improving care is not to look
for a single-point solution. "We address these problems in
communities by aligning ourselves collaboratively behind
a single problem," he says. And that alignment is getting results. From 2012 to 2015, the number of unique patients visiting Children's Health's EDs with a primary clinical diagnosis
of asthma decreased by 49 percent, while overall volume
remained relatively flat.

Into the home
While Children's Health in Dallas had success reducing asthma admissions by developing community partnerships, Le
Bonheur Children's Hospital in Memphis successfully brought
asthma education and programming into patients' homes.
When team members at Le Bonheur examined asthmarelated ED visits and hospitalizations in Shelby County, they
noticed the county had twice as many visits
Learn more about
and hospitalizations than other areas-31
hospitals' efforts
percent of all pediatric asthma visits in
to help patients
and families
Tennessee occurred in Shelby County. "We
manage asthma at
knew asthma was a big problem here because
childrenshospitals
.org/asthma.
we'd been in the trenches caring for these
children," says Christine Michaels, M.D. "But
we were surprised by how much bigger of a problem it was."
In Memphis, poor housing conditions with mold and mildew
combined with few community resources were negatively affecting kids with asthma.
The majority of the children who present with asthma exacerbations are admitted to Le Bonheur, so the hospital had a
large dataset to examine. The bottom line was patients were
spending time in the ED or in the hospital for sick care rather
than managing this chronic illness at home or school.
To reverse the trend, Le Bonheur set out to reduce ED visits, hospitalizations and observation days. "We also wanted
to improve the patient and family experience with the

CHILDREN'S HOSPITAL S TODAY Fall 2017

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