Children's Hospitals Today - Fall 2017 - 26

FEATURE / ASTHMA

medical system," says Susan Stamberg, social worker at Le
Bonheur. "Many of our patients are not accustomed to being
active in their own health care. They're used to being told
what to do. They're treated acutely, and not involved as partners in care and educated in the tenants of self-management
of their disease."
The hospital launched Changing High Risk Asthma in
Memphis through Partnerships (CHAMP) in 2012, a program funded by the U.S. Department of Health and Human
Services, Centers
for Medicare and
Medicaid Services,
to improve the
health of children with highrisk asthma by
improving
selfmanagement, reducing unplanned
medical encounters and reducing
health care costs.
With 587 children
currently enrolled, CHAMP was designed to affect as many
areas of the community as possible. "We wanted to take down
the walls of the clinic and build connections in the community and in the patients' and families' homes," Stamberg says.
CHAMP serves asthma patients ages 2 to 18 who are Memphis
residents and TennCare recipients (Tennessee's Medicaid
Program). A majority of the children participating in CHAMP
live in single-parent households where resources fall below
the poverty line. Seventy percent of CHAMP patients live in
rental properties with mold, mildew or cockroaches, which
exacerbate asthma episodes. And many of these families move
frequently or spend time in more than one residence over the
course of a week or a month.

We wanted to take
down the walls of
the clinic and build
connections in the
community.

How it works
Providers in the hospital consult with the CHAMP team
for children who are admitted to the intensive care unit.
CHAMP also has a 24/7 call line staffed by two Le Bonheur
EMTs. They evaluate the severity of asthma and can give advice about whether the patient needs to visit the ED or begin
treatment at home. If needed, the EMTs can contact one of
the doctors on call.
To help manage the population, the CHAMP team receives monthly downloads of TennCare encounters and
claims data on all CHAMP-enrolled patients. "For asthma
management, you can't follow the guidelines appropriately
if physicians don't know how often a patient is going to the

CHILDREN'S HOSPITAL S TODAY Fall 2017

ED or filling albuterol," Stamberg says. This data becomes
a powerful tool for individual case management and for
tracking outcomes, including costs.
CHAMP also has a group of community health workers and
educators who enroll and engage families in their homes. To
capitalize on their ability to connect with patients and families,
they can track medication refills and make referrals as needed.
"We can be that hub for other community-based efforts that
support these families," Stamberg says. "And even though we
can't solve the problem, we can often provide information that
will help the family access resources they need."
This team conducts home visits that include asthma education and environmental assessments using an Environmental
Protection Agency tool, which is embedded in the CHAMP
registry. After completing the assessment, the team provides
families with basic cleaning supplies in buckets.

Helping with housing and schools
The CHAMP team plays a role in helping patient families
communicate with their landlords. "Families struggle to communicate with the landlord, or they're scared to talk to him
or her," Stamberg says. CHAMP gives families tips on how
they can make a service request. "Sometimes, we help a family get important improvements made to their residence just
by supplying a letter on Le Bonheur letterhead that says, 'You
have a high-risk asthma patient living here, we see mold, and
we would appreciate your help in addressing a water leak,'"
Stamberg says. "First, we help families ask for help. Then
we go with the letter." For complicated legal situations, Le
Bonheur's medical-legal partnership can step in.
Like Children's Health, Le Bonheur established relationships with schools. The CHAMP team ensures every school
or child care center where a CHAMP patient is enrolled has
access to information and medication. "They know what to do
if one of our children is wheezing," Stamberg says. "And our
parents tell us that's one of the things they like about the program. They feel like the schools and child care providers hear
them when we speak on their behalf."
CHAMP started with a goal to reduce ED visits by 15 percent. Today, the program has helped reduce ED visits by about
36 percent and has reduced the number of patients who return to the hospital within 30 days of a previous admission
to zero. The hospital also had a 50 percent reduction in actual
cost of care per child per year.
By taking information and education directly to families
and building partnerships with community organizations,
children's hospitals are making strides in reducing asthma
admissions and helping kids breath easier.
Send questions or comments to magazine@childrenshospitals.org.

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