Asthma Medical Home at Boston Children’s Hospital Wins Innovation Challenge

Childhood asthma, if not properly managed, can cause dangerous symptoms, leading to not only missed days from school, but also to expensive emergency department visits and hospitalizations.

Childhood asthma, if not properly managed, can cause dangerous symptoms, leading to not only missed days from school, but also to expensive emergency department visits and hospitalizations.

A comprehensive, multi-disciplinary pediatric asthma medical home at the Children’s Hospital Primary Care Center (CHPCC) at Boston Children’s Hospital is helping to fight needless trips to the emergency room for kids and their families by providing resources and skills for asthma cases.

The CHPCC is a large, hospital-based urban care center, providing medical care to over 2,000 patients with asthma. Many of the patients come from underserved neighborhoods, with various added social stressors. As a result, many patients have high rates of emergency department visits and in-patient hospitalization.

After observing children hospitalized for conditions that grew serious due to lack of resources for treatment, the asthma team at CHPCC developed a program that would help both the children and their families.

“We recognized the need for an innovative system within primary care to address the needs or our patients and their families, to improve quality of life and improve health quality outcomes,” said Faye Holder-Niles, MD, Program Director of the CHPCC Asthma Medical Home.

The CHPCC Asthma Care Center is lowering overall care costs and is one of three winners of the AAMC’s 2012 Readiness for Reform Innovation Challenge. The winning entry was submitted by Holder-Niles and Linda Haynes, MS, PNP-BC, AE-C, and several associate authors.

From left: Winning submission authors  Linda Haynes, MS, PNP-BC, AE-C and Faye Holder-Niles, MD, MPH with AAMC Chief Health Care Officer Joanne Conroy, MD.

In the case submission, they wrote:

“We are committed to providing increased access, high-quality, cost-effective and culturally appropriate health care. Thirteen staff attending, three nurse practitioners, and seventy resident trainees provide care to over 2,000 patients with asthma. The major objective of our program is to provide comprehensive asthma care, reduce health disparities and improve health outcomes for this vulnerable patient population.”

The winning submission lists the objectives in full, which are centered on patient wellness outcomes:

• Develop an innovative and sustainable QI model for asthma care within primary care
• Provide easily accessible, cost-effective, high-quality care for all patients with asthma
• Utilize evidence-based guidelines to improve the standard and practice of asthma care across all providers and trainees
• Utilize information technology and an asthma patient registry to improve disease-specific population management
• Improve the quality of life and health outcomes for asthma patients.

Prior to starting the program, the team reviewed barriers to care and medication adherence. From there, they developed a plan to partner with patient families to increase compliance with medications, understanding of the disease process, and agreement on how to pursue treatment.

The result is a multi-lateral, patient-centered approach to asthma care that incorporates not just physicians and clinical care, but elements of psycho-social wellness as well. The care team includes an asthma physician, an asthma nurse practitioner, and certified asthma educators within the clinic, as well as onsite social workers to meet with patient families.

CHPCC networks with community agencies, helping families reach out to other programs in the city and spreading awareness of how to properly treat pediatric asthma in the school systems.  Clinic staff have created educational materials [J1] and multimedia resources that are available to the public through the CHPCC website, such as YouTube videos that provide instructions on how to use devices such as nebulizers.

Both Holder-Niles and Haynes agree that, while the CHPCC Asthma Medical Home is successful in delivering top-quality care to patients and providing vital education, certain challenges remain.

“There are often multiple competing factors, particularly in teaching institutions,  like many urgently sick patients, multiple providers, and new resident trainees,” said Holder-Niles. “But our primary care team has been integral in making our program successful and breaking down challenges and barriers. Our team-based initiative has been a great asset.”

Such family-centered elements as the CHPCC Asthma Medical Home smoking cessation program have led to a variety of patient success stories.

“It is wonderful to have parents or guardians return and say, ‘This is the first time in my life that I have quit smoking and been three months smoke-free!’,” said Holder-Niles. “It’s wonderful to see and hear that, and to hear the excitement and the enthusiasm of the parents because they are so invested in their child’s health.”

To learn more about the CHPCC Asthma Medical Home and view the other submissions from the 2012 Innovation Challenge, please visit the AAMC iCollaborative.