UnityPoint Health, Des Moines, IA
Improving Pediatric Asthma Management by Using Care Coordination to Reduce ED Visits

Background: The control of asthmatic symptoms in pediatric patients is an important medical concern. Without optimized medical care, children are at risk for repeated exacerbations and unnecessary medical encounters. Recurrent ED visits for asthma-related symptoms in pediatric patients may be minimized with better outpatient management. Our goal was to decrease the number of ED encounters for pediatric patients with asthma symptoms by improving care coordination with increased follow-up office visits, decreased time to follow-ups, and more comprehensive assessments/management.

Methods: We reviewed 765 (n = 553 unique patients) ED encounters from the historic and prospective time periods, with 148 (136 unique patients) and 176 (130 unique patients), respectively, eligible. For the prospective group, an ED manager contacted the patients/guardians after the encounter and encouraged them to have a follow-up outpatient clinic visit within 7 days. At the clinic visit, the patient was evaluated using questionnaires that assessed barriers and goals. Subsequent clinic telephone contacts were made to the patient as needed. If suspected eligible, the patient was referred to a community partner for home assessment. A multidisciplinary team including an ED physician, ED care manager, pediatric and family medicine residents, pediatric and family medicine clinical care coordinators, and medical education department staff was assembled, and hospital and community resources were used to conduct follow-up and analyze the data.

Results: The prospective period patients had a 4 (RR: 95% CI 2.1, 7.5) times greater rate of at least an additional ED encounter than historic period patients, rates being 9% (95% CI 5%, 16%) vs 35% (95% CI 27%, 47%). Follow-up visit rates were 59% vs 66% for the historic and prospective periods, respectively. Of referrals made to the community health partner, 59% were from the study’s health system, which represented more than all other community hospitals combined. Of referred patient families, 59% received some type of service, including asthma education, home supplies, and home repairs.

Conclusion: Management of asthma symptoms in pediatric patients is a dynamic problem with many contributing factors. The present study focused on creating a greater collaborative relationship between pediatric ED, primary care clinics, and community partners. Results were encouraging although it was difficult to control for possible data dependencies for patient observations within and between study periods, and it was also difficult to attribute outcomes to interventions in a nonrandomized study, although many future opportunities were revealed.