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Reducing emergency department visits utilizing a primary care asthma specialty clinic in a high-risk patient
Dane A Snyder1,2, Olivia W Thomas1,2, Sean P Gleeson1,2
1a Section of Ambulatory Pediatrics, Nationwide Children's Hospital , Columbus , OH , USA.
Insights
An innovative Asthma Specialty Clinic in primary care significantly reduced pediatric emergency visits for asthma. This model improved asthma care quality, including increased spirometry use and controller medication adherence.
Area of Science:
- Pediatric Pulmonology
- Primary Care Medicine
- Healthcare Management
Background:
- Asthma is a major cause of pediatric emergency department (ED) visits.
- Nationwide Children's Hospital (NCH) aimed to optimize asthma outcomes within its network.
- A predominantly Medicaid-serving primary care network sought to reduce asthma-related ED utilization.
Purpose of the Study:
- To evaluate if an Asthma Specialty Clinic (ASC) within a primary care office could decrease ED asthma visits.
- To assess the ASC's impact on asthma quality measures compared to standard care.
- To determine the sustainability of improved asthma management in a primary care setting.
Main Methods:
- A pilot Asthma Specialty Clinic (ASC) incorporated patient monitoring, provider continuity, standardized assessments, and multidisciplinary education.
- A registry facilitated patient follow-up, and extended visits included pediatrician evaluation and team-based education.
- Key metrics compared were ED asthma visit rates, spirometry utilization, and controller medication fills before and after ASC implementation.
Main Results:
- Asthma ED visits were similar at baseline but significantly lower in the ASC group post-intervention (p < 0.001).
- The intervention group saw sustained declines in ED visits (25-32%) while the usual care group experienced increases.
- Spirometry completion, controller fills, and favorable Asthma Medication Ratios significantly improved for ASC patients.
Conclusions:
- A primary care-based Asthma Specialty Clinic effectively reduced emergency department utilization for asthma.
- This comprehensive, multidisciplinary model demonstrated sustainable improvements in asthma management within a medical home setting.
- The study highlights a novel approach to managing high-risk pediatric asthma populations, improving key quality indicators.
Objective:
Asthma is a leading cause of pediatric emergency department (ED) use. Optimizing asthma outcomes is a goal of Nationwide Children's Hospital (NCH) and its affiliated Accountable Care Organization. NCH's Primary Care Network, comprised of 12 offices serving a predominantly Medicaid population, sought to determine whether an Asthma Specialty Clinic (ASC) operated within a single primary care office could reduce ED asthma rates and improve quality measures, relative to all other network offices.
Methods:
An ASC was piloted with four components: patient monitoring, provider continuity, standardized assessment, and multi-disciplinary education. A registry was established to contact patients at recommended intervals. At extended-length visits, a general pediatrician evaluated patients and a multi-disciplinary team provided education. Novel educational tools were utilized, guideline-based templates recorded and spirometry obtained. ED asthma rate, spirometry utilization, and controller fills by intervention office patients were compared to all other network offices before and after ASC initiation.
Results:
At baseline, asthma ED visits by intervention and usual care populations were similar (p = 0.43). After, rates were significantly lower for intervention office patients versus usual care office patients (p < 0.001), declining in the intervention population by 26.2%, 25.2%, and 31.8% in 2013, 2014, and 2015, respectively, from 2012 baseline, versus increases of 3.8%, 16.2%, and 9.5% in the usual care population. Spirometry completion, controller fills, and patients with favorable Asthma Medication Ratios significantly increased for intervention office patient relative to the usual care population.
Conclusions:
A primary care-based asthma clinic was associated with a significant and sustainable reduction in ED utilization versus usual care. What's new: This study describes a comprehensive, multi-disciplinary, and innovative model for an asthma management program within the medical home that demonstrated a significant reduction in ED visits, an increase in spirometry utilization, and an increase in controller fills in a high-risk asthma population versus comparison group.
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