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Screening Social Determinants of Health in a Multidisciplinary Severe Asthma Clinical Program
Sydney Leibel1, Bob Geng1, Wanda Phipatanakul2
1Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, UC San Diego School of Medicine/Rady Children's Hospital, San Diego, Calif.
Insights
A new pediatric severe asthma clinic significantly reduced emergency visits and hospitalizations by addressing social determinants of health (SDH). This multidisciplinary approach improved outcomes for children with severe asthma.
Area of Science:
- Pediatric pulmonology
- Public health
- Health disparities
Background:
- Asthma is a leading chronic childhood illness with high healthcare costs.
- Minority children in poverty face a disproportionately higher asthma burden.
- Social determinants of health (SDH) significantly contribute to these health disparities.
Purpose of the Study:
- To evaluate a multidisciplinary severe asthma clinic.
- To assess the impact of addressing SDH through home visits on healthcare utilization.
- To reduce emergency department (ED) visits and hospitalizations in pediatric asthma patients.
Main Methods:
- Recruited patients with high ED visit or hospitalization rates to a severe asthma clinic.
- Employed a multidisciplinary team for systematic patient evaluation.
- Implemented a Community Approach to Severe Asthma (CASA) program with home visits for a subset of Medicaid patients to address SDH.
Main Results:
- A 75% reduction in ED visits and a 73% decrease in hospitalization days were observed in clinic participants.
- The CASA program subset showed an additional 90% reduction in ED visits.
- Commonly addressed SDH included basic needs like shelter, food, and utilities.
Conclusions:
- A novel pediatric severe asthma clinic effectively reduces healthcare utilization.
- Integrating a multidisciplinary approach that actively addresses SDH improves outcomes.
- This model demonstrates success in mitigating asthma-related healthcare burdens in vulnerable populations.
Abstract:
Asthma is the most common cause of chronic disease in children and has high healthcare utilization costs. Minority children living in poverty have a higher asthma burden. These health disparities are associated with the social determinants of health (SDH). A severe asthma clinic was implemented at Rady Children's Hospital in San Diego to determine whether a multidisciplinary approach, including an asthma home visit addressing SDH, would lead to decreased healthcare utilization in terms of emergency department (ED) visits and hospitalizations.
Methods:
Patients with 2 or more ED visits in the past 6 months or 2 or more hospitalizations in the previous year were recruited to Rady Children's Hospital Severe Asthma Clinic. A multidisciplinary team evaluated each patient systematically. A subset of patients on capitated Medicaid insurance plans also had a comprehensive asthma home visit with community health workers as part of the Community Approach to Severe Asthma (CASA) program.
Results:
A significant reduction in ED visits (75%, P < 0.001) and hospitalization days (73%, P < 0.001) was demonstrated in 74 Severe Asthma Clinic participants with 1 year of pre-/postdata to analyze. In a subset of 12 patients in the CASA program, further reductions in ED visits (90%, P = 0.002) were also demonstrated. Basic needs, including shelter, food, and assistance with utilities, were the most common domain of SDH identified and addressed in CASA participants.
Conclusion:
We demonstrate that a novel pediatric severe asthma clinic with a multidisciplinary approach, including actively addressing SDH, is associated with decreasing health care utilization.
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