Transforming Pediatric Asthma Care Anna Volerman, MD November 14, - - PowerPoint PPT Presentation

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Transforming Pediatric Asthma Care Anna Volerman, MD November 14, - - PowerPoint PPT Presentation

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Transforming Pediatric Asthma Care Anna Volerman, MD November 14, 2017 Objectives Describe components of high quality asthma care Explain role of multidisciplinary teams and care coordination in advancing asthma care and lowering

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Anna Volerman, MD

Transforming Pediatric Asthma Care

November 14, 2017

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Objectives

  • Describe components of high quality

asthma care

  • Explain role of multidisciplinary teams and

care coordination in advancing asthma care and lowering healthcare costs

  • Identify potential areas for asthma care

transformation

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Outline

  • Why transform?
  • What is the goal?
  • How do we get there?
  • Where do we start?

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Why transform?

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47.5%

493,000

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Centers for Disease Control and Prevention, Most Recent Asthma Data, 2017.

137,000 13.8 million

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What is the goal?

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HIGH QUALITY asthma care for EVERY child ALWAYS EVERYWHERE

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NAEPP, 2007.

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35% overall hospitalization rates

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Cloutier et al, J Pediatrics, 2005.

27% asthma emergency department visits 19% outpatient visits

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  • 1. Assessment

and monitoring

  • 2. Education
  • 3. Environmental

control

  • 4. Medications

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Assessment and Monitoring

  • Classify severity to initiate treatment
  • Assess control, technique, asthma action

plan, adherence, and concerns at every visit

  • Adjust treatment based on control
  • Use spirometry for objective measure
  • Monitor at and between clinical visits

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NAEPP, 2007.

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Education

  • Develop active partnership
  • Provide written asthma action plan
  • Integrate self-management education
  • Encourage patient adherence
  • Support health care professional / system

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NAEPP, 2007.

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Environmental Control

  • Identify and reduce exposure to

allergens and irritants

  • Consider immunotherapy
  • Encourage influenza vaccine
  • Identify and treat comorbid conditions

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NAEPP, 2007.

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Medications

  • Long term control
  • Quick relief
  • Stepwise approach

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NAEPP, 2007.

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The goal is….

CONTROL

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How do we get there?

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HIGH QUALITY asthma care for EVERY child ALWAYS EVERYWHERE

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Chin et al, JGIM, 2012; Volerman et al, Pediatrics, 2017

Level Definition Example Patient Change the knowledge and/or behaviors of patients to improve their health outcomes Education for child / parents Provider Change the knowledge and/or behavior of providers to improve patient outcomes Education for health care providers Microsystem Add new members to or shift responsibilities among the immediate care team, such as primary care provider, nurse, and staff Case management, community health workers Organization Change organization operations; may require coordination among management, providers, information technology, and/or human resources Clinical decision support tools with alerts and reminders Community Work with people and organizations outside traditional health settings, such as churches, schools, and social service agencies Controller medication administration in school, housing redevelopment Policy Influence laws, regulations, and/or resource allocation on a regional or national basis Insurance enrollment, smoke-free laws

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Electronic decision support

controller medications prescribed spirometry performed

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Bell et al, Pediatrics, 2010.

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Child with asthma Parents Pediatrician Teachers / staff School nurses Coaches / activity leaders Family / Caregivers Pulmonologist / Allergist

Peers

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Fox et al, Pediatrics, 2007.

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Where do we start?

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Thank You!

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Contact: avolerman@uchicago.edu

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Pediatrician Pulmonologist / Allergist Emergency Dept / Hospital School Community Organizations Family / Caregivers Parents

Child