Partnerships take aim at improving children's asthma

Asthma is one the main causes of pediatric hospital admissions, both nationally and locally. Last year, there were 900 asthma-related visits to the Pediatric Emergency Department at Golisano Children's Hospital. Golisano Children's Hospital at Strong is working to lower that number.

Asthma care can be complicated, but the hospital is working with area organizations and health care providers to increase awareness about how to keep children with asthma healthy after emergency treatment and gain better control of their symptoms.

In the summer of 2007, a six sigma team was developed to brainstorm ways to improve children's asthma care in and out of the hospital. The team decided that the best way to decrease the number of patients who come to the hospital for asthma emergencies, is to encourage follow-up care after an asthma visit. After a child is seen in the Pediatric Emergency Department (ED), ED health care professionals fax the incident over to the child's primary care physician in AC-6, the pediatric outpatient unit.

"Our goal is to get as many children in for follow-up appointments within two weeks of being in the ED with asthma," said Jan Schriefer, M.B.A., Dr.P.H., assistant professor at the Department of Pediatrics at Golisano Children's Hospital at Strong and a co-leader of the six sigma team with Ted Sigrest, M.D., senior instructor and department fellow at the Department of Pediatrics. "In the ED, health care providers have very little time to show parents and children how to properly use inhalers." By connecting with primary care pediatricians at Golisano Children's Hospital, ED health care providers can let the patient's pediatrician know that a child was hospitalized for an emergency. Pediatricians take over from there, following up with patients and families during appointments and walk them through proper asthma care.

In the ED, health care providers also administer an Asthma Control Test (ACT) on children with asthma that may be poorly controlled. Patients answer several basic questions about their asthma, which indicate how well the child's asthma is being controlled. Five ACT questions ask about the strength and frequency at which asthma affects the child's daily life. The answers range from one to five, with one being the most strong and frequent and five being the weakest and least frequent. If the child's score is below 19, the ED health care provider might prescribe a control medication and inform the child's primary care physician.

"This is a big change in practice, since ED doctors typically provide emergency care and do not order control medication for asthma. Helping with preventative care for asthma in the ED is a new way of thinking," said Patsy Pangia, nurse manager of the Pediatric Emergency Department at Golisano Children's Hospital at Strong.

Golisano Children's Hospital has increased its referrals to Regional Community Asthma Network (RCAN), a non-profit coalition committed to helping kids with asthma. RCAN provides certified asthma educators and nurses for at-home tutorials on asthma management. If families living in the city of Rochester express interest in receiving RCAN services, educators visit homes, where they can walk families through asthma care and also point out things that can trigger asthma in the house. Rochester Primary Care provides funds that allow RCAN educators to provide items to minimize asthma symptoms such as mattress covers, vacuums and dehumidifiers. RCAN extends to nine counties in the Finger Lake region. RCAN sponsors educational programs, serves as a resource for information and educational materials, supports special projects for asthma, and serves as a resource for area physicians and asthma educators.

Because about 50 percent of children with asthma have a smoker in the home, Golisano Children's Hospital has also increased referrals to the New York State Quitline (866-NY-QUITS). "This is the best quit line in the country, because of the resources it has and the percentage of successful outcomes, and it's free to all residents," said Schriefer. "Some providers are reluctant to discuss smoking with parents, but it is important to let them know that quitting smoking can significantly improve their child's health, and the New York State Quitline helps with that process and increases their chance of quitting by 30 percent."

The Department of Pediatrics is working on several projects to improve asthma care in the Rochester area, including another recently formed collaboration with the area's other hospital systems and the Rochester City School District. That new project is in the planning stages but is meant to allow the hospital systems and the school district to coordinate health information about children with asthma to help keep the chronic disease under control. Also, children admitted to the hospital have access to new education information on asthma through a computer and entertainment system at their bedside.

http://www.rcanasthma.org/ and http://www.urmc.rochester.edu