Childhood Asthma Improves With Provider-Community Collaboration
Cincinnati Children's Hospital Medical Center embarked on this quality improvement initiative in late 2004 with four school-based health centers operated in Cincinnati by Neighborhood Health Care, Inc. (NHCI). These urban centers provide comprehensive primary, mental and dental health services to children in grades K-8.
"We brought our expertise in data evaluation and quality processes to these centers that are experienced in working within the community. Everybody brought their skills to the table to optimize what we could do for these kids," says Mona Mansour, MD, a physician at Cincinnati Children's and medical director of the school-based health centers.
Cincinnati Children's provides physicians and nurse practitioners for the centers and collaborates with the city's health department, which provides school nurses; the Cincinnati Public Schools; and parents of children with asthma.
"If our small staff can bring these three huge organizations together to achieve these outcomes, then others can certainly realize similar improvements," says Dr. Mansour, who hopes these learnings spark greater communication between community physicians and schools.
The partners developed a vision of "perfect asthma care," along with measures and interventions to achieve it. Perfect care became a composite measure of asthma severity classification, a written care plan and appropriate controller medications. Outcomes measures addressed activity restrictions and asthma-related emergency department visits.
"We spent the first year or so getting processes and our web-based registry in place, and we trained staff to coach parents and kids in effective techniques to manage asthma," she explains.
Encouraged by dramatic improvements, the team is expanding its scope. The processes, measures and interventions are being introduced into three NHCI-run urban community health centers that serve both adults and children.
The team is also taking project elements into schools where no health centers exist, for example, helping school nurses identify more children with asthma and ensure they have emergency plans, including on-site medications. "We're exploring whether we can replicate our results without the health center infrastructure," Dr. Mansour says.
Within the school-based health centers, the team is ramping up efforts to optimize self-management skills and intervene proactively with high-risk students.
"We have the registry; we know who they are," Dr. Mansour says. A monthly printout of ED visits prompts intervention to help prevent more. "We're also showing kids how much better they can perform in gym or other activities when they use a rescue inhaler beforehand. Then we monitor behavior to make sure it happens."
Going forward, Dr. Mansour hopes these learnings spark greater communication about asthma management between community physicians and schools. After all, she notes, "Many of these doctors have patients with asthma, and they are in school somewhere – six to eight hours a day."
