Pediatric CM interventions improve care for patients

Family education is a key intervention

The first year that Christopher Chevalier, BSN, pediatric emergency department (ED) case manager at Jackson Health System in Miami, began referring young asthma patients to the hospital’s new asthma center, ED visits for asthma decreased by 22%.

"Everything came together because we had case managers who could flag the patients, let them know the resources of the clinic were available, and see that they got one-on-one disease management," Chevalier says.

Before the asthma center was established, juvenile asthma patients came to the ED over and over because their families had no knowledge of how to handle the disease and no resources to help them cope. Now, if a child has two or more ED visits for asthma within a year, the child and the mother are directed to the asthma center where they are evaluated and taught how to handle the disease. For instance, the mothers are taught how to look for triggers to asthma attacks and what conditions in the home may contribute to an attack.

"We were able to identify the consistent return to the emergency room because of lack of resources within our facility of getting patients with asthma direct disease management," Chevalier says.

Among pediatric patients at Jackson Health System, 85% to 95% have HMOs, mostly with Medicaid, he says.

Before the case managers were involved, the appointment setters had no clue who was covered by an HMO. As a result, many parents brought their children in for clinic appointments but were turned away because their insurance company had not approved the visit.

"Many of the population we serve are poor and treat their children’s health care like their own. They bring them in only when they’re sick. They are not big on preventative care because they are afraid of having to pay out of pocket," Chevalier says.

He works to help educate parents on the value of preventive checkups and helps them find community resources that can subsidize the cost. "We put out fires here and there. For instance, Medicaid in Florida stopped approving a certain medication. We call and get an override for each child who needs it."

The case manager helps remove any obstacles that may be in the way of patients getting the post discharge care they need.

Chevalier follows up, especially with chronically ill children who do not show up for appointments. He keeps a record of the appointments and calls the parents the day before to remind them, and again the day after to make sure they kept the appointment.

The third time a parent fails to bring the child in for a follow-up visit, he contacts the state Department of Children and Family Services for investigation of medical neglect.