Pediatric asthma programs help kids feel right at home
Pediatric asthma programs help kids feel right at home
Hospitals can hold a wealth of information
If you’ve been thinking about diversifying your agency’s services, you might consider a pediatric asthma specialty program. It can save money by helping patients avoid costly emergency department visits, and it can be attractive to managed care organizations when you are negotiating contracts.
Hospital-based agencies have an advantage over freestanding agencies in building their own pediatric asthma programs because of their ability to draw from a wealth of resources, including physicians to help develop and review the program.
At Presbyterian Hemby Children’s Hospital in Charlotte, NC, a pediatric pulmonologist, pediatric clinical nurse specialist, and a CareMap coordinator led a multidisciplinary team to develop a pediatric asthma program.
Hemby was able to consolidate multidisciplinary interventions, including education, and improve outcomes across the health care continuum, which included the ED, the inpatient unit, pediatric intensive care, schools, and home health.
The end result has been lower utilization of hospital services and improved care in the first year. For instance, of the 44 patients that completed the hospital’s asthma education program, only one has returned to the emergency department.
Judith Grubbs, RNC, MN, clinical nurse specialist for Hemby Children’s Hospital, says the program soon will include an asthma outreach nurse, a case manager-type who would be responsible for determining the best approach to educating patients.
Hemby uses group sessions to educate patients, but the challenge the hospital faces is low patient attendance. While only one in 44 who completed the program has had an ED visit, those 44 patients are only about 32% of the total referrals to the programs. And while the hospital’s home care agency helped fashion the program, it has yet to play a significant role in the education program.
Still, Grubbs sees a partnership with home health in delivering education programs. With only one-third of its referrals attending group sessions, she says home health will have a role in educating more patients and their parents.
Another approach
Olsten Health Services (formerly Olsten Kimberly QualityCare) has developed a pediatric asthma program that it markets to doctors, managed care organizations, Medicaid, and other payers. Though not a hospital-affiliated organization, Olsten has drawn upon the expertise that can be found within a hospital, such as pediatric nurses and pediatric pulmonologists.
"The hospital-based agency has the advantage of hospital resources and being able to capture the patient and provide training in a classroom environment," acknowledges Ann Reissiger, RN, vice president for clinical business development with Olsten Health Services in Atlanta.
Olsten began with a research project involving four nurses and a researcher who pulled information from government resources and other publicly accessible resources. The research resulted in a complex set of critical pathways, which placed an emphasis on patient and parent education.
Olsten’s program calls for seven one-on-one lessons by a nurse over a seven-week period, one lesson per week. Nurses come equipped with coloring books, crayons, and other teaching materials designed to make it fun for children to learn about their disease.
Impressive outcomes
The approach has worked well. Acuity levels of pediatric asthma patients declined significantly for those who completed Olsten’s program. For example:
• Severe asthma cases were reduced from 16% to 2%.
• Parents’ time lost from work dropped from 6.9 days a quarter to 1.1 days.
• Children missed fewer school days per quarter, from 7.4 to 3.4.
• An average of $10,500 per patient was saved. Savings were greater for severe asthmatics as a result of fewer emergency department visits and hospitalizations, but were lower for mild cases. (See outcomes chart on p. 17.)
Clinical protocols outlined in Olsten’s critical pathways were based on the National Institute of Health’s guidelines. The protocols were reviewed by a pediatric pulmonologist who was part of a secondary committee of 15 people who assisted the core research group. Others in the committee included marketing personnel to assist in developing teaching tools that would be visually appealing and fun. Olsten’s sales department made its contribution also.
If your agency doesn’t have a sales force, Reissiger recommends you seek the input of the managed care organizations in your market prior to building the program. It’s easier to sell a program to an MCO that has invested time and effort in creating that same program, she says.
In three years, Olsten has won 30 managed care contracts. Reissiger points out that contracts can include as many as 2,000 patients. "We have sold this a lot," she says. "When NCQA [National Committee for Quality Assurance] identified asthma as a problem, a lot of managed care organizations became interested."
The information is out there
Agencies can build pediatric asthma education programs around existing programs or guidelines set forth by the National Institutes of Health, the Washington, DC-based Asthma and Allergy Foundation of America, and the National Asthma Education & Prevention Program Information Center in Bethesda, MD. The Asthma and Allergy Foundation has books, games, and videos to help teach children how to manage their disease. One popular educational program is Asthma Care Training For Kids, aimed at 7- to 12-year-olds and their parents. The program, which Hemby uses, provides a three-session educational program to be delivered in group sessions in hospitals. The foundation also sells a series of educational pamphlets that provide basic information about the disease, exercise programs, and ways to prevent asthma episodes though its Living with Asthma and Allergies Series.
Asthma Care Training For Kids sells for $150. The Living with Asthma and Allergies Series sells for $50, which includes a packet of 50 pamphlets.
"It’s not rocket science," Reissiger says. "If we did it, they can do it too."
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