“So our specialty asthma clinic now communicates directly and electronically with those primary care providers who are going to carry on the ongoing longitudinal asthma care of the patients that we see”
Stephen J. Teach, M.D., M.P.H., IMPACT DC Medical Director, Children's Research Institute, Children's National Medical Center (Washington, DC)
Stephen J. Teach, M.D., M.P.H., describes how Children's Research Institute helps specialized and primary care providers coordinate asthma care.
From Children's National Medical Center, Dr. Stephen J. Teach, M.D., M.P.H. (IMPACT DC) and Mark I. Weissman, M.D. (DC PICHQ, CHCs) co-lead the CRI project.
Children’s Research Institute (CRI) of Children’s National Medical Center (“Children’s National”) implemented a project it designed to break the cycle of emergency department (ED) recidivism for asthma among disadvantaged urban and minority children. The project aimed to demonstrate the seamless transition of patient care for asthma from the ED to primary care.
Using standard asthma encounter forms, the project electronically integrated three parts of Children’s National, namely the ED-based IMPACT DC Asthma Clinic (IMPACT DC), seven Children’s Health Centers (CHCs), and the DC Partnership to Improve Children’s Healthcare Quality (DC PICHQ). The forms, which communicate essential patient information for carrying out the six priority Guidelines Implementation Panel (GIP)messages, are now integrated into the CHCs electronic health record as well as IMPACT DC’s clinic workflow.
Leveraging other resources, IMPACT DC also provided short-term case management to guide patients and their families through a transition from the ED to CHC as the primary care medical home. In addition, it conducted an Improving Pediatric Asthma Care in the District of Columbia through Electronic Care Coordination (ECCO) study to assess patient‐level outcomes associated with the CRI Demonstration Project.
Pilot an effort to seamlessly transition the care of patients seen in Children’s National Medical Center ‘sEmergency Department through the IMPACT DC to primary care providers in the Children’s Health Centers through the standardized electronic transfer of asthma-related health care information and short-term case management.
Challenges & Solutions
Challenge: Standardizing forms for different settings. Feedback from clinical stakeholders collaborating on a standard asthma encounter form indicated the need for two separate forms instead.
Solution: Create separate forms with common elements. CRI developed two versions of the asthma encounter form, one for CHC primary care providers to capture all aspects of an asthma visit and one for IMPACT DC to streamline communication of summary information to primary care providers. Both forms incorporate all six of the GIP priority and structured data elements that are reportable over time and across clinic practices.
Dr. Stephen J. Teach in exchange with Floyd J. Malveaux, M.D., Ph.D., Merck Childhood Asthma Network, during a NACI meeting in Baltimore, MD.
Since the end of its NACI project, Children's National leveraged its experience with the use of electronic asthma encounter forms to transition its entire clinical operation to the electronic medical record used by Children's Health Centers.
This change has been transformational, as all visit data is now entered into the electronic medical record in real-time during clinic visits, resulting in improved work flow, data capture, and more extensive data sharing with Children's Health Centers' primary care providers.
CRI shared and collaborated with additional NACI-funded projects to advance asthma care best practices. For example:
Following conversations initiated at a NACI meeting between IMPACT DC and the National Environmental Education Foundation (NEEF), a NACI Strategic Partner, IMPACT DC used NEEF’s environmental asthma management tools to modify its clinic intake documents.
A primary care provider based at one of Children’s National’s community health centers was selected to participate in the Clinical Asthma Champions Leadership Training Program run by the South Bronx Asthma Partnership/Bronx-Lebanon Hospital, a NACI Clinical Champion.
To meet its project goals, CRI focused on asthma disparities and systems change.
Other NACI-funded projects that used CRI-type approaches are: