- Volume 2 | Summer 2010
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NACI Partner Profile
Children’s National Medical Center: Tackling the Capital’s High Asthma Rates as a Team
“In Washington, DC, asthma among children is nearly 20 percent higher and emergency room visits for asthma attacks are up to five times greater than the national average,” said Stephen Teach, MD, MPH, medical director of Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC) and principal investigator of one of 13 NACI pilot demonstration projects.
Stephen J. Teach, MD, MPH, left, and Mark Weissman, MD
Not only that, emergency department (ED) visit rates among children from disadvantaged, minority-dense parts of the District are nearly 12 times higher than those in more affluent areas.
How does one bridge this deep chasm?
Or get families to realize that rushing to the hospital when their child is struggling to breathe is not the long-term solution to managing a lifelong disease?
“We need to work with our families to help them better understand the benefits of preventive care,” said Mark I. Weissman, MD, project co-investigator, DC Partnership to Improve Children’s Healthcare Quality (DC PICHQ) leader, and division chief of the Diana L. and Stephen A. Goldberg Center for Community Pediatric Health at Children’s National Medical Center (Children’s National). “Some families need to learn that taking time off from school or work for a doctor’s appointment beats rushing to the ED in the middle of the night.”
But it takes more than parental education.
That’s why Dr. Weissman and DC PICHQ have partnered with Dr. Teach and IMPACT DC, an award-winning, pediatric-asthma surveillance, research, and intervention project that’s exploring novel, evidence-based ways to curtail the District’s epidemic of uncontrolled pediatric asthma.
The two groups are collaborating to examine whether electronic integration of the ED-based IMPACT DC Asthma Clinic with the seven Children’s Health Centers (CHCs) affiliated with Children’s National can bridge disparities and improve outcomes for the capital’s disadvantaged, minority, urban children by providing more seamless care. Together, the seven community-based CHCs provide primary health care to about 50% of the District’s Medicaid-enrolled children.
“In general, what we’re trying to do is leverage electronic records as a means to better communicate results and transition care from episodic to longitudinal, from the ED to primary care,” said Dr. Teach.
The creation of a uniform electronic tracking process can potentially improve:
- Scheduling and delivery of patient appointment reminders
- Collection and storage of “rich” data (such as patient and family history and test results)
- Movement of information between settings
- Documentation of guidelines-based care during an asthma visit
Now, Drs. Teach and Weissman and their colleagues are putting the NACI’s six priority messages to improve asthma care and control into action and taking the next steps in their investigation.
This pilot project is overseen by the Children’s Research Institute at Children’s National and focuses on two groups: patients and families seen at the IMPACT DC Asthma Clinic who have a history of using the ED for primary care, and clinicians and health care providers at the CHCs.
“There are too many boys and girls with asthma in the District who are receiving less than optimal care,” said Dr. Weissman. “Many of our families don’t see asthma as a chronic condition that you can control—they think of it as an acute illness that you address when you get sick.”
Turning around this situation means providing the information and tools that will make it easier for primary care providers (PCPs) to deliver guidelines-based asthma care, and convincing families that asthma can be controlled.
By combining technology, patient education, and short-term case management, Drs. Teach and Weissman aim to create an integrated model for transitioning families from EDs to PCPs that can be expanded locally and replicated in other inner-city communities.
Stay tuned to NACI In the Know for findings from this study and the NACI's other demonstration projects.