Similar to what we witnessed in Louisville and Oakland,
Washington, DC’s prevalence of pediatric asthma is 22%, which is substantially higher than the 9.6% national average. Out of the 700,000 asthma-related emergency department visits in the US each year, 1% occur in Washington, DC. On average, each emergency room visit results in 15-20 missed school days. In addition to environmental pollutants, low socioeconomic status, and various stressors, many people visit the emergency room more frequently than their primary care doctor because they perceive asthma as an episodic illness rather than a chronic one.
IMPACT DC, headed by Dr. Stephen Teach, is an asthma education program at Children’s National Medical Center in Washington, DC that began about ten years ago as a randomized control trial for pediatric patients with poorly controlled asthma and frequent emergency room visits. After several years of working in the emergency room, Dr. Teach was frustrated with the amount of times the same children would come to the emergency room due to a flare-up or an asthma attack. Because of high rates of ER visits and poor follow-up rates with primary care physicians, IMPACT DC invites families back to the ER about two weeks after a flare up for a one-time intervention with the goal of transitioning better educated patients back to their primary care doctors.
Today, the program uses community outreach and care coordination to provide interactive education for patients and caregivers using posters, demonstration kits, practicing spacer use, and short videos. The educators reinforce key messages through follow-up phone calls and summary notes, which they share with the pediatrician, the school nurse, and the family after a visit.
The integrated approach IMPACT DC has taken by capitalizing on teachable flare up moments, educating patients and parents using a variety of hands on techniques, and following up with stakeholders after the information session is effective and innovative. After meeting with key players in the health care delivery system over the past few weeks, we are excited to go into our hackathon-style Design Challenge later this month with a strong understanding of what a solution to managing pediatric asthma should include.
By: Abena Dakwahene, Miki Lendenmann and Glenn Means III, 2013 Health for America Fellows