366 - The Impact of a Primary Care Asthma Program, Including Inter-Visit Asthma Outreach, on Pediatric Asthma Control
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 366 Publication Number: 366.302
Sarah P. Justvig, Boston Children's Hospital/Harvard Medical School, Boston, MA, United States; linda haynes, Boston Childrens Hospital, boxford, MA, United States; Sheila Petrosino, Boston Children's Hospital, Boston, MA, United States; Patricia Glidden, Boston Children's Hospital, Boston, MA, United States; Urmi Bhaumik, Boston Children's Hospital, Boston, MA, United States; Joanne Cox, Boston Children's Hospital, Weston, MA, United States; Faye Holder-Niles, Boston. Children's Hospital, Boston, MA, United States
Clinical Fellow, General Academic Pediatrics; Staff Physician; Instructor in Pediatrics Boston Children's Hospital/Harvard Medical School Boston, Massachusetts, United States
Background: Asthma is the most common chronic health condition among U.S. children. Poor control is associated with decreased quality of life and school performance. Given asthma’s prevalence and the importance of optimal control, our academic primary care practices created an interdisciplinary asthma program. Besides comprehensive education, our program implemented proactive administration of the Asthma Control Test (ACT) at all visits, including well and urgent care, for patients with asthma. Inter-visit nursing outreach follow-up calls were made to patients with suboptimal control, ACT score ≤19. These calls provided education on treatment recommendations and support around medication pick-up and administration. Symptoms and asthma control were assessed with a repeat ACT. Objective: We assessed the impact of the asthma program and proactive ACT monitoring on emergency department (ED) and urgent care utilization, inpatient stays, and ACT scores at our 2 sites pre- and post-implementation of inter-visit outreach. Design/Methods: Retrospective chart review of 475 primary care patients ≥2 years of age with asthma billed seen at Site 1 (11/2012-10/2014) or Site 2 (03/2014-02/2016). These 2-year periods represent 1 year pre-implementation of inter-visit outreach and 1 year post-implementation with patients serving as their own controls. Our population is majority urban, Medicaid-insured, and Black and Latino/a/e. Outcome measures were ED and urgent care utilization, inpatient stays, and ACT score (t-tests). Results: At both sites, all asthma program patients with monitored ACT had significant improvements in all 4 outcome measures (p≤0.001) (Table 1). No statistically significant differences in these outcomes were observed post- vs. pre-implementation of inter-visit outreach (Table 2).
Conclusion(s): The primary care asthma program has been impactful regarding ED, urgent care, and inpatient visits and ACT score. Proactive ACT assessment at all visits is an intervention opportunity. Follow-up inter-visit outreach did not show additional statistically significant benefit; however, the effect of the individual intervention components may not be fully elucidated with small sample sizes. Implementing more targeted inter-visit outreach, focusing on patients at highest risk for poor outcomes, should also be evaluated. Studies with larger sample sizes and qualitative patient and family feedback are needed to further capture inter-visit outreach’s impacts.
