A Primary Care-Based Quality Improvement Project to Reduce Asthma Emergency Department Visits.

Background And Objectives: Asthma exacerbation is a common and often preventable cause of Emergency Department (ED) utilization. Children eligible for Medicaid are at increased risk of poor asthma control and subsequent ED visits. In 2010, we implemented a multicomponent longitudinal quality improvement project to improve pediatric asthma care for our primary care population, which was 90% Medicaid-eligible.

Quality Improvement-Driven Reduction in Countywide Medicaid Acute Asthma Health Care Utilization.

Objective: This study evaluates the impact of a coordinated effort by an urban pediatric hospital and its associated accountable care organization to reduce asthma-related emergency department (ED) and inpatient utilization by a large, countywide Medicaid patient population.

Methods: Multiple evidence-based interventions targeting general pediatric asthma care and high health care utilizers were implemented using standardized quality improvement methodologies. Annual asthma ED and inpatient utilization rates by 2- to 18-year-old members of an accountable care organization living in the surrounding county (>140,000 eligible members in 2016), adjusted per 1000 children from 2008 through 2016, were analyzed using Poisson regression.

Gaps in health insurance coverage and emergency department use among children with asthma.

: Gaps in health insurance coverage may complicate asthma management and increase emergency department (ED) use. Using two nationally-representative surveys, we characterize the prevalence of coverage gaps among children with asthma, and describe their association with ED visits in this population. : De-identified data were obtained from the 2016 National Survey of Children's Health (NSCH) and National Health Interview Survey (NHIS).

Implementation of the Asthma Control Test in a Large Primary Care Network.

Introduction: Achieving control in asthma is a primary goal of pediatric care, and assessing the degree of control is a principal step in management. The purpose of this quality improvement project was to implement the Asthma Control Test (ACT) and the Childhood Asthma Control Test (C-ACT) in a large primary care network as a means to reliably and consistently assess asthma control at all visit types.

Methods: A prospective design was used to measure provider documentation of the ACT or C-ACT.

Association between pediatric asthma care quality and morbidity and English language proficiency in Ohio.

Objective: Limited English proficiency can be a barrier to asthma care and is associated with poor outcomes. This study examines whether pediatric patients in Ohio with limited English proficiency experience lower asthma care quality or higher morbidity.

Methods: We used electronic health records for asthma patients aged 2-17 years from a regional, urban, children's hospital in Ohio during 2011-2015.

Implementation of a "real world" School-Based Asthma Therapy program targeting urban children with poorly controlled asthma.

Objective: Describe implementation and clinical impact of a "real world" School-Based Asthma Therapy (SBAT) Program serving an urban, largely Medicaid population in a large midwestern city in the United States.

Methods: A retrospective, descriptive evaluation of SBAT was conducted. Students were referred by school nurses or providers, enrolled throughout the year, and could reenroll in subsequent years.

Reducing emergency department visits utilizing a primary care asthma specialty clinic in a high-risk patient population.

Objective: Asthma is a leading cause of pediatric emergency department (ED) use. Optimizing asthma outcomes is a goal of Nationwide Children's Hospital (NCH) and its affiliated Accountable Care Organization. NCH's Primary Care Network, comprised of 12 offices serving a predominantly Medicaid population, sought to determine whether an Asthma Specialty Clinic (ASC) operated within a single primary care office could reduce ED asthma rates and improve quality measures, relative to all other network offices.