Impact of integrated care coordination on pediatric asthma hospital presentations

Nusrat Homaira; Emma Dickins; Stephanie Hodgson; Mei Chan; Sandra Wales; Melinda Gray; Sarah Donnelly; Christine Burns; Louisa Owens; Michael Plaister; Anthony Flynn; Jennifer Andresen; Kimberley Keane; Karen Wheeler; Bronwyn Gould; Nadine Shaw; Adam Jaffe; Christie Breen; Lisa Altman; Susan Woolfenden

doi:10.3389/fped.2022.929819

Impact of integrated care coordination on pediatric asthma hospital presentations

Front Pediatr. 2022 Sep 23:10:929819. doi: 10.3389/fped.2022.929819. eCollection 2022.

Authors

Nusrat Homaira^{1

2}, Emma Dickins³, Stephanie Hodgson³, Mei Chan¹, Sandra Wales², Melinda Gray², Sarah Donnelly², Christine Burns², Louisa Owens², Michael Plaister², Anthony Flynn⁴, Jennifer Andresen³, Kimberley Keane⁵, Karen Wheeler⁶, Bronwyn Gould⁷, Nadine Shaw², Adam Jaffe^{1

2}, Christie Breen³, Lisa Altman³, Susan Woolfenden^{1

3}

Affiliations

¹ Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW, Australia.
² Sydney Children's Hospital, Sydney, NSW, Australia.
³ Integrated Care, Sydney Children's Hospital Network, Sydney, NSW, Australia.
⁴ Asthma Australia, Melbourne, VIC, Australia.
⁵ Rozelle Medical Centre, Sydney, NSW, Australia.
⁶ Central and Eastern Sydney Public Health Network, Sydney, NSW, Australia.
⁷ General Practitioner, Sydney, NSW, Australia.

Abstract

Introduction: Frequent asthma attacks in children result in unscheduled hospital presentations. Patient centered care coordination can reduce asthma hospital presentations. In 2016, The Sydney Children's Hospitals Network launched the Asthma Follow up Integrated Care Initiative with the aim to reduce pediatric asthma emergency department (ED) presentations by 50% through developing and testing an integrated model of care led by care coordinators (CCs).

Methods: The integrated model of care was developed by a multidisciplinary team at Sydney Children's Hospital Randwick (SCH,R) and implemented in two phases: Phase I and Phase II. Children aged 2-16 years who presented ≥4 times to the ED of the SCH,R in the preceding 12 months were enrolled in Phase I and those who had ≥4 ED presentations and ≥1 hospital admissions with asthma attack were enrolled in Phase II. Phase I included a suite of interventions delivered by CCs including encouraging parents/carers to schedule follow-up visits with GP post-discharge, ensuring parents/carers are provided with standard asthma resource pack, offering referrals to asthma education sessions, sending a letter to the child's GP advising of the child's recent hospital presentation and coordinating asthma education webinar for GPs. In addition, in Phase II CCs sent text messages to parents/carers reminding them to follow-up with the child's GP. We compared the change in ED visits and hospital admissions at baseline (6 months pre-enrolment) and at 6-and 12-months post-enrolment in the program.

Results: During December 2016-January 2021, 160 children (99 in Phase I and 61 in Phase II) were enrolled. Compared to baseline at 6- and 12-months post-enrolment, the proportion of children requiring ≥1 asthma ED presentations reduced by 43 and 61% in Phase I and 41 and 66% in Phase II. Similarly, the proportion of children requiring ≥1 asthma hospital admissions at 6- and 12-months post-enrolment reduced by 40 and 47% in Phase I and 62 and 69% in Phase II.

Conclusion: Our results support that care coordinator led integrated model of asthma care which enables integration of acute and primary care services and provides families with asthma resources and education can reduce asthma hospital presentations in children.

Keywords: care coordination; childhood asthma; healthcare utilization; integrated care; model of care.