The Center for Pediatric Medicine is a primary care outpatient center and residency training site serving a diverse population of approximately 18,182 active patients with multiple ethnicities. The Asthma Action Team operates a multidisciplinary asthma clinic four half days per week. Staff includes pediatricians, certified asthma educators, respiratory therapy, nursing, social work, translators and community parents in collaboration and partnership with Family Connection of South Carolina Project Breathe Easy. Residents training in Pediatrics, Med-Peds and Family Practice, as well as 3rd and 4th year medical students from the University of South Carolina School of Medicine rotate through the Asthma Action team Clinic, where they learn evidence and guidelines-based asthma diagnosis and care. A registry of 4,338 children and adolescents with asthma is maintained with real-time tracking of ED visits and hospitalizations. Case management is provided with an emphasis on pro-active identification and treatment of children with asthma.
The Center for Pediatric Medicine (CPM) within the Greenville Health System Children’s Hospital is the major clinical provider of outpatient care for children with limited health care access in Greenville, South Carolina. A diverse community, Greenville is South Carolina’s most populous county and asthma/bronchitis is the leading cause of hospitalization for children under 18 in the area. 90 percent of the population served at CPM receives Medicaid funding. The AAT is multidisciplinary, multilingual and a family-centered program. With the foundation of a pre-existing "asthma clinic" created at CPM in 1997, the CPM Medical Home Asthma Initiative formed in 2008 to address increasing asthma prevalence, increasing pediatric emergency department (ED) visits and hospitalizations and ED recidivism for asthma, and growing asthma disparities in greater Greenville.
The program strives to ensure that patients and families receive consistent asthma education and support services in clinics, homes, schools and daycares, including support for environmental asthma control, in order to promote effective self-management and avoid emergency health care utilization. The AAT coordinates with payers, local schools, community-based organizations and others to identify patients in need and to provide case management for children and adolescents with hard to control asthma. Case management includes asthma education, home visits, office visit coordination and school visits with a certified asthma educator from CPM serving as the case manager.
All AAT patients receive personalized pictorial asthma action plans written in their primary language which AAT staff review and update at every patient interaction and share with providers across the Greenville Health System (GHS) network and with school and daycare providers. The action plans are stored in the patients’ EMR and on a web-based platform where clinical providers and educators working across both inpatient and outpatient settings can access and update them. The AAT also maintains a registry and alert system to help manage pediatric patients with asthma, to track their asthma outcomes in real time, to stratify patients for care and to ensure high quality and appropriate care is consistently delivered.
The AAT focuses on delivering comprehensive and guidelines-based clinical and environmental care everywhere people with asthma spend time. The team is acutely aware of the social, economic and cultural factors that affect pediatric asthma outcomes for the diverse community GHS serves. To help children with asthma and their families access appropriate clinical care and avoid emergency health care use, the CPM offers extended evening and weekend hours, same day service to children experiencing asthma exacerbations, and an after-hours telephone triage line. The AAT also partners extensively to provide education, diagnostics, in-home services and social supports for environmental interventions in the community. Partners include the Family Connection of South Carolina’s Project Breathe Easy (PBE), the South Carolina Asthma Alliance, the Greenville Pediatric Asthma Community Collaborative, Greenville County Schools and many others. This network of partners allows the AAT to provide personalized environmental counseling in the clinic, environmental home visits and asthma education that includes environmental counseling in the community, and at school and day care sites.
Perhaps the strongest evidence of the AAT’s impact is the fact that at the same time that the population of children with asthma in the CPM system grew by an annual rate of 63 percent, rates of ED visits for asthma declined. Data from the AAT’s partnership with PBE – which applies only to AAT clients who receive referrals to PBE – demonstrate a 71 percent decrease in urgent health care utilization, a 21 percent decrease in unscheduled clinical care visits, a 51 percent decrease in missed school days, and a 41 percent decrease in missed work days for parents post intervention.