Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC) Asthma Clinic targets inner-city, minority and disadvantaged children who suffer disproportionate asthma morbidity and mortality. Most live with challenging social and environmental circumstances with daily exposure to multiple asthma triggers. Their families often have a tenuous connection with their primary care providers, and thus frequently rely on emergency departments (EDs) for asthma care. While EDs typically provide excellent episodic care for acute asthma exacerbations, they usually pay little attention to longitudinal management issues. As a result, many families view asthma as an episodic problem instead of a chronic disease requiring daily management. IMPACT DC's fully validated program recruits from a large urban ED (Children's National Medical Center) and focuses on three distinct domains: environmental control, medical management, and longitudinal care. In a prospective clinical trial, it improved multiple patient outcomes. It is an innovative, replicable, and cost-efficient national model for asthma mitigation among children in the inner city.
Blue Cross of California, State Sponsored Business Unit (SSB), has designed a Comprehensive Asthma Intervention Program (CAIP) to improve care for California Medi-Cal and Healthy Families members with asthma. Because standard asthma management programs seldom address the needs of all members in a culturally and linguistically diverse, low-income population, like the Blue Cross SSB membership, who often face environmental health challenges, CAIP encompasses innovative partnerships with members, providers, academic institutions, public health organizations, and communities, to maximize opportunities for improved asthma outcomes. CAIP includes individual member outreach; resources and incentives for physicians and pharmacists to encourage improved asthma care; Plan/Practice Improvement Project (PPIP), a collaboration modeled after the Institute for Healthcare Improvement's Breakthrough Series, to enhance asthma chronic care through practice-specific redesign; Valley Air Quality Project, a county-specific partnership to improve community responses to environmental air pollution affecting the respiratory health of Fresno County, where asthma prevalence is high.