Controlling Asthma Requires Coordinated Care—and Trust

Published on in Children's Doctor

Trude Haecker, MD, the medical director of Quality Improvement for the CHOP Care Network and a pediatrician at the Karabots Pediatric Care Center, talks about caring for children with asthma.

When it comes to caring for a child with asthma, I’ve found that it takes a village.

In Philadelphia, where 25% of children have asthma— compared to 9% nationally—we are compelled to invent and re-invent strategies that will help families best control their children’s asthma.

To that end, at CHOP we are relentless in our efforts to put together the right mix of clinical services, family education, ongoing support, insurer collaboration, and research that will keep each patient’s asthma under control. A combination of medical home (emphasizing management of all of his or her medical/developmental needs and getting to really know the family, its circumstances and potential barriers to optimal care), care coordination (having the Emergency Department, specialists, inpatient, and primary care all looped in on patients), and outreach (visiting the child’s home to evaluate potential triggers and training school nurses, for example) can bring measurable improvement in outcomes.

We plan the different pieces to reinforce each other. For example, clinicians review the child’s Asthma Care Plan (ACP) at each visit. We recently redesigned the ACP printout parents receive to make it more user friendly. We also have an after-hours phone triage system for parents or caregivers to call before automatically heading to the ED; our After Hours Program nurses redirect them back to the ACP to review the steps to mitigate a flare. If the child does end up in the ED and/or being admitted, the primary care practice is notified so it can reach out to the family right away to get the child in for a follow-up visit.

Even with all this planning and support, it often comes down to trust. One of my patients was still having flares and multiple ED visits—despite being on a daily controller medication and even after pets were removed and blinds replaced curtains in the child’s room. I could sense her mother was holding something back. It took a few more office visits before she trusted me enough to tell me that they were living with extended family because they had nowhere else to go, and a family member smoked in a closed-off, upstairs bedroom. Even though the child was never in the same room with the smoker, the residual effects triggered her flares.

We were able to find healthier, alternative housing for this family. The child hasn’t been to the ED since, and her asthma is now well controlled. This is one more example: When you care for the whole child, good things happen.