Assessing Primary Care Providers’ Opinion of the Urgent Asthma Clinic at Seattle Children’s Hospital

Katie Powell BSN, RN, DNP Pediatric Nurse Practitioner-PC Student

> This project was supported by the UW Pediatric Pulmonary Center, with mentorship from Marijo Ratcliffe DNP, ARNP, PPCNP-BC, and by the Washington State Chapter of the National Association of Pediatric Nurse Practitioners

> This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), under grant #T72MC00007/University of Washington Pediatric Pulmonary Center/PI: Redding, for total grant amount of $1,718,642. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Acknowledgements

• 38.4% of children with asthma have uncontrolled asthma1

• 868,000 ED visits and 150,000 hospitalizations for children each year10

• The Urgent Asthma Clinic (UAC) targets children with uncontrolled asthma after an acute asthma exacerbation

• Other organizations across US and Canada have opened specialty asthma clinics

• No literature on PCP opinion of asthma specialty clinics

Introduction & Background

1. Elicit feedback from community PCPs: Develop and disseminate an electronic survey to assess local PCP opinion of the UAC

2. Provide recommendations: Describe themes identified in the PCP survey and provide a list of recommendations based on strengths and barriers

3. Describe the UAC patient population: Analyze the UAC patient demographic database and summarize the patient population served by pilot program thus far

Objectives

• Introduction and 14 response questions: 5 multiple choice, 4 likert-scale, 4 yes/no, and 2 open-ended

• Content reviewed by UW committee chair/content expert, 3 pediatric pulmonary providers and a community PCP

• Hosted on RedCap for a 3-week response window

• An email reminder was sent out during the second week

• Incentivized

• Sent to approximately 350 PCPs

• 123 respondents (35.1% response rate)

• 104 respondents met the inclusion criteria

• Physicians and Advanced Registered Nurse Practitioners (ARNPs) comprised the majority of the respondents (54.9% and 43.3%, respectively)

PCP Survey

Outcomes: Survey Descriptive Analysis (n=104)

Outcomes: Survey Descriptive Analysis (cont’d)

• Common Themes:

• Location is not convenient for all patient populations (n=13)

• PCP should be medical home for asthma (n=13)

• The education piece is valuable and more than I can do in primary care (n=8)

• Communication must be thorough and prompt (n=4)

• I would like to be able to refer directly to the UAC as well (n=2)

Outcomes: Thematic Analysis (n=40)

• 3-7 years old (n=15) and male (n=15)

• Public insurance (n=19)

• Moderate Persistent Asthma (n=12)

Outcomes: Patient Demographics (n=20)

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2 6 10 14 18 22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86 90 94 98

Count

Miles

PatientCountbyDistancefromSeattleChildren'sHospital

> Recommendations Based on Identified Strengths:

• Focus on Education: Continue to emphasize patient and family asthma education.

• PCP Referral: Consider trialing a referral pathway for PCPs

> Recommendations Based on Identified Barriers:

• Accessible Location: Consider rotating SCH locations to increase access

• PCP as Medical Home: Provide education regarding model of care: The UAC does not manage asthma, they are a service for treatment plan optimization

• Improved Communication: Develop a consistent, evidence-based communication plan

Recommendations

• Community PCPs support referrals to the UAC for patients with uncontrolled asthma, especially those who have been hospitalized, seen in the ED or needed 2+ courses of oral steroids in 1 year for asthma

• Though there is some variation in support based on credentials, the majority of both ARNPs and MDs support referrals to the UAC

• These results, in conjunction with analysis of efficacy and cost effectiveness of the clinic, can be used by the organization to determine the future of the UAC

Conclusion

1. Centers for Disease Control and Prevention. National Center for Health Statistics; FastStats-Asthma.

https://www.cdc.gov/nchs/fastats/asthma.htm. Published January 2017. Updated March 2017. Accessed October 2018.

2. Safi KH, Stoermer-Grossman KJ, Kidwell KM, et al. A comprehensive pediatric asthma management program reduces emergency

department visits and hospitalizations. Pediatric Allergy, Immunology & Pulmonology. 2016;29(1),17-23.

3. Centers for Disease Control and Prevention. Uncontrolled Asthma among Persons with Current Asthma.

https://www.cdc.gov/asthma/asthma_stats/uncontrolled_asthma.htm. Published September 2015. Updated September 2015. Accessed

October 2018.

4. Taras H, Potts-Datema W. Childhood asthma and student performance at school. The Journal of School Health. 2005;75(8),296-312.

5. Li Z, Huang IC, Thompson L, et al. The relationships between asthma control, daytime sleepiness, and quality of life among children with

asthma: A path analysis. Sleep Medicine. 2013;14(7),641-647.

6. Centers for Disease Control and Prevention. Asthma-related Missed School Days among Children aged 5–17 Years.

https://www.cdc.gov/asthma/asthma_stats/missing_days.htm. Published 2013. Updated October 2015. Accessed October 2018.

7. Zeiger R, Schatz M, Dalal A, et al. Utilization and costs of severe uncontrolled asthma in a managed-care setting. The Journal of Allergy

and Clinical Immunology. In Practice. 2015;4(1),120-129.

8. Mirabelli M, Hsu J, Gower W. Comorbidities of asthma in U.S. children. Respiratory Medicine. 2016;116, 34-40.

9. Grainge C, Lau L, Ward J, et al. Effect of bronchoconstriction on airway remodeling in asthma. The New England Journal of Medicine.

2011;364(21), 2006-2015.

10. Rui, P. and K. Kang. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables.

http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2015_ed_web_tables.pdf. Published 2017. Accessed October 2018.

11. Centers for Disease Control and Prevention. Asthma: Most recent asthma data. https://www.cdc.gov/asthma/most_recent_data.htm.

Published 2016. Updated May 2018. Accessed October 2018.

12. Centers for Disease Control and Prevention. Vital Signs- Asthma in Children. https://www.cdc.gov/vitalsigns/childhood-

asthma/index.html. Published February 2018. Updated May 2018. Accessed October 2018.

13. Soni A. Top Five Most Costly Conditions among Children, Ages 0-17, 2012: Estimates for the U.S. Civilian Noninstitutionalized

Population. Statistic Brief #472. Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK447180/.

Published April 2015. Accessed October 2018.

14. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the diagnosis and management of

asthma- summary report 2007. Journal of Allergy and Clinical Immunology. 2007; 120(5 Suppl), S94–S138.

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