A Multipronged Effort to Reduce Asthma Exacerbations and Readmissions

Asthma exacerbations or asthma attacks in children can lead to disruptive symptoms, missed school days and extracurricular activities, and costly hospital admissions. The asthma program at Arkansas Children's takes a variety of steps to ensure children at risk for exacerbations receive the care they need. This multifaceted, multidisciplinary effort has led to a deep reduction in exacerbations and a low readmission rate.

Dedicated Care for Children With Severe Asthma

As the only pediatric hospital in the state featuring allergy and pulmonology specialists, Arkansas Children's is uniquely positioned to deliver comprehensive care for children with asthma. A key component of this effort is identifying children with the highest risk for asthma exacerbations - those with severe asthma - and addressing their needs through a targeted clinic.

“What makes our severe asthma clinic unique is we focus not only on asthma, but also all of the other factors, the social determinants of health that put patients at risk for exacerbations,” said Robbie Pesek, M.D., medical director of the severe asthma and eosinophilic gastrointestinal disorders clinics at Arkansas Children’s Hospital and associate professor of Pediatrics in Allergy and Immunology at the University of Arkansas for Medical Sciences. “We partner with pediatric pulmonologists, clinical psychologists and respiratory therapists to address all of a patient’s risk factors during his or her visit.”

The entire severe asthma clinic multidisciplinary team meets regularly to review every patient's case. The team creates a management plan for each patient and follows a shared decision-making model with families to identify and mitigate exacerbation risk factors.

"We've seen a reduction in acute encounters and increased control of asthma symptoms after patients receive care in the severe asthma clinic," said Kim Cobb, RRT, AE-C, asthma program coordinator at Arkansas Children's Hospital. "Uniquely, we have more than 25 nationally-certified asthma educators dispersed throughout our organization. These educators provide comprehensive asthma education to patients daily in the severe asthma clinic, the emergency department and elsewhere."

Patients the severe asthma clinic team followed for at least a year experienced a 50% reduction in exacerbations. Previously, many of these patients had three or four exacerbations annually.

Keeping Readmission Rates Low

Another key aspect of the asthma program is discharge planning, which is tailored to benefit every patient who enters the hospital for an asthma exacerbation.

"From the moment patients enter the hospital, we're thinking about the follow-up care they need to reduce their risk of readmission," Cobb said. "If patients need to see a specialist, such as an allergist or pulmonologist, or simply follow up with their primary care provider, we try to get those appointments scheduled before they leave the hospital. Our scheduling rate for discharge planning exceeds the 90th percentile for patients with asthma."

Before leaving the hospital, patients and their families receive a written asthma action plan and additional asthma education. A pharmacist meets with patients and families to educate them about asthma medications and ensure patients have the medicines they need before discharge. Seven to 10 business days after discharge, a registered nurse calls to check on the patient's condition and answer follow-up questions.

The discharge planning program has led to significant improvements in the number of patients attending follow-up appointments. Sixty to 70% of patients show up for their post-discharge visits.

"Before this program, patients admitted to the hospital for exacerbations weren't getting scheduled for follow-up appointments before discharge," Dr. Pesek said. "Now, all patients are scheduled for follow-up care, and we have a high rate of compliance."

Thanks to the severe asthma clinic, the discharge planning program and the asthma program’s other efforts, fewer than 10% of children admitted to Arkansas Children’s Hospital for asthma are readmitted within 30 days.

A Future of Innovation, Exploration and Education

The asthma program is working to reduce readmission rates and the burden of pediatric asthma even further through additional initiatives moving forward. Internally, the team uses the Epic electronic medical records system to develop tools that will allow clinicians to identify patients at risk for asthma exacerbations via medical records.

Beyond the Arkansas Children’s Hospital doors, the asthma program aims to expand the reach of its care.

"We've partnered with school districts to develop a standard asthma action plan so patients who don't have their own plan will at least have one at school," Dr. Pesek said. "We hope to expand into more school districts and youth sports teams. We also want to expand our telemedicine services, so children have better access to specialty care across our state."

Finally, Dr. Pesek and his colleagues are heavily involved in asthma research. Their areas of investigation include new medications; the impact of viruses, including the COVID-19 virus, on asthma; and asthma-related health disparities.

"A lot of different factors affect asthma, and we have to conduct research to understand what each of those components means for patients," Dr. Pesek said. "That allows us to keep advancing the field."

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