Asthma Management Survey of Participants in an Inner City Asthma Intervention

Background: The Inner City Asthma Intervention (ICAI) was a national multi-center implementation of an evidence-based intervention to reduce asthma morbidity. Objective: This study describes mitigating behaviors and reported outcomes in families with asthma who completed the intervention and a post-intervention survey at one of the ICAI sites. Results: Eighty percent (0.72- 0.88, 95% confidence interval) of these families made five or more changes to mitigate exposure to environmental asthma triggers. The majority of families (0.84-0.96, 95% confidence interval) reported an improved awareness of asthma symptoms and less school absences, limitations of activity, unplanned doctor visits, and asthma related sleep disruption.Asthma, health intervention, health behavior

Building Sustainability in Times of Uncertainty

Obama era grants were filled with the hopes of developing and implementing measures to improve healthcare delivery. Springfield Pediatrician Matt Sadof will present his experience as one of the Principal Investigators for the Massachusetts Alliance for Coordinated Care, a care coordination for children with medical complexity and social fragility funded by Center for Medicaid and Medicare Innovation at two urban centers in Massachusetts Baystate Children’s Hospital and Boston University Medical Center. As a consultative program it supported improved communication between primary care providers and specialists at two geographic locations across the state. Relying on an ambulatory ICU (complex care physician, nurse care coordinators, nutritionists, developmental specialists, social workers and family navigator) it identified and developed systems that would streamline acquisition of services and equipment and housing that would improve the lives of families and decrease morbidity and cost in medically and, long term care costs and increased home care costs. ACO and CHIP uncertainty had lead organizations, state and private insurers reluctant to commit. By paying attention to processes and emphasizing data important to each of their local environments they have been able to transform these programs into functioning programs designed to improve care

Redesigning Health Care Practices to Address Childhood Poverty

Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty

A Step-by-Step Guide to Building a Complex Care Coordination Program in a Small Setting

Children with medical complexity comprise a growing population that stresses existing models of pediatric care. This report will describe a care support project that delivered shared plans of care to providers and families of children with medical complexity. This program was built around carefully constructed care support teams where each member had clearly defined roles and responsibilities. The teams worked collaboratively to improve provider communication, create SMART (Specific, Measurable, Assignable, Realistic, and Timely) goals, and perform task tracking. This process created a scaffolding to support community physicians, allowing patients to remain in their local medical homes and to access services closer to home and reducing hospital admissions and emergency room overutilization

Determinants of Health and Pediatric Primary Care Practices

More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association\u27s Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty\u27s negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of poverty-related risks in ways that promote long-term health and well-being for children