Care transition interventions for children with asthma in the emergency department

Abstract

The Emergency Department (ED) is a critical point of identification and treatment for some of the most high risk children with asthma. This review summarizes the evidence regarding care transition interventions originating in the ED for children with uncontrolled asthma, with a focus on care coordination and self-management education. While many interventions on care transition for pediatric asthma have been tested, only a few were actually conducted in the ED setting. Most of these targeted both care coordination and self-management education but ultimately did not improve attendance at follow up appointments with primary care providers, improve asthma control, or reduce healthcare utilization. Conducting any ED-based intervention in the current environment is challenging due to the many demands on ED providers and staff, poor communication within and outside of the medical sector, and caregiver/patient burden. The evidence to date suggests ED care transition interventions should consider expanding beyond the ED to bridge the multiple sectors children with asthma navigate, including health care settings, homes, schools, and community spaces. Patient-centered approaches may also be important to ensure adequate intervention design, enrollment, retention, and evaluation of outcomes important to children and their families.

Transition for Adolescents and Young Adults With Asthma

“…There is very little published literature specifically examining the transition process in adolescents and young adults with asthma (66). This is surprising given asthma is the most common chronic medical condition in children (5), and highlights the need for further research to determine optimal care for adolescents transition with asthma. For the majority of young people and adolescents with well-controlled asthma, transitioning to adult services is unlikely to be a difficult process.…”

“…Asthma is the most common chronic medical condition in children, affecting over 7 billion children in the United States of America (5) and about 300 million people worldwide (6). Although the underlying pathology (reversible obstruction of the small airways) is similar in asthma at any age, there can be marked differences in presentation, triggers, phenotype and treatment when considering asthma in children, adolescents and adults.…”

Schools and Health: An Essential Partnership for the Effective Care of Children with Chronic Conditions

“…CHECK also works with CPS school nurse leadership to identify improved methods of communication between schools and health care providers. Currently, parents are the conduit for important and often complicated information, which sometimes results in gaps in care or miscommunication . CHWs relieve some of this burden by serving as a liaison between schools and health professionals and can be strong community advocates to help patients and families navigate challenging systemic processes, such as school enrollment and other necessary public benefits.…”

Characterization of Stress in Low-Income, Inner-City Mothers of Children with Poorly Controlled Asthma

“…Housing difficulties were likewise associated with higher daily life stress in these vulnerable mothers. In fact, home rodent infestation was one of the most commonly reported negative life events, comparable to rates observed in a sample of urban Puerto Rican families of children with asthma [43]. Addressing poor housing stock is particularly critical since, beyond its relationship with elevated caregiver life stress, environmental exposures stemming from sub-standard housing were associated with higher rates of ED visits in children with asthma aged 6-17 years [44].…”