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The Pediatric CLEAR (Community Linked Educational Asthma Resource) Program: Providing Evidence Based Asthma Care to An At-Risk, Low-Income Population In a Pediatric Clinic Setting

Friday, October 19, 2012
Room R06-R09 (Morial Convention Center)
Patti Lucarelli, MSN, CPNP, APN, RN-BC, PMHS, Marie Chisvette, MS, RN-BC, Cathleen Ballance, M.D., Elna Kochummen, M.D. and Paul Schwartzberg, D.O., Family Health Center, Jersey Shore University Medical Center K. Hovnanian Children's Hospital, Neptune, NJ

PURPOSE: According to the CDC, seven million children (9.4%) currently have asthma (Summary Health Statistics for U.S. Children, 2010) and emergency room (ER) visits and hospitalizations for asthma has risen, despite evidence-based guidelines (Akinbami, L., 2006). In New Jersey, the highest asthma hospitalization rate was for children age < 5 years (N.J. Department of Health & Senior Services, 2009).  Evidence supports clinical practice asthma guidelines focusing on reducing asthma severity, ER visits, hospitalizations and morbidity and mortality and improving the quality of life for patients with asthma  (NHLBI, nhlbiinfo@nhlbi.nih.gov). The Pediatric CLEAR (Community Linked Educational Asthma Resource) Program commenced in May 2011 to incorporate the Expert Panel Report 3 Asthma Guidelines into the care of pediatric asthmatic patients seen in our Family Health Center (FHC) primary care clinic.  This family-centered, interactive approach includes an attending pediatrician, pediatric nurse practitioner, residents and nurse care coordinator, and provides culturally & linguistically appropriate services to combat asthma in the low-income patients served by the Jersey Shore University Medical Center (JSUMC) FHC clinic. The Purpose of this program is to increase our pediatric residents, patients & families’ knowledge of asthma, provide a medical home for these patients, provide evidence-based care to these patients and evaluate this program for usability in a primary care & clinic setting.  The program also provides participants with the resources, education and support necessary for improved control of their asthma, thereby reducing ER visits and hospitalizations. 

METHODS: Methods & strategies include: pre- and post-surveys, recruitment across multiple points of care, an education needs assessment, asthma treatment plans, follow-up care, and education. Patient/family education includes videos, written materials and instruction in both English and Spanish.  Research methods include review of existing evidence-based asthma guidelines and chart review to analyze findings.  Follow-up visits are scheduled and phone calls monitor progress and reinforce behaviors.                                        

RESULTS: 40 patients have been seen in the Pediatric CLEAR Program since May 2011 with the following Results: 36 patients (90%) seen in follow-up and 4 patients (10%) lost to follow-up. Age distribution for patients was (years): 1 to 5: 11 (27.5%); 6-11: 19 (47.5%) and 12-18: 6(15%). Of the 36 patients followed, there were 26 total asthma-related ER visits from these patients 1 year before being enrolled and 1 asthma-related ER visit since being enrolled.  18/36 (50%) of patients had at least 1 asthma-related ER visit 1 year prior to enrollment and only 1/36 (2.7%) had a subsequent asthma-related ER visit. Surveys are included in data analysis and preliminary data suggests high patient/parent satisfaction, reduced asthma symptoms/exacerbations, and improved quality of life.   

CONCLUSION: In Conclusion , implementation of evidence-based guidelines for identification, assessment and management of asthma in a pediatric primary care clinic has resulted in a 96% reduction in asthma-related emergency department visits over the past year.