Risk-Based Program Decreases Asthma-Related Health Care Resource Use in Children

A risk-based program at Le Bonheur Children’s Hospital, Changing High-Risk Asthma in Memphis through Partnerships (CHAMP), significantly decreased asthma-related health resource use by targeting barriers to asthma care, compared with other regions in Tennessee.

Child is using an asthma inhaler | Image credit: WavebreakmediaMicro - stock.adobe.com

“Children in Shelby County, which includes the Memphis metro area, have disproportionally high asthma-related health care resource use compared with other regions in Tennessee,” said Christie Michael, MD, allergist, immunologist, and medical director for the CHAMP program, in a statement.¹ “Our results show that taking down the walls of the clinic and going to where kids live, play, and go to school has been a success.”

This study is published in Annals of Allergy, Asthma & Immunology.²

The areas around Le Bonheur have the highest rate of emergency department (ED) visits and hospitalizations for asthma in Tennessee, which is twice as high for kids with Medicaid compared with children who have private insurance. Therefore, the CHAMP program aimed to improve asthma care and reduce risk of exacerbations for patients with high-risk asthma, who have a higher use rate and cost of health care resources due to their increased mortality and morbidity.

The CHAMP program established a multidisciplinary team of medical staff and community health workers; implemented a 24/7 call line, patient data registry, and community health education; and partnered with services aimed at addressing environmental triggers and social determinants of health. By doing so, the program aimed to improve access to care, address fragmented care, improve asthma education and social needs, and address external factors that contribute to the high burden of asthma in this patient population.

Eligible patients were aged 2 to 18 years with high-risk asthma, enrolled in Tennessee’s Medicaid managed care program, and residents of Shelby County. The study analyzed data for children who had completed 1 full year of the CHAMP program between January 2013 and December 31, 2022.

A total of 1348 children enrolled, in which 948 completed a full year of the program. Of these participants, 63% were male and 90% were Black, with a mean age of 6.8 years.

At the end of the study period, patients had reductions in ED visits (58%), inpatient and observation visits (68%), urgent care visits (42%), and total asthma exacerbations (53%). Additionally, the number of exacerbations per patient significantly decreased from 2.97 to 1.40 at 1 year post enrollment. Furthermore, of the calls made to the 24/7 call line, 58% occurred after hours and 52% were able to resolve patient issues without requiring a medical facility visit.

The researchers also highlighted the importance of education coordination among all providers to eliminate confusion for caregivers. Additionally, the researchers noted that many families enrolled in the program are affected by social determinants of health. Almost all children enrolled in the program live in homes below the poverty line, and many live in rental housing with environmental hazards that exacerbate asthma.

“Relationships are a huge part of what makes CHAMP successful, so that families know who we are and who they are dealing with,” said Michael. “CHEs [community health educators] have relationships with families and can be an extra set of eyes to help us know about any needs—utility bill payments, food shortages, or the need for asthma education reinforcement.”

Furthermore, the researchers believe that the key to ensuring future sustainability of the program requires optimizing the number of patients they can serve and determining funding, with the hope of expanding CHAMP to patients with private insurance or into other smaller counties outside of the Memphis area.

References

1. Paradigm shift: How a risk-based program is changing health care use and outcomes for children with high-risk asthma. EurekAlert! News release. February 14, 2024. Accessed February 20, 2024. https://www.eurekalert.org/news-releases/1034466

2. Steppe S, Stokes DC, Underhill C, Winders TA, Gardner DD, Michael CF. Changing high-risk asthma in Memphis through partnership: results from the CHAMP program. Ann Allergy Asthma Immunol. 2023:S1081-1206(23)01486-2. doi:10.1016/j.anai.2023.12.002