Health Care Provider

The Center for Pediatric Medicine (CPM) with the Greenville Health System Children’s Hospital is the major clinical provider of outpatient care for children with limited health care access in Greenville, South Carolina. A diverse community, Greenville is South Carolina’s most populous county and asthma/bronchitis is the leading cause of hospitalization for children under 18 in the area. Ninety percent of the population served at CPM receives Medicaid funding.

The Asthma Action Team (AAT) is a multidisciplinary, multilingual, family-centered program that was formed in 2008 to address increasing asthma prevalence, increasing pediatric emergency department (ED) visits and hospitalizations and ED recidivism for asthma, and growing asthma disparities in greater Greenville. The AAT is staffed by pediatricians, certified asthma educators, respiratory therapists, case managers, nurses, social workers, translators, an electronic medical record (EMR) technician, and community home visitors. Residents training in pediatrics, internal medicine, family practice and third and fourth year medical students also rotate through the AAT clinic where they learn an evidence-based approach to asthma care according to the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma.

The program strives to ensure that patients and families receive consistent asthma education and support services in clinics, homes, schools and daycares, including support for environmental asthma control, in order to promote effective self-management and avoid emergency health care utilization. The AAT coordinates with payers, local schools, community-based organizations and others to identify patients in need and to provide case management for children and adolescents with hard to control asthma. Case management includes asthma education, home visits, office visit coordination and school visits with a certified asthma educator from CPM serving as the case manager.

All AAT patients receive personalized pictorial asthma action plans written in their primary language which AAT staff review and update at every patient interaction and share with providers across the Greenville Health System (GHS) network and with school and daycare providers. The action plans are stored in the patients’ EMR and on a web-based platform where clinical providers and educators working across both inpatient and outpatient settings can access and update them. The AAT also maintains a registry and alert system to help manage 4,338 pediatric patients with asthma, to track their asthma outcomes in real time, to stratify patients for care and to ensure high quality and appropriate care is consistently delivered.

The AAT focuses on delivering comprehensive and guidelines-based clinical and environmental care everywhere people with asthma spend time. The team is acutely aware of the social, economic and cultural factors that affect pediatric asthma outcomes for the diverse community GHS serves. To help children with asthma and their family’s access appropriate clinical care and avoid emergency health care use, CPM offers extended evening and weekend hours, same day service to children experiencing asthma exacerbations, and an after-hours telephone triage line. The AAT also partners extensively to provide education, diagnostics, in-home services and social supports for environmental interventions in the community. Partners include the Family Connection of South Carolina’s Project Breathe Easy (PBE), the South Carolina Asthma Alliance, the Greenville Pediatric Asthma Community Collaborative, the Greenville County Schools and many others.

Perhaps the strongest evidence of the AAT’s impact is the fact that at the same time that the population of children with asthma in the CPM system grew by an annual rate of 63 percent, rates of ED visits for asthma declined. Data from the AAT’s partnership with PBE – which applies only to AAT clients who receive referrals to PBE – demonstrate a 71 percent decrease in urgent health care utilization, a 21 percent decrease in unscheduled clinical care visits, a 51 percent decrease in missed school days, and a 41 percent decrease in missed work days for parents post-intervention.

Mission Children’s Hospital serves the 21 most rural and isolated counties in North Carolina. This area’s  diverse minority population faces some of the greatest health disparities in the state, and further, the majorty of Mission Children’s Hopsital patients are uninsured or underinsured. Pediatric asthma, unsurprisingly, is one of these disparate health concerns.

Through an innovative and bold approach designed to meet the unique needs of this population and to impact minority children suffering from asthma in a significant way, Mission  Hospital developed the Regional Asthma Disease Management Program (RADMP). 

RADMP confronts these issues at the root of the problem — taking the clinical approach to asthma management and control into non-clinical settings, such as homes, schools and other care facilities in outlying areas. The program addresses social determinants of health, medical and environmental management, education on asthma and environmental triggers, and comprehensive care through an ever-expanding network of invested stakeholders and agencies.

In order to reach minority and low-literacy populations, RADMP utilizes population specific outreach materials and interpretive services. For low-income families, the program offers access through Mission’s Medication Assistance Program for asthma medications. Home remediation to eliminate environmental exposures is provided through RADMP’s strong network of community partners.

In 2008, the program was recognized as one of the state’s top three asthma disease management programs. In 2009, RADMP received a two-year demonstration project grant from the National Heart, Lung, and Blood Institute (NHLBI), as part of the National Asthma Control Initiative. Since 2009, RADMP activities have contributed to reducing asthma-related emergency room visits by 94 percent and hospitalizations by 95 percent, equaling a total savings of more than $800,000. In addition, the average number of school days missed by children in the program decreased from 17 to nine, indicating an increased quality of life. Statistically significant improvements were made in clinical measures including lung spirometry and eosinophilic inflammation.