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A Quality Improvement Project to Improve Attendance and Outcomes in a Pediatric Pulmonary Clinic
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A5570 - A Quality Improvement Project to Improve Attendance and Outcomes in a Pediatric Pulmonary Clinic
Author Block: R. C. Cohn1, L. Langdon2, C. Driscoll2, K. McClaskie2; 1Pediatric Pulmonary, Dayton Children's/Wright State Univ., Dayton, OH, United States, 2Pediatric Pulmonary, Dayton Children's Hospital, Dayton, OH, United States.
RATIONALE: Asthma is the most common chronic disease in childhood and responsible for more Emergency Department (ED) visits and hospitalizations than any other chronic disease. Failure to keep pulmonary subspecialty appointments may have a detrimental effect resulting in unnecessary healthcare utilization. Our previous clinic policy enforced patient dismissal after 3 no shows. In an effort to improve this problem focus was shifted to addressing family needs and obstacles. The primary outcome measurement was improvement in in visit show rate. Secondary outcome in ED visits and hospitalization was assessed. METHODS: Children with asthma who missed 3 or more appointments in a rolling calendar year were identified. Families were contacted and given the opportunity to maintain their relationship with us by attending a multidisciplinary adherence clinic. The clinic team provided one or more multifaceted extended appointments addressing both medical and social needs (focused education, transportation, housing needs including home visits). Show rates in clinic, ED utilization, and hospitalizations were measured 12 months before enrollment and 12 months after enrollment. Results were analyzed with chi square and ANOVA tests. RESULTS: Sixty-eight children were initially enrolled in the program. Prior to enrollment there were a total of 204 ""no shows"", 113 ED visits, and 62 hospitalizations amongst the 68 children. For the 12 month period following enrollment ""no shows"" were reduced to 95, ED visits 74, and 39 hospitalizations. Our previous policy would have resulted in the dismissal of all 68 children. Despite helpful interventions 5 children were dismissed for continued no shows. All results were statistically significant. CONCLUSION: The initiation of a multidisciplinary adherence clinic model resulted in an improvement in visit show rates, decreased ED and hospital utilization for high risk children with asthma in our pulmonary practice.
Author Block: R. C. Cohn1, L. Langdon2, C. Driscoll2, K. McClaskie2; 1Pediatric Pulmonary, Dayton Children's/Wright State Univ., Dayton, OH, United States, 2Pediatric Pulmonary, Dayton Children's Hospital, Dayton, OH, United States.
RATIONALE: Asthma is the most common chronic disease in childhood and responsible for more Emergency Department (ED) visits and hospitalizations than any other chronic disease. Failure to keep pulmonary subspecialty appointments may have a detrimental effect resulting in unnecessary healthcare utilization. Our previous clinic policy enforced patient dismissal after 3 no shows. In an effort to improve this problem focus was shifted to addressing family needs and obstacles. The primary outcome measurement was improvement in in visit show rate. Secondary outcome in ED visits and hospitalization was assessed. METHODS: Children with asthma who missed 3 or more appointments in a rolling calendar year were identified. Families were contacted and given the opportunity to maintain their relationship with us by attending a multidisciplinary adherence clinic. The clinic team provided one or more multifaceted extended appointments addressing both medical and social needs (focused education, transportation, housing needs including home visits). Show rates in clinic, ED utilization, and hospitalizations were measured 12 months before enrollment and 12 months after enrollment. Results were analyzed with chi square and ANOVA tests. RESULTS: Sixty-eight children were initially enrolled in the program. Prior to enrollment there were a total of 204 ""no shows"", 113 ED visits, and 62 hospitalizations amongst the 68 children. For the 12 month period following enrollment ""no shows"" were reduced to 95, ED visits 74, and 39 hospitalizations. Our previous policy would have resulted in the dismissal of all 68 children. Despite helpful interventions 5 children were dismissed for continued no shows. All results were statistically significant. CONCLUSION: The initiation of a multidisciplinary adherence clinic model resulted in an improvement in visit show rates, decreased ED and hospital utilization for high risk children with asthma in our pulmonary practice.
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