For children with asthma, and their families, a trip to the emergency room due to a severe asthmatic flare-up can be a traumatic and frightening experience and can often lead to a hospital stay. For a pediatric healthcare system, effective management of the pediatric asthma population improves the wellbeing of the patients and their families, reduces emergency department visits and improves overall health outcomes.
With this goal in mind, physician and IT leaders and care management teams at Children’s Hospital of Orange County (CHOC Children’s), based in Orange, California, leveraged health IT tools to improve the health of pediatric asthma patients through a population health approach in the health system’s primary care clinics. CHOC Children’s is a regional pediatric healthcare network that includes a 279-bed main hospital facility in the City of Orange and a hospital-within-a-hospital in Mission Viejo. CHOC also operates many primary and specialty care clinics, more than 100 additional programs and services and four centers of excellence – The CHOC Children’s Heart, Neuroscience, Orthopaedic and Hyundai Cancer Institutes. CHOC Health Alliance, an IPA comprised of Children’s Hospital of Orange County and CHOC Physician Network, manages approximately 160,000 fully capitated Medicaid pediatric patients through a contract with the Orange County-affiliated health plan, CalOptima.
Alexandra Roche, M.D., pediatrician at CHOC Children's
The pediatric asthma population health initiative, which entailed the implementation of health IT-supported care model redesign, has produced impressive results so far, with emergency department visits reduced 18 percent year-over-year, with asthma-related issues driving many of those ED visits. Further, this reduction in ED visits has resulted in $1 million in avoided emergency room costs. For their use of health IT to improve health outcomes and patient care, the editors of Healthcare Informatics have named CHOC Children’s as a semi-finalist winner in the 2017 Healthcare Informatics Innovator Awards Program.
Health IT-Supported Care Model Re-Design
Four years ago, CHOC Children’s developed a strategic plan, the “CHOC 2020,” and a major pillar of the strategic plan was the development of the CHOC Pediatric System of Care to better manage pediatric lives in the communities that the healthcare system serves.
“As part of that, we built in physician alignment, we built in care model redesign, we built in the information technology pieces that need to support that, and with all those being successful, we built in the ability to take on innovative payment models,” Mike Weiss, D.O., vice president of CHOC Health Alliance, CHOC’s Children’s health insurance plan. “As part of that foundation, we quickly realized that we could look at small segments of our population where we had an opportunity to use data to effect change. So we incorporated some tools, specifically disease registries, to approach a very common clinical condition that leads to a lot of morbidity and mortality and high cost, which is pediatric asthma.”
Three years ago, clinician, care management and IT leaders at CHOC Children’s working collaboratively on the Pediatric System of Care began looking at analytics tools to support population health programs. For this particular initiative, the collaborative team includes Bill Feaster, M.D., CHOC Children’s chief medical information officer; Weiss, who also works with the population health division; Bonnie Wolf, IT program manager at CHOC Children’s and Christina Grapentine, informatics specialist. Also instrumental in this effort were Cathy Nesselroad, R.N., care manager at the CHOC Primary Care Clinic and Carmen Namenek, manager of clinical operations for the CHOC primary care clinic, who implemented the technology tools within the primary care practices.
The team decided to focus on pediatric asthma patients in four CHOC primary care clinics in order to develop care models that could then be rolled out to other primary care practices, and they implemented Cerner’s HealtheIntent population health management platform in those four primary care clinics. Approximately 27,000 pediatrics in the CHOC Health Alliance are seen in the health system’s primary care clinics, and of this, 6,000 are registered in the asthma registry, Wolf says.
“Two of the diseases we decided to focus on were asthma and seizures, based on the fact that those are two of the highest utilizers within the hospital for ED and hospitalization services,” Feaster says. “So asthma was our first registry that we really developed. It was a multi-disciplinary group of primary care and specialty physicians, Dr. Weiss, myself, and Bonnie, we had a very broad-based approach to defining the measures of the asthma registry. We have been a development partner with Cerner, so that asthma registry, and the other registries we developed, are now the pediatric registries for Cerner.”
As part of this registry, the CHOC Children’s team worked together to research and define measures that were appropriate for the care of pediatric asthma patients. Ten measures were defined and built into the HealtheIntent asthma registry. Of these, two were selected for a focus on improvement—patients with an asthma control test completed in the past year and patients with an asthma action plan completed in the past year.
Get the latest information on Health IT and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.