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SUHI Project: The CHICAGO (Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes) Plan

Project:

The CHICAGO (Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes) Plan

Introduction:

The Sinai Urban Health Institute (SUHI) and Mt. Sinai Hospital's Emergency Department (ED) are part of a multi-site asthma collaborative that was awarded a $4 million, three-year contract by the Patient-Centered Outcomes Research Institute (PCORI). The Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes, or CHICAGO Plan, is designed to investigate how health outcomes for Black and Latino children with uncontrolled asthma might best be optimized. The focus is on filling gaps concerning how to best implement asthma guidelines in the ED. 

The project is led by the University of Illinois Hospital & Health Sciences System, and includes researchers from the Ann & Robert H. Lurie Children’s Hospital of Chicago, the University of Chicago Medicine, Rush University Medical Center, John H. Stroger and Jr. Hospital of Cook County, in addition to those from SUHI and Sinai. The CHICAGO Plan will investigate the effectiveness of two interventions among 640 children ages 5 to 11 visiting the aforementioned institutions’ EDs with uncontrolled asthma. The interventions began March 1, 2015.

For more information on the CHICAGO Plan please visit the website: http://chicagotrial.uic.edu/

Project Plan:

The first intervention will involve an ED Coordinator, hired by the CHICAGO Plan, providing the patient and his or her parent or guardian with guidance on how to better self-manage asthma, and arranging for follow-up visits to a primary care provider. This will occur while the child and family is in the ED. The ED Coordinator will use an educational and decision support tool developed for the intervention, to assist in providing the education. The tool will follow established guidelines for prescribing medications (oral and inhaled corticosteroids and rescue medication).

The second intervention will include visits to the home of the child by a community health worker to provide comprehensive asthma management education and help the family reduce environmental asthma triggers at home. CHWs will help caregivers create goals to empower them to make behavior changes to improve their child’s asthma control. To date, SUHI has led the efforts to recruit, hire and train CHWs across all sites, and will oversee the design and implementation of the home-based intervention throughout the course of the project. 

The success of the interventions will be assessed through interviews with the children’s caregivers and will focus on outcomes meaningful to children, such as not missing school and being able to participate in sports, and on outcomes meaningful to caregivers and families, such as feeling less anxious or not having to miss work. The researchers will also examine adherence to self-management skills and prescribed medications, avoidance of asthma triggers and acute care use.

Project Updates:

Overview

The CHICAGO PLAN was designed to improve the health of children with uncontrolled asthma. It is a research study to compare emergency department and home-based interventions to learn which produces the best outcomes for children. The CHICAGO Plan spans Chicago’s south and west side neighborhoods, which are the hardest hit by asthma.

 

The Problem

Chicago has among the highest asthma rates in the U.S.

Chicago’s asthma problem is severe. Our hospitalization rates are double the national rate. African American and Latino families living in Chicago’s south and west side neighborhoods bear the brunt of it. The burden falls most heavily on their children.

Download a larger version of Chicago asthma by the numbers

 

A Discovery

Today, the places where children get asthma care have weak ties to one another

The CHICAGO Plan learned that there is a disconnect between the asthma care children receive in emergency departments and the care they get in clinics, at school and at home. This causes gaps and fragmentation in treatment. People who care for a child with asthma need a way to coordinate their care with others. They also need to share critical information.

Download a larger version of the CHICAGO Cross Sector Model

Listen to the story of a community health worker (CHW) who discovers a child having an asthma attack: 10 Roadblocks to Caring for a Child with Asthma in Chicago

 

The Intervention

CHICAGO Plan starts in the emergency department

CHICAGO Plan seeks to improve the health outcomes of minority children with asthma who visit the emergency department. It compares three approaches to asthma care to see which is most effective.

Download a larger version of the CHICAGO Interventions.

 

The Innovation

A new asthma discharge tool built by everyone, for everyone

The CHICAGO Plan worked with communication designers to create a new asthma discharge tool. The designers worked with doctors, patients and caregivers to build a tool that is easy to read and use. It is designed to help everyone who cares for a child with asthma talk to each other about asthma management and asthma medicine. It is designed to work in the ED, at home, at school, and with families and outpatient doctors.

Download the Asthma Discharge Tool here

 

The Team

CHICAGO Plan is a unique cooperative

The CHICAGO Plan built an extraordinary new partnership model in asthma care. It included caregivers of children with asthma and their families. It also included community partners, local asthma research experts, six hospital systems, and the Chicago Department of Public Health. Together this new cooperative worked to create a better approach to asthma care for children and reduce the health disparities seen in Chicago.

Everyone counts in CHICAGO. We involved:

  • 6 Chicago Emergency Departments: their nurses, doctors and administrators
  • Caregivers
  • Children
  • Local asthma research experts
  • Community health workers
  • Community advocacy groups
  • Doctors who work in outpatient clinics
  • … and others

 

COMING SOON: Findings

Publications:

Martin MA, Press VG, Nyenhuis SM, Krishnan JA, Erwin K, Mosnaim G, Margellos-Anast H, Paik SM, Ignoffo S, McDermott M; CHICAGO Plan Consortium. Care transition interventions for children with asthma in the emergency department. Journal of Allergy and Clinical Immunology. 2016; 138(6): 1518-1525. doi: 10.1016/j.jaci.2016.10.012

Resources:

Project Partners

Respiratory Health Association

Chicago Asthma Consortium

City of Chicago Department of Public Health

Illinois Institute of Technology

Illinois Emergency Department Asthma Surveillance Program

NIH/NCATS Clinical and Translational Science Award Chicago Consortium

North Shore University Health System