P0022 - Leveraging IT Tools and Analytics Decreases ED Return Rates for Children with Asthma

Background: Asthma is one of the most prevalent conditions in pediatrics and crosses the continuum of care. Rady Children’s Health Network (RCHN), a clinically integrated network has a prevalence of asthma of 8.6% (compared to 8.3% nationally). We have a predominance of patients requiring ED with Medicaid insurance. Overall, 71.6% patients presenting to our ED in the measurement year (2019) had Medicaid insurance, 22.3% had commercial coverage, and 6.1% unknown. Utilizing population health initiatives, we identified opportunities for improvement to proactively engage and educate. IT tools were utilized to help track outcomes for patients.

Design: We designed an IT tool to track patients through a Call Back Pilot with the Respiratory Therapist (RT) Team to call patients seen in the emergency room for an asthma. A Population Health Clinical Informaticist created a dashboard that identified eligible patients and tracked related outcomes including return visits. RTs used this platform to interact with families after a recent exacerbation to ensure patients understood their condition and medications while connecting them to appropriate services, including their primary care physician. Using the dashboard, we are able to routinely monitor 7-day and 30-day Emergency Department (ED) return rates. The dashboard calculates rates based on timeframe, whether the patient received a call, group types, insurance, and age.

Results: Analyses were conducted using Stata 16 (College Station, TX). Two sample tests of proportions were calculated to compare ED return visits at 7 and 30 days between patients who received a follow-up call and those who did not. Overall, and by insurance comparisons were made. The overall odds of not returning to the ED was 3.5 times higher among patients who received a follow-up all when compared to those without a follow up call (95% CI = 2.2,5.7). The odds of not returning to the ED within 30 days was 2.0 times higher in patients with follow up calls when compared to patients without follow up calls (95% CI – 1.5, 2.6). For Medicaid patients, the 7-day and 30-day ED return rates decreased from 7.92% to 2.87% and 13.6% to 2.87%, respectively (P<.001). (Table 1). For patients with Commercial insurance, the 7-day and 30-day ED return rates decreased from 6.26% to 0.405% and 9.39% to 3.64%, respectively (p<.01) (Table 2). In total, contact was made with a third of patients seen in ED for an asthma.

Conclusion: Our results are encouraging and demonstrate the impact of providing after visit contact, education, and care coordination for children with asthma. Immediate outreach for patients with asthma resulted in reduced 7-day and 30-day ED return rates. RT outreach can be a valuable asset to provide education. These initial results show promise for improving overall outcomes for patients with asthma after ED visits.