Addressing Environmental Triggers: Increasing Referrals to Asthma Home-Based Services in the Twin Cities
Asthma is the most common chronic childhood disease. Exposure to environmental triggers in the home such as animal dander, smoke, and dust mites can lead to poor asthma control and increased ED visits and hospitalizations; trigger reduction has been shown to improve patient outcomes.1 Asthma Home-Based Services (AHBS) are county level programs which provide in-home assessment and mitigation of environmental triggers, in addition to teaching about medication adherence and inhaler technique. Despite reducing asthma symptoms and improving control, AHBS utilization has remained low.
Problems we identified:
The program is not well known to healthcare providers
Each MN county has its own referral process making it burdensome for providers to refer their patients
24% increase in overall referrals post-intervention:
Pre-intervention 9/2022-2/2023: 49 referrals
Post-intervention 9/2023-2/2024: 60 referrals
January and February 2024 had the greatest increase in referrals
All programs excluding Minneapolis demonstrate an increase in referrals post-intervention
No trends, shifts, or astronomical points; appropriate number of runs relative to number of data points
Limitations of data:
Only reflects referrals placed; does not include relative number of asthma exacerbations (ER visits, hospitalizations) during pre/post-intervention periods
Does not reflect number of AHBS referrals which were offered but refused by family or which referrals resulted in a home visit
Multiple interventions were implemented simultaneously, thus making it difficult to quantify the effects of each individual intervention
Did we meet our aim?
We did not meet our goal of a 50% increase in referrals, but saw an increase of 24% within a 6-month period. → This demonstrates that improvement of AHBS program referrals is possible with the implementation of a standardized form and increased physician awareness.
Why could our interventions have been less effective than expected?
Differences in number of asthma exacerbations seen each year due to changing patterns of respiratory infections
Adherence to referral recommendations dependent on teaching which may be forgotten over time or with staff turnover; lack of “hard-wired” reminders
References
DEPARTMENT OF PEDIATRICS
Collect more data!
Address limitations of our data and continue to follow post-intervention referrals over a longer period of time
Expansion of the standardized form to other hospitals (HCMC)
More resident training, EMR integration into asthma admission workflow
Data on # of completed home visits
Advocacy for improved equity of services to highest need areas
Future Directions
Conclusion/Discussion
Aim
By 02/29/24, our team will increase the gross number of asthma home-based services referrals across chosen metro-area counties by 50%.
Rationale: address provider knowledge & utilization of AHBS
Interventions took place across three sites University of Minnesota Masonic Children’s Hospital, Children’s Minnesota (St. Paul and Minneapolis), and three provider groups; hospitalists, residents, pulmonologists
We defined our pre- and post-intervention time periods (9/2022-2/2023, 9/2023-2/2024) to account for the typical seasonality of asthma exacerbation rates