- Monitoring and controlling childhood asthma presents many challenges.
- The CHAMP program in Shelby County, Tennessee, is tackling these issues proactively.
- Using a multifaceted community approach, program officials say they are making a real difference in people’s lives.
- They say the improvements include reduced exacerbations, fewer emergency department visits, and reduced costs.
In the United States, about
In 2020, childhood asthma resulted in 270,330 visits to the emergency department and 27,055 hospital inpatient stays.
Hospitalization rates for children with asthma, however, are not evenly distributed.
In a new paper, it’s reported that the highest rates of pediatric hospitalizations in Tennessee is in Shelby County, which is home to around 925,000 people.
In this region, each year there is an average of 1,996 emergency department visits and 165 hospitalizations for asthma per 100,000 individuals.
These visits are more common in people enrolled on TennCare, the Tennessee Medicaid program, than those with private insurance.
In addition, the paper notes that children with asthma tend to be concentrated in areas with fewer primary care options.
In 2012, the Le Bonheur Children’s Physicians and Community Outreach division set up an innovative program to address this need. They called it the Changing High-Risk Asthma in Memphis through Partnership (CHAMP).
The CHAMP program aims to “improve asthma management for children who experience frequent and severe asthma exacerbations and preventable hospital visits.”
Recently, some of the members of CHAMP published their new paper in the Annals of Allergy, Asthma & Immunology, charting their methods and successes to date.
Their methodology is based on these principles:
- Using evidence-based methods.
- Establishing good relationships with individuals and the community.
- Improving the healthcare experience.
- Hiring employees who represent the demographics of the population.
- Improving access to care when people truly need it.
- Addressing the social determinants of health.
“These high-risk asthma patients would come to see us in clinic and it was evident that we care about them, but once they left, we might as well be on Mars,” explained Dr. Christie Michael, CHAMP’s medical director, in a statement.
“We were looking at people in snapshots rather than taking into account all risk factors they faced,” she added. “Our results show that taking down the walls of the clinic and going to where kids live, play, and go to school has been a success.”
Medical News Today spoke with Michael about how she first got interested in asthma in children.
“I did all of my medical training in Memphis. During that time, I cared for so many children with asthma and recognized the need for more data and resources to optimize their care,” she said.
“I also developed an appreciation for the difficulties regarding access to care,” Michael added. “Others felt the same, so with LeBonheur’s support, we assembled like-minded people to pursue the grant from CMS [Centers for Medicare & Medicaid Services] and to comprise our CHAMP team.”
From January 2013 to December 31, 2022, the CHAMP program enrolled 1,348 children. In their analysis for the recent paper, program officials included data from 945 children who had completed one full year of the program.
Of the 945 children, 63% were male and 90% were Black, with an average age of nearly 7 years.
All children were considered high risk, meaning that they fulfilled at least one of these criteria:
- Three or more asthma-related visits to the emergency department or urgent care in the past year.
- At least two asthma-related hospitalizations in the past year.
- Admission to the intensive care unit (ICU) at any time during their life.
Children with high-risk asthma often face many barriers to care. For instance, finding transport to visit clinics or collect medicines. And because out-of-hours care is almost non-existent in Shelby County, the emergency department often becomes the default.
CHAMP helps address some of the shortfalls experienced by people in this community. They have a transportation service and a team of experts operating 24 hours each day.
This team includes community health educators who make home visits and a respiratory therapist who helps coordinate care. They also partner with services to tackle environmental asthma triggers and social determinants of health.
“Relationships are a huge part of what makes CHAMP successful so that families know who we are and who they are dealing with,” explained Michael.
“[Community health educators] have relationships with families and can be an extra set of eyes to help us know about any needs — utility bill payments, food shortages, or the need for asthma education reinforcement,” she added.
In their recent paper, program officials outlined some of the positive impacts the program has had on the children it supports.
For instance, these children had:
- A 58% reduction in emergency department visits.
- A 68% reduction in inpatient and observation visits.
- A 42% reduction in urgent care visits.
- A 53% reduction in total asthma exacerbations.
Also, the number of asthma exacerbations per children decreased from 2.97 to 1.40 after one year of enrollment.
CHAMP also runs a 24-hour phone line where caregivers can receive support and advice. Between November 2013 and December 2022, 415 people made 1,053 calls.
More than half of these calls (58%) were after hours and 52% of calls led to resolution without a visit to a medical facility.
“I am not surprised the program has been successful, but I might not have predicted how successful it would be, and that we would have consistent results over 10 years,” Michael said.
Dr. Toby Lewis, an associate professor at the University of Michigan and the director of the Complex Asthma Management Program, said he also is not surprised by the results.
“I’m not surprised by CHAMP’s success — these kinds of comprehensive, wrap-around approaches that address the multiple contributors to asthma morbidity simultaneously are really the best way to tackle this complex problem,” Lewis told Medical News Today.
“I was particularly impressed by the way CHAMP worked to coordinate efforts between family in their home and school, and multiple care providers across different health systems,” she noted.
The CHAMP program has also significantly reduced costs for insurers.
After receiving the 3-year CMS grant, program officials employed a third party to conduct a cost analysis. The analysis showed that CHAMP reduced healthcare costs by $2,180 per child per year.
“There is interest in expanding CHAMP, but first we need to make it sustainable,” Michael said.
“After the grant period ended, we had to run hard to remain in place,” she said. “The cost is better for insurance companies but does not account for community team salaries and components of the program run by the medical team, which are reimbursable in the current system.”
Lewis said projects such as CHAMP should be rolled out more widely.
“While I would advocate for tailoring to local needs, strengths, and population, I think that all communities with high-risk asthma patients would benefit from the general approach,” she said.
“I would go so far as to say that there are applications to other kinds of high-risk disease conditions — like diabetes, sickle cell anemia, congestive heart failure, and [chronic obstructive pulmonary disease] to name a few — that could benefit from a similar approach,” Lewis noted.
Still, Lewis believes CHAMP can be further improved by answering questions including, “How can we best help the families that didn’t enroll or who dropped out before a year? Are there other program elements that that might be a useful addition?”
Some of these potential elements could include “the addition of a social worker or psychologist for behavioral health support, coordination with other community programs, like for safe housing, food assistance, and more.”