GRASS-ROOTS QI
GRASS-ROOTS QI
High hospitalization and lost productivity for pediatric asthma patients and their families prompted Spectrum Health in Grand Rapids, MI, to craft an innovative pediatric asthma management project. This capitated inpatient system aims to improve overall pediatric asthma outcomes by apportioning capitation dollars to community care. Spectrum’s pediatrics care facilitators Lillian DeLaat and Sibyl Biles and director of Outcomes Management Janice Schriefer explain the pilot phase involving 12 medical practice test sites.
o Problem
Chart reviews showed that 100 of Spectrum’s patients with DRG 98 diagnoses had 1,000 outpatients and 150 inpatient stays of one to two days. Challenges included:
• Inconsistent patient care protocols.
• Delayed starts on steroid regimens.
• Inconsistent and incomplete distribution of patient education materials.
• Underutilization of Visiting Nurse Association’s home assessment programs.
o Solutions
1. Two pediatrician volunteers adapted clinical practice guidelines from those of the Washington, DC-based National Asthma Education & Prevention project at the National Heart Lung and Blood Institute.
2. A standard consumer education packet is put together.
3. DeLaat and Biles visit high-risk families at community test sites.
4. Two-month baseline data pinpoints improvement goals: 56% of patients had care plan, 15% of families missed work due to kids’ asthma, 48% of kids’ activities affected, and 44% of kids’ sleep impacted. Parents say, "Teach us more about home management of asthma."
o Solutions
Interventions expected to have greatest impact:
• Consumer educational packets.
• Clinical practice guidelines.
• Full-time pediatric care facilitators.
While this project is still in the pilot phase, it models an inpatient facility’s community outreach to community physicians and families with the aim of preventing unnecessary hospital admissions and lost productivity.
o Keys to success
Volunteer pediatrician assistance; cooperation by test-site physicians.
o Contact
Lillian (Lill) DeLaat, Pediatric Care Facilitator, Spectrum Health, Grand Rapids, MI. Telephone: (616) 391-3866.
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