Improving Connections Between the Family, Medical Home, and

School to Decrease Morbidity due to Asthma Exacerbations

Alberta Negri1; C. Graham, MD1; S. Ayli, DO2; K. Toole, DNP2; N. Zechella, MA2; T. Cunningham, RN2; D. Dreyfus, RN2; J. Watson, RN2; K. Britton, RN2; J. Dunbar, RN2; M. Van Scyoc2
1Cincinnati, OH, CCHMC Department of General Pediatrics; 2Cincinnati, OH, Price Hill Health Center

Methods (cont.)

Introduction
Every year, the nation faces formidable challenges due to asthma
complications: the US spends billions of dollars in medical costs; thousands of
children die from potentially preventable attacks; students miss innumerable
valuable school days.
Aim: decrease morbidity due to poor asthma management.
Primary cause of poor care coordination (Fig.1): after a physician visit,
schools are not given a copy of the appointments notes. The school is
missing tools for up-to-date asthma care management.
In 2013, a division of the Cincinnati Health Department staff took part in a
collaborative focused on asthma education: identified increased care
coordination as a potential method to improve asthma care.

Figure 2: Geographic distribution of patients.

Many of the initial patients missed visits due to
the hassle of commuting to the Health Center
(green marker): the majority of the 11 patients
who were present in the final analysis lived near
the Center.

An improved visit would:

Perform/document an ACT and review the Asthma Action Plan
Send the childs school a fax/send the parents home with a folder to bring
back to the school
Expect the school to send any information in a reciprocal fashion

Also suggest that increased communication is not only valuable for

drastically improving ACT scores to safer levels, but in fine-tuning
management skills.
Several patients were excluded from this graph due to insufficient data
points to represent an accurate trend.
Future studies would benefit from having a larger population sample and
longer data collection period.
Reasons for lack of improvement include comorbidities such as obesity
and blood pressure history.
Our method involved using folders or fax machines as the primary mode
of communication; however, an alternate study carried out by doctors at
Penn State University suggests that e-mail could help us better overcome
collaboration barriers [1]. A future study could include different types of
correspondence to determine which is most effective.
If this method worked for asthma management, perhaps it can also be
applied for issues such as hyperglycemia or hypertension.
If nurses and physicians would continue stressing communication in a
childs medical home, then expand this strategy to a larger scale, it may be
possible to increase more patient scores above 20.

Hypothesis: by improving communication between physician and

school, Asthma Control Test (ACT) scores will improve as well.

During the 2015-2016 school year, Price Hill HC medical staff began
implementing processes to encourage communication between the physician
and school. The initial study sample size was 63 children, however patients
would often miss visits, restricting the final pool to n=11 (Fig. 2).

Conclusion: Results support that enhancing communication

between physicians and medical homes in asthmatics can
benefit asthma management in most cases.

Results

Figure 1: Graph from a

preliminary study with the
PHHC medical staff on
what the main reason is
for poor communication
between branches of a
childs medical home.
Approximately 87% of the
issue is caused by
omitting the school from
the discussion.

Methods

Discussion

Figure 3: For an accurate measure of ACT score changes, only patients with at least three
data points were analyzed. A linear trend line was created for each of the patients, and these
lines were then superimposed upon each other on a single graph. The dotted line marks the
start of the ideal ACT score range. Blue indicates score increase, red indicates decrease.

References
Unable to report significance values due to lack of control group, however:
7 out of 11 (64%) cases showed overall increases in their ACT scores.
More importantly, out of the 6 children who initially had poorly-controlled
asthma, 4 of them (67%) finished with scores of 20+: this is the ideal range.
These four patients had a fairly intense trending increase in their scores.
For the 3 patients who already started with ACT scores 20+ and improved
throughout, their scores also increased, although moderately.

1. Ling Leong, S., MD, Gingrich, D., MD, Lewis, P. R., MD, Mauger, D. T., PhD, &
George, J. H., PhD. (2005, May 1). Enhancing Doctor-Patient Communication Using
Email: A Pilot Study [Abstract]. JABFM, 18(3), 180-188. doi:10.3122/jabfm.18.3.180

Acknowledgements
We would like to thank CCTST for providing the funding for this study, as well as the
Biomedical Research Internship for Minority Students (BRIMS) for partnering the
student researcher with a mentor and project.