Improving the care of children with frequent asthma admissions through partnerships with hospitals, GPs and families
Professor Harriet HiscockFull Bio
Murdoch Children’s Research Institute
Northern Health; Royal Children’s Hospital; The University of Melbourne
This project aims to identity modifiable: (1) health system, (2) primary care, and (3) family factors associated with asthma re-admissions.
We will follow a group of children who were admitted to one of three hospitals for asthma treatment in 2017. We will compare a group of children with at least 1 subsequent asthma re-admission in 2018 to the group of children who are not re-admitted during this time.
We know from previous studies that to keep children out of hospitals, partnerships between hospitals, GPs and families are important. We will therefore identify modifiable differences in the hospital management between these two groups of children, i.e. whether an asthma action plan was given, preventer medication was prescribed when indicated and follow-up was arranged. We will identify differences in treating GPs’ understanding of asthma and adherence to best practice guidelines. Families provide the day to day care for children with asthma and are ideally placed to drive and coordinate care. We will interview families to better understand their knowledge of asthma, how they manage an asthma attack, any problems with access to health services and medications, and what may stop them giving their child their preventer medications.
Expansion activities funded through the MRFF RART 2.2 Scheme include co-designing and testing across the Australian Hospital Research Network of an innovative model of care (app) to increase family and GP care for children with asthma in the community. Health services guidelines will also be revised and GP education programs developed based on findings from the study.
This project is supported by the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation program.
Findings will inform better asthma care through (i) dissemination to clinicians and families and (ii) future interventions. We will disseminate findings through the Victorian Paediatric Clinical Network (network of hospitals caring for children), GP electronic guidelines, and journal publication(s). Project partners will use findings to develop and test novel interventions.
At completion of the funding period, we have designed and implemented an electronic medical record outpatient Asthma Hub to improve the quality of asthma care at The Royal Children’s Hospital. The Hub automatically captures data on the patient’s severity phenotype and guides clinical decisions. The Hub also automatically prompts the clinician for a referral to the relevant community asthma service depending on the patient’s address. Our multidisciplinary Asthma Quality Improvement group completed the “Adolescent preventer treatment in adolescents 12 years plus” guideline which is integrated in the RCH Clinical Practice Guideline used widely nationally and internationally. We have also built an eLearning package on this guideline which is housed on the externally facing RCH eLearning platform supported by the Education Hub.
We are working on extending the use of the electronic Asthma Hub to the inpatient and emergency settings to facilitate a holistic review of each child’s asthma management at each exacerbation. Through securing funding from the Victorian Government for the Improving Childhood Asthma Management program in inner west Melbourne, guided by the care gaps and potential solutions delineated in the CARE study, will be delivering improved asthma care to children in the community beyond the Royal Children’s Hospital.
- Chen KY, Jones R, Lei S, Shanthikumar S, Sanci L, Carlin J, Hiscock H. Primary health care utilization and hospital readmission in children with asthma: A multi-site linked data cohort study. J Asthma 2023:1-12. doi: 10.1080/02770903.2022.2164200 [published Online First: 2023/01/04]
- Jones R, Hiscock H, Shanthikumar S, Lei S, Sanci L, Chen KY. Exploring gaps and opportunities in primary care following an asthma hospital admission: a multisite mixed-methods study of three data sources. Arch Dis Child 2023 doi: 10.1136/archdischild-2022-324114 [published Online First: 2023/01/05]
- Chen KY, Chu W, Jones R, Vuillermin P, Fuller D, Tran D, Sanci L, Shanthikumar S, Carlin J, Hiscock H. (2022). Modifiable factors associated with pediatric asthma readmissions: a multicentre linked cohort study. Journal of Asthma. doi:10.1080/02770903.2022.2089996
- Jones, R, Turner, B, Perera, P, Hiscock, H, & Chen, K. (2021). Understanding caregiver perspectives on challenges and solutions to pediatric asthma care for children with a previous hospital admission: a multi-site qualitative study. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 1–8. https://doi.org/10.1080/02770903.2021.1984528
- Chen, K., Saxon, L., Robertson, C. and Hiscock, H. (2021). Reducing asthma hospitalisations in at-risk children: A systematic review. J Paediatr Child Health. doi: https://doi.org/10.1111/jpc.15666
- Chen K, Lawrence J, Berry A, Hiscock H, Robertson C. (2020) Can Burst Ventolin Therapy be safely given at home to reduce emergency and hospital presentations with asthma in children? J Paediatr Child Health. 56:1657-1658, doi: https://doi.org/10.1111/jpc.15153
- Asthma preventer treatment in Adolescents clinical practice guideline https://www.rch.org.au/clinicalguide/guideline_index/Asthma_preventer_treatment_in_adolescents_12_years__/
- Hiscock H, Chen K. Asthma and staying out of hospital; 2020. Available from: https://pursuit.unimelb.edu.au/articles/asthma-and-staying-out-of-hospital