Emergency Departments

Challenging Assumptions: The Emergency Department Demonstration Program

Treating children with asthma in emergency departments (ED) is not only costly, but in many cases, unnecessary. Research shows that ED visits typically cost five times as much as primary care visits, and 17 percent of all pediatric ED visits could be eliminated by proper therapy.

What can be done to counter this problem—and maximize delivery of care for children with asthma?

Program Highlights and Outcomes

Challenging conventional wisdom about what is possible in the rushed and strained atmosphere of most emergency departments, the Emergency Department Demonstration Program (EDDP) sought new answers: Could ED visits help parents learn how to manage their children’s asthma? Can ED staff successfully initiate long-term therapy for children with asthma, link these children to primary care for long-lasting asthma control, improve their quality of life and reduce their ED visits?

Perhaps most importantly, the project set out to investigate whether emergency departments can serve as drivers of system change, and not only impact how children’s asthma is treated locally, but how all emergency medicine professionals approach chronic disease therapy.

Highlights from the program:

  • Each site used a data system to track patients’ asthma severity, access to care, emergency department visits, hospitalizations and other factors.
  • Researchers found that these emergency department-based tracking systems can enhance understanding of the local pediatric asthma population and inform clinical and educational interventions.
  • All program sites found that an unexpectedly high number of children receiving ED treatment could be classified as having “mild intermittent” asthma, a finding that points to the need for more study and updated recommendations for children in this category.

EDDP Program Sites

For an executive summary of the program, including research strategies, tactics and results, click any of the EDDP program titles below:

girlHawaii Child Asthma Research to Elevate Standards (Hawaii CARES)

Honolulu, Hawaii

“To move Oahu treatment standards towards NAEPP guidelines, we took what we knew to the community, using the emergency department as a center of outreach to local physicians,” says Rodney Boychuk, M.D.

 

EDTexas Emergency Department Asthma Surveillance (TEDAS)

Houston, Texas

“Our studies challenged two assumptions,” says Charles Macias, M.D. “The first is the widely held belief that it is impossible to accurately address the chronic severity of a child’s asthma in the emergency department. The second is that children and families are too stressed and fatigued while they are in the ED to learn.”

 

girl with inhalerEmergency Department Allies (ED Allies)

Milwaukee, Wisconsin

“This project shows how important common medical records are to promote better health,” says lead investigator Kevin Kelly, M.D. “Adding supplemental tracking is very beneficial and gives a picture so specific that it can be used to shape a particular child’s care.”

 

dr and patientImproving Pediatric Asthma Care in the District of Columbia (IMPACT DC)

Washington, D.C.

“Our study was designed to exploit the ‘teachable moment,’” says Stephen Teach, M.D. “It was also comprehensive and highly family- and patient-centered, an approach that has been shown to be especially important to inner-city families.”