EDDP Press Release


November 2, 2006

Studies Help Emergency Departments Break Cycle of Dependence in Children’s Asthma

RWJF-Funded Research Finds Emergency Department-Based Intervention Can Reduce Return Visits for Chronic Disease by 40 Percent

Princeton, NJ – Early and consistent education during and after a visit to the emergency department is the key to successful long-term management of pediatric asthma, says recent research supported by the Robert Wood Johnson Foundation. One study shows that educational intervention can reduce emergency department visits for asthma by 40 percent.

Over five years, Managing Pediatric Asthma: Emergency Department Demonstration Program (EDDP), a national initiative of the Robert Wood Johnson Foundation, sought to monitor trends in pediatric asthma and asthma care; implement emergency department-based interventions that improve clinical care delivery and patient, family and caregiver education; and create sustainable strategies for dealing with asthma in the emergency department.

“Our studies challenged two assumptions,” says Dr. Charles Macias, director of the Texas Emergency Department Asthma Surveillance (TEDAS), one of the four sites awarded a grant through the EDDP. “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 emergency department to learn how to better manage asthma.”

“For many children, especially those in major cities, the emergency department is the primary source of asthma care,” says Dr. Stephen Teach, medical director of IMPACT DC, a pediatric asthma surveillance, research and intervention project located at Children’s National Medical Center. “We are attempting to break this cycle of dependence.”

This is particularly important information for cities and health systems with high rates of emergency care for pediatric asthma. Each year, children with asthma make approximately one million visits to emergency departments for care, and in cities like Washington, D.C., where children often have poor geographical access to primary care, the number of visits can skyrocket in the fall and winter—“high season” for asthma exacerbations.

Nationwide, the emergency department is the costliest place to receive care—one visit costs five times that of primary care. However, less than 20 percent of children seen in the emergency department follow up with primary care providers for treatment. Because emergency departments do not traditionally focus on long-term aspects of care (such as education and controller medications), many children develop unhealthy patterns of emergency department recidivism. Yet costly and repeat visits to the emergency department for children with asthma can be avoided, according to this new research.

The Emergency Department Demonstration Program focused on U.S. cities with inordinately high pediatric asthma rates, including:

  • Washington, D.C.: District children under the age of 5 with asthma visit emergency departments five times more than children nationally, and the vast majority of these visits are made by those from the most disadvantaged parts of the city.
  • Houston: According to the American Lung Association of Texas, about one million Texas children suffer from asthma, and the numbers continue to increase. Each year, 200,000 children in Texas are hospitalized due to asthma.

“We see the project sites in Washington, D.C., and Houston, as laboratories developing models that can be replicated throughout the country,” said program director Gary Rachelefsky, M.D., a past president of the American Academy of Allergy, Asthma and Immunology. “The emergency department provides a unique setting for interventions, and we’re finding that families may be more receptive to information about prevention and care immediately following an acute attack than during a routine visit to their regular physician.”

Washington, D.C. Program Results

Surveillance data from IMPACT DC clearly shows how poor access to primary pediatric care in Washington, D.C., results in fewer scheduled asthma visits. “We see 1 percent of all the pediatric emergency department visits for acute asthma in the United States in our own emergency department in central Washington, D.C.,” says Dr. Teach. “Our mapping demonstrates strong local racial, ethnic and economic disparities in asthma care and outcomes. ED visits are most common among children from areas marked by poverty, high concentrations of minority residents and poor spatial access to primary care.”

In response, Dr. Teach created a model that meets parents and their children with asthma where they are—in the emergency department. Though he and his team emphasized linking to primary care providers, they also encouraged children and families to return to the emergency department two to 15 days after an acute visit for asthma for a single, 90-minute educational session aimed at helping them take charge of asthma. Seventy percent of 488 children followed through with their appointments. At six months, significantly more children in the intervention group reported use of asthma control medications and no functional limitations on their quality of life due to asthma. In addition, they made 40 percent fewer ED visits for asthma during the follow-up period. The study was published in the May 2006 issue of Archives of Pediatrics & Adolescent Medicine. For more information about IMPACT DC’s surveillance of pediatric emergency department visits and intervention models, visit www.impact-dc.org.

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

Houston, TX Program Results

In Houston, where another 1 percent of the nation’s children with asthma seek emergency care at Texas Children’s Hospital, Dr. Charles Macias and the TEDAS team designed education and interventions to help emergency room physicians diagnose children’s asthma severity and to help families gain confidence in managing children’s asthma in the long-term.

Study results show that, with proper training, emergency department staff can assess asthma’s chronicity and severity in the youngest patients, leading to better chronic care plans. The educational intervention for parents and children resulted both in increased levels of confidence and increased numbers of well-asthma visits among participants. The study also decreased the need for subsequent emergency department visits by participants. Both models have been adopted by hospitals in southeast Texas to improve care for the more than 53,000 children who seek asthma care there each year.

About the Emergency Department Demonstration Program

Directed by the American Academy of Allergy, Asthma and Immunology, the program was based at pediatric asthma care centers in Milwaukee, Honolulu, Washington, D.C., and Houston. Each developed tracking systems that gathered data and identified logical points of community intervention. Each center partnered with four to six emergency departments where asthma-related visits represent an opportunity to educate patients and their families about the disease and how to better control it.

The Emergency Department Demonstration Program was one of a group of RWJF-funded programs promoting better management of pediatric asthma. Related initiatives included testing approaches to improving publicly financed asthma care, coalition-building, providing training on asthma control to primary care physicians, analyzing the barriers to treating asthma and financing care, and a blueprint for policy action.

About The Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need—the Foundation expects to make a difference in our lifetime.


Betsy Parkins