Dallas is known for its gleaming office towers, sparkling entertainment venues and booming economy.
But it’s not all glitz in Dallas. The city has pockets of poverty along with the health challenges that brings. One such challenge is childhood asthma, which affects more than 60,000 children in Dallas County alone. The direct medical costs and indirect costs to county taxpayers exceed $60 million annually.
“One in 10 children in Dallas County has asthma,” says Matt Moore, vice president of government relations and public policy for Children's Health, a winner of this year's American Hospital Association NOVA Award. “Looking at our own data, we realized that asthma was among the top five reasons that kiddos came to our [emergency department].”
Moore says the data convinced Children's Health that it needed to “do more in the clinical pathways and treatments provided to the kids who have asthma in our region, and more in reaching out to other community partners to address kids’ health and wellness before they become sick.”
To that end, in 2012 Children's Health organized the Health and Wellness Alliance for Children. The alliance comprises a broad coalition of stakeholders, including local health systems, health insurers, school districts, the Environmental Protection Agency, local health departments, faith-based organizations, and organizations such as the YMCA, United Way and the American Heart Association.
As its first area of focus, the alliance established the Childhood Asthma Program. The program was designed with a “collective impact” approach, which calls for organizations to align around difficult social problems.
Through its various work groups, the alliance addresses asthma wellness issues, such as clinical care access and delivery. One work group evaluated ways to decrease asthma triggers in the air and in the built environment. Another focused education to better equip children, families and other caregivers in asthma self-management.
Children's Health effectively used technology as part of its program, establishing a school-based telemedicine program that links its physicians with 100 school nurses throughout North Texas. “In that way we’re able to treat symptoms of asthma before they become emergency conditions,” Moore says. It also distributed “My Asthma Pal,” a smartphone app that enables children and their parents to customize an asthma action plan. In addition participants are encouraged to use a Bluetooth device that fits on top of an asthma inhaler to track whether, when and how kids are using their inhalers.
“If they're overusing it, the physician can call the family and make sure everything is OK,” Moore says. “If they're not using it enough, the physician can call the family and make sure everything is OK. It's about managing the population health for the kiddos who are coming through our system, as opposed to sitting back and waiting for them to get sick and show up in the [ED].”
Recognizing that changes to Dallas city housing codes were essential to changing the physical environments of children with asthma, the alliance successfully advocated to upgrade city housing standards in order to decrease common triggers such as mold, cockroaches and extreme temperatures.
The clinical, community and technological initiatives together nearly cut in half the number of unique patients visiting the Children's Health ED with a primary diagnosis of asthma between 2012 and 2016.
“That's a testament to what a population-based community strategy can do,” Moore says. “If you want to improve population health in a community, a health care provider simply can't do it alone. You have to partner with community organizations. You have to reach kids where they live and where they learn and where they play.”
Each year, the American Hospital Association honors up to five programs led by AHA member hospitals as “bright stars of the health care field” with the AHA NOVA Award. Winners are recognized for improving community health by looking beyond patients’ physical ailments, rooting out the economic and social barriers to care and collaborating with other community stakeholders. The AHA NOVA Award is directed and staffed by the AHA's Office of the Secretary. Visit www.aha.org/nova for more information.