Care Transformation Center Blog

How school-based asthma care saved one health system $6.7 million

by Tomi Ogundimu and Petra Esseling

Each year, 1 in 5 children in the United States visit the ED at least once, often unnecessarily. A major driver of this preventable ED use is asthma. That's true across the country, but particularly in Illinois, which has one of the highest asthma morbidity and mortality rates in the United States. Mobile Care Chicago made it their mission to improve access to asthma services in Chicago neighborhoods that are short on asthma specialists.

Mobile Health Clinics: How to improve access to care for the underserved

Mobile Care Chicago is a non-profit organization that delivers no-cost care and support to low-income families via mobile medical clinics. Two of their vans specifically target asthma patients, which has helped them accomplish their mission of reducing asthma-related ED use and producing savings for the local health system.

How did they do it? Here are four major lessons you should take away from their program:

1. Schools are ideal grounds for the proactive identification of children with asthma

For Mobile Care Chicago, everything hinges on proactive identification. Every year, a community health worker visits each of their 47 partner schools in Chicago to distribute a survey that helps to identify patients with asthma symptoms who may require services.

The survey includes five standardized yes/no questions that children fill out with their parents. Patients with asthma symptoms are contacted via phone to schedule an appointment with the Asthma Van.

2. Convenient access to care, location, and time ensures ongoing services

Each month, Mobile Care Chicago's asthma vans go to partnering schools to diagnose asthma. At each location, staff provide education and ongoing treatment to children who lack access to allergy and asthma specialists.

Appointments are scheduled during class sessions to ensure that patients are already at the site of care and caregivers don't have to travel far. On average, each patient visits a van four times per year during the first year of enrollment to reassess symptoms across seasons and refill needed medications, free of charge.

3. Re-education across each mobile care team member interaction reinforces self-management skills

Each visit takes up to 45 minutes and involves multiple staff members. First, the driver of the van (also a clinic technician) takes the patient's vital signs, after which the medical assistant reviews the patient's medical history, performs an asthma control test, and provides education. Then, a nurse practitioner reviews medication plans, develops or adjusts the patient's treatment plan, and reinforces education.

4. If clinical care remains ineffective, deploy a non-clinical team member to address social needs

If no progress is measured year-over-year, Mobile Care Chicago deploys regionally-based community health workers (CHWs) to perform a home visit to determine if external factors are hindering clinical improvement. The CHW identifies asthma triggers (e.g., presence of smokers, cats, or dust, lack of cleanliness) in the home that may exacerbate symptoms. If necessary, Mobile Care Chicago partners with the American Lung Association and Chicago Tenant's Association to address related problems.

For patients connected with the Asthma Van, hospital or ED visits for asthma symptoms dropped from 36% to 3% within one year of treatment, which saved the local health care system an estimated $6.7 million.

May 17 webconference: Care Management 101

Join us for a webconference on Thursday, May 17 at 3 p.m. ET where we'll provide an introductory review of the five key attributes of effective care management organizations—from patient recruitment through graduation.

Register Here