Short or long end of the lever? Associations between provider communication of the “Asthma-Action Plan” and outpatient revisits for pediatric asthma

Objective: At the Children’s Hospital of Georgia (CHOG), we found that outpatient revisits for pediatric asthma were significantly above national norms. According to the NIH, costly hospital revisits for asthma can be prevented through guidelines-based self-management of asthma, central to which, is the use of a written Asthma-Action Plan (AAP). The asthma services literature has emphasized the role of the healthcare provider in promoting asthma self-management using the AAP, to prevent hospital revisits. On the other hand, the asthma policy literature has emphasized the need for a community-based approach to promote asthma self-management. A gap remains in understanding the extent of leverage that healthcare providers may have in preventing hospital revisits for asthma, through effective communication of AAP in the outpatient setting. Our study sought to address this gap.

Methods: We conducted a 6-month intervention to implement patient-and-family-centered communication of the AAP in CHOG outpatient clinics, based on the “change-management” theoretical framework. Provider communication of AAP was assessed through a survey of “Parent Understanding of the Child’s AAP”. A quasi-experimental approach was used to measure outpatient revisits for pediatric asthma, pre- and post-intervention.

Results: Survey results showed that provider communication of the AAP was unanimously perceived highly positively by parents of pediatric asthma patients, across various metrics of patient-and-family-centered care. However, there were no statistically significant differences in outpatient “revisit behavior” for pediatric asthma between pre- and post-intervention periods after controlling for several demographic variables. Additionally, revisits remained significantly above national norms.

Conclusions: The study suggests that effective provider communication of the AAP by itself, may have limited potential to reduce hospital outpatient revisits for pediatric asthma. Results indicate the need for a broader community-based approach to address patient life variables impacting self-management and hospital revisits for pediatric asthma. Findings suggest need for a revised “socio-ecological” theoretical framework, and also provide insight into various research and practice implications for asthma management and control.