Optimizing Health Outcomes for Children with Asthma in Delaware: A Population Health Case Report

Abstract

BACKGROUND The transformation of the U.S. health care delivery system is under way. As health care providers and community-based partners recognize the impact of the multifaceted determinants of health that extend beyond the clinical setting, there is an "opportunity for health care delivery systems, public health agencies, community-based organizations, and many other entities to work together to improve health outcomes in the communities they serve" (Stoto, 2013, p. 2). The Center for Medicare and Medicaid Innovation's Health Care Innovation Awards (HCIA) Round 1 funded 107 awardees to implement the most compelling new ideas to deliver improved care, better health, and lower costs to Medicare, Medicaid, and Children's Health Insurance Program enrollees, particularly those with the highest health care needs. Among the awardees was the Nemours Children's Health System's Optimizing Health Outcomes (OHO) for Children with Asthma in Delaware project, which tests a multifaceted model that incorporates a focus on the upstream determinants of health. Nemours Children's Health System's interest in HCIA grew out of a long-standing commitment to child health. In 2004, Nemours established an operational division called Nemours Health and Prevention Services to focus on preventing disease and promoting health, broadening the focus from the patient panel to the health of all of Delaware's children. For a decade, the division has operated alongside Nemours's flagship Nemours/Alfred I. duPont Hospital for Children and Nemours's primary and specialty care practices in the Delaware Valley. To enhance integration of clinical care and community-based prevention, as well as to achieve a broader mission of helping children grow up healthy, in 2011 Nemours established a leadership work group to develop a strategy to optimize health for Delaware's children. When the Innovation Center announced its competition for the first round of HCIA, the Nemours team identified an opportunity to further catalyze transformation. DESCRIPTION OF THE OPTIMIZING HEALTH OUTCOMES FOR CHILDREN WITH ASTHMA IN DELAWARE INITIATIVE On July 1, 2012, as part of the Innovation Center's HCIA Round 1, Nemours was awarded $3.7 million for a 3-year period to work with community partners in Delaware to better integrate clinical care with community-based prevention for children with asthma, including Medicaid beneficiaries. The target population comprises children with asthma receiving care in a family centered medical home at each of three Nemours primary care sites in Delaware, care that includes targeted clinical interventions for the more than 800 children enrolled in asthma registries. This nested model (see Figure 1) includes 42,000 children in six identified, associated 1 The project described was supported by Grant Number 1C1CMS331017 from the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), to Nemours. The contents of this publication are solely the responsibility of the authors and do not necessarily represe...

A Review of Community Health Worker Integration in Health Departments

“…Additionally, state health department sponsored CHW programs have shown economic benefits. The Delaware Public Health Department partnered with Nemours Children’s Health System to promote advancement of CHWs in a collaboration between community-based prevention efforts and clinical care for children with asthma [ 35 ]. Preliminary data suggested that ED visits decreased by 60% from 2012 to 2014 and healthcare costs for children with asthma decreased compared to children in the control group [ 35 ].…”