September 19, 2011
YCCI has partnered with the Children's Fund of Connecticut (CFC), a statewide public charitable foundation affiliated with Yale, the University of Connecticut and the CT Children's Medical Center, to jointly fund the 2011 Child Health Innovations Grants for research projects that promote and enhance high quality health care services for children and families.
Two projects that address some of the most prevalent health issues in children received awards in June 2011. Both fulfill CFC's vision of providing access to effective community-based health care for all children in Connecticut and YCCI's mission to improve the health of the community in New Haven and beyond.
Improving Asthma Care in the Latino Community
While treating Latino children of Spanish-speaking families in the emergency department, Antonio Riera, MD, assistant professor of pediatrics (emergency medicine), noticed that non-English speaking parents did not understand how to prevent worsening of symptoms and many families lacked an asthma action plan altogether. The problem seemed to stem from factors other than language barriers. "Even with the comprehensive interpreter services that we have at Yale, asthma management goals may not translate out into the community well," he said.
This observation prompted Riera to collect data on action plan use by parents. Data showed about a 20 percent difference in reported rates of use between English-speaking and limited English proficiency (LEP) families. To find out why this is the case, he is collaborating with JUNTA for Progressive Action, New Haven's oldest Latino community based non-profit organization, on a qualitative study to determine barriers surrounding asthma plan use by LEP parents.
"Communication and language aspects play a significant role in disparities experienced by Latinos and haven't been studied in any sort of rigorous fashion in any research I've come across," he said.
The study will consist of in-depth structured interviews to explore those facets of culture and language that have an impact on asthma plan use. After reviewing the data to determine recurrent themes, JUNTA will conduct interviews designed to stimulate conversation among LEP parents of asthmatic children. Riera hopes that conducting the interviews in a community center that has no affiliation with a doctor's office or university will enable the research team to draw forth meaningful responses.
The goal of the study is to use the feedback of the LEP Latino families to develop a tool that addresses their needs in a culturally appropriate manner. It could be an instructional video, an interactive website, or something as simple as promoting education through more exposure to commercials on Spanish TV channels. Whatever avenue is developed, Riera plans to test it with a group of families and follow them prospectively to determine if it makes a difference.
"To me, it's incredibly exciting to participate in this sort of community-centered investigation," said Riera. "We have the potential to make a difference for so many families and so many lives."
Co-Managing Patient Care Among Pediatric Primary and Subspecialty Practices
National shortages of pediatric subspecialists coupled with an increasing demand for these experts are undermining access to specialty care for children who need it. As Karen Rubin, MD, professor of pediatrics and head of the division of endocrinology at the University of Connecticut School of Medicine and PI on the second grant describes it, "One of the frustrations my colleagues and I experience as specialists is that we receive a lot of consults and believe that if we just took the time to educate the primary care providers (PCPs), they could probably manage a good proportion of these cases on their own. This would free up our schedules to see the kids that really need to be seen by us."
Rubin was used to offering guidance to primary care pediatricians in an informal way but demands on her time have increased in recent years, prompting her to devise a more structured system. She began by creating a template for a co-management plan. The plan has six key components including a service agreement, a pathway for managing the condition, templates for clinical decision support, a specialist feedback form, diagnostic and other support materials and patient and family-centered education materials.
Following a successful pilot study involving five conditions that showed this was a viable way to co-manage care, she is using the new award to test the program in one urban and one suburban primary care practice, where it will be used by all PCP staff members and patients who meet eligibility criteria. The four conditions used for the study all involve areas in which there are shortages of pediatric subspecialists: pediatric voiding dysfunction, migraine headache, concussion, and obesity co-morbidities. The program has an education component consisting of live CME or webstream video to train PCPs to participate in co-management. For this second study, patient outcomes will also be evaluated.
"We're anticipating that care is improved because the time to alleviating symptoms should be shorter due to the fact that patients won't have to wait to see a specialist - the PCP is initiating care from the beginning," said Rubin.
Co-management fits in well with the concept of a medical home, and Rubin believes that pediatric subspecialists have a role in building and participating in medical homes, by training and supporting PCPs to provide increased levels of care. "Co-management results in coordinated care and reduces redundancies and unnecessary high cost testing," she said. "I think that if it could become part of our practice culture, it really could have an impact on outcomes and costs."