Hospital awarded $7.9M grant for pediatric asthma care

November 14, 2017

The National Heart, Lung and Blood Institute (NHLBI) has awarded a $7,999,307 grant to Rhode Island Hospital to develop a community-based asthma care implementation program (ACIP) to address disparities in asthma outcomes in children. The center – one of only four in the country – will help determine both best practices for improving asthma outcomes among high-risk children with asthma and long-term program sustainability.

“Nationally we are in need of coordinated systems of asthma care and this initiative represents a first step in building a sustainable delivery model for evidence-based pediatric asthma interventions,” said co-principal investigator Elizabeth McQuaid, Ph.D., staff psychologist at Rhode Island and Hasbro Children’s Hospitals and a professor of psychiatry, human behavior and pediatrics (research) at the Alpert Medical School of Brown University.

The rate of asthma morbidity in the United States is increasing year after year and according to the American Lung Association’s 2012 report, “Trends in Asthma Morbidity and Mortality,” racial and ethnic minorities have greater prevalence and higher rates of urgent health care use such as hospitalizations, where the rate for minority groups can be as much as three times higher than that of whites. Locally, according to the Rhode Island Department of Health, Rhode Island has recently seen an increase in emergency department visits and hospitalization rates (up 2.2 percent and 10.9 percent respectively in 2014) after previously showing a decline.

“We’ve been invested in providing high-quality pediatric services to children at high risk for over two decades. This project builds on our research and intervention efforts with urban families, allowing us to make comprehensive asthma care services more tailored to childrens’ specific needs, and more accessible to at-risk families in a way that’s less burdensome to them,” said co-principal investigator Daphne Koinis-Mitchell, Ph.D., a staff psychologist at Rhode Island Hospital and Hasbro Children’s Hospitals and an associate professor of psychiatry and human behavior and pediatrics (research)  at the Alpert Medical School of Brown University.

With this funding, asthma researchers McQuaid and Koinis-Mitchell will be examining 16 targeted communities. They will evaluate the effectiveness of an integrated system called the Rhode Island Integrated Response Program (RI-AIR), created to identify children with asthma living in the most afflicted /high-risk areas, conduct screening, and refer to their evidenced-based interventions. The assessment will center around approximately 1,500 urban, ethnically diverse children with asthma and their families over a period of six years and will include a review of program effectiveness among communities and school districts, families’ acceptance of the program, and long-term program sustainability.

McQuaid and Koinis-Mitchell, also researchers at the Hassenfeld Child Health Innovation Institute (HCHII), used funding provided by HCHII in February, 2016 to develop an asthma innovation program, which supported the development of RI-AIR. Funding from HCHII allowed for the establishment of The Asthma Community Collaborative, a coalition of community stakeholders that informed a needs assessment to identify gaps in pediatric asthma care in the state. Support from HCHII also allowed for piloting the RI-AIR model, including the development and testing of:

  • A technological platform to integrate data from LifeChart (electronic health record), research data collection methods, and the KIDSNET public health database
  • An algorithm to classify asthma services based on level of asthma control (multi-level school-based education and/or intensive home-based environmental intervention)
  • A system of enhanced coordination between caregiver, school nurse, and health care provider to promote care integration

“The innovative integration of technology and thoughtfully reimagined clinical care apparent in RI-AIR is exactly the kind of groundbreaking research on behalf of children’s health that we imagined when the Hassenfeld Institute was created,” said Phyllis Dennery, M.D., Hasbro Children’s pediatrician-in-chief, chair of the department of pediatrics at The Warren Alpert Medical School of Brown University, and a Hassenfeld Institute executive committee member. “With the new grant, Drs. McQuaid and Koinis-Mitchell will be able to improve asthma care for even more children. In addition, with increased availability of pulmonary and allergy/immunology services at Hasbro Children’s, we will make great strides in the care of children in Rhode Island suffering from this devastating condition.”

As part of this NHLBI program, McQuaid and Koinis-Mitchell will also meet with investigative teams from the other three supported centers in the U.S. to discuss approaches to implementing evidence-based interventions, measuring sustainability, and defining best practices in specific settings. Results will be disseminated to communities caring for children with asthma to improve outcomes for children.

“We hope that sustainable implementation of this model will help streamline care for pediatric asthma, leading to improvements such as reduced school absences for kids and increased overall wellbeing,” McQuaid added.