Children and adults in Illinois have the highest rate of mortality from asthma in the country for reasons that are not fully known. But prevention of mortality is fully possible. The Extension for Community Healthcare Outcomes in Chicago (ECHO-Chicago) is a program of weekly clinical training sessions that connect University of Chicago Medicine subspecialists with health care providers throughout Chicago via high-definition videoconferencing. Four asthma experts lead the ECHO series on complex pediatric asthma, which completed its inaugural year in 2017. Funded by a five-year grant from the U.S. Health Resources and Services Administration, the 15-session asthma module is one of three pediatric-specific ECHO programs currently offered to community providers.
Primary care providers on the South Side of Chicago are well aware that asthma affects 20 percent of children living in these neighborhoods and is one of the most common reasons that their patients end up in the emergency department and have to be admitted. By enrolling in ECHO-Chicago, community providers expect to upgrade their skills in managing children with poorly controlled asthma by learning the latest evidence-based guidelines.
There is a common misperception among families and providers that using a nebulizer on a child who is having a severe asthma attack is first-line treatment at home, but nebulizer use is associated with more complications in complex asthma and frequently delays a child coming to the ED when it is warranted. Clinicians should be instructing families that the use of a metered-dose inhaler is the appropriate treatment at home when a child is having an asthma attack. The ECHO team is currently developing a video demonstrating the proper use of an inhaler for community providers to show to patients and families.
Clinicians should be instructing families that the use of a metered-dose inhaler is the appropriate treatment at home when a child is having an asthma attack.
The ECHO-Chicago team will be collecting data on the impact of the asthma sessions on health outcomes of kids and on provider behavior, similar to the research conducted on other ECHO-Chicago training modules. Daniel Johnson, MD, director of ECHO-Chicago, studied prescribing patterns of practitioners before and after receiving ECHO training on pediatric ADHD, for example. The number of first-time prescriptions of ADHD medications fell as much as 73 percent post-ECHO training, reflecting the curriculum’s emphasis on behavioral approaches to managing ADHD, according to Johnson.
The ECHO asthma project will also partner with the new South Side Pediatric Asthma Center, a collaboration between the Department of Pediatrics and the University of Chicago Medicine’s Urban Health Initiative and other health providers, to improve pediatric asthma management in underserved areas. “We are aligning our teaching with the recommendations of the center to ensure we consistently deliver asthma care across the South Side of Chicago,” says Johnson. “In addition, patients with asthma who come to the ED and don’t have a primary care provider will be connected to an ECHO-Chicago asthma-trained provider for ongoing care.”
Additional pediatric-specific ECHO modules include ADHD and obesity and co-morbidities, with modules on headache and concussion and trauma-informed care in the works. In 2016-17, ECHO-Chicago participants included 368 health care providers from 51 different community health centers in Chicago.
Michael Boettcher, MD
Donald Brown, MD
Joy Elion, MD
Gary Fernando, MD
Aisha Jameel, MD
Munzareen Padela, MD
Carl Toren, MD
Anitha Vinod, MD