Urgent care for childhood asthma

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Item: Detail:
Clinical lead Dr Mathew Mathai
Academic/research team: Dr Mathew Mathai, Dr Brian Kelly, Dr Lorna Fraser, Owen Johnson, Dr Stefan Williams, Prof. John Wright


Background and Need

The incidence and prevalence of asthma among Bradford children is high, and poorly controlled asthma can be life-threatening.  Asthma is one of the commonest reasons for urgent admissions to secondary care among children in Bradford, accounting for around 30% of the total.  Carers are using emergency hospital care more and more as their initial health provider and there is a steady rise in A&E attendances.  Unplanned admissions to hospital result in considerable stress for the child and family, and they are also costly for the family and the wider health economy.

We know that acute exacerbations of asthma requiring hospital admission could be prevented in approximately 75% of cases, but at present only around 20% of children with asthma receive all the elements of clinical care that they require to manage their condition successfully.  In addition, there is a variation in how children present to health care services and how they are managed by the professionals they see.  In Bradford, there is a system wide guideline for asthma management in children that has been agreed across primary and secondary care and education.  It is based on BTS guidelines.  However, the complexity and variety of city-wide health systems and patient pathways has previously made it difficult to gather data to understand exactly how real care might differ from the guidelines.

Commissioners and providers in Bradford agree that ‘The key to delivering effective emergency and urgent care is ensuring that the whole system is designed to support self-care and community care at home, thereby reducing avoidable hospital admissions and facilitating timely early discharges’ a quote from the Institute for Innovation and Improvement.  This ethos is reflected in the Royal College of Paediatrics and Child Health 2015 publication, ‘Facing The Future: Together For Child Health’, which states, “No child should be in hospital when care can be provided to an equivalent or better standard outside the hospital in their locality and closer to their home if appropriate (right care, right time and right place)”.

Linked, routine electronic data offers a new opportunity to understand the whole patient pathway for urgent care in children with asthma, and use this understanding to support self-care at home and to reduce unnecessary hospital admissions.

Aim

To use linked, routine electronic healthcare data to help improve the urgent care pathway for paediatric asthma, so that more care is provided in the community and unplanned hospital admissions are reduced.

Objectives

  • Map and model the current pathway for urgent asthma care in children across Bradford, using routine linked data, to identify potential pathway targets for improvement.
  • Work with local stakeholders using linked, whole pathway data as a measurement for tests of change to the pathway for urgent paediatric asthma care.
  • Explore associations between routine data parameters in the community (such as prescription data) and subsequent unplanned hospital admission with asthma. To use any identified associations as the basis for an electronic decision support tool designed to help reduce emergency admissions.

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