Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC)

The Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC) program uses the emergency department (ED) to recruit families for asthma education and care coordination. Following an asthma-related ED visit, patients return to the IMPACT DC Asthma Clinic within the ED or at a community site to learn about medical and environmental management of asthma. The program works with school nurses and local groups to provide outreach, home visits, and smoking cessation education. Participants complete an asthma action plan, and learn about asthma, pharmaceuticals, and how to use a peak flow meter. Families also learn about environmental triggers, and how to control dust, mold, pests, and smoke in their home. Patients are encouraged to receive longitudinal asthma care with a primary care provider. IMPACT DC forwards patient information to primary care physicians, a case manager, and a school nurse to coordinate future care.

The goal of IMPACT DC is to improve access to asthma education and care coordination through the emergency department.

On average 40 to 50 new families receive asthma education at the IMPACT DC Asthma clinic each month. In a randomized clinical trial intervention patients showed significant improvements over the control group, and more than 70 percent of patients randomized to the intervention group attended the Asthma Clinic. At a one-month follow-up IMPACT DC patients had an increased use of hypoallergenic mattress pad or pillow cover (75%) when compared to the control group (23%) and daily smoking in the home reduced from 9.9% to 4.4%. Use of an asthma action plan increased from 40% to 62%. Improvements continued at a six-month follow-up with decreased ED visits (1.4 visits vs. 2.3 visits in the control group) and increased daily use of inhaled corticosteroids (49% vs. 27% in the control group). The program won a National Environmental Leadership Award in Asthma Management from the EPA in 2006.