Asthma is frequently viewed as an episodic condition that occasionally flares and requires medical attention. Treating it as a chronic condition gives patients better outcomes, but several other factors—socioeconomic, housing, environment and access to care—can make significant impacts on a patient’s overall health. In 2021, Cincinnati Children’s launched its Health Equity Network to specifically address the racial and social disparities around four medical conditions. Asthma is one. According to the US Department of Health and Human Services Office of Minority Health, Black children are five times more likely to be hospitalized for asthma and eight times more likely to die from the condition than white children.

“There’s no cure for asthma, but we can control it. To keep it well controlled and prevent exacerbations, emergency room visits, and admissions, we need to address all aspects of asthma,” says Karen McDowell, MD, leader of the Cincinnati Children’s Health Equity Network Asthma team and associate director of the Asthma Center. “That means we can’t just focus on the medical aspects of the disease. We must also focus on addressing the social determinants of health that impact asthma outcomes.”

Health Equity Network

To fully address all aspects of asthma care, McDowell says, Cincinnati Children’s created a multidisciplinary team for its Health Equity Network asthma work. The group includes pulmonary medicine specialists, general pediatricians, allergists, respiratory therapists, nurses, social workers, care managers, and insurance professionals. Their first goal is to reduce hospital admission rates for Black children with asthma.

“The idea is to intercept these children when they come to the hospital,” she says. “We want to connect with them and make sure they get the tools they need to stay out of the hospital in the future.”

The Network is starting small with 322 patients currently seen by the Asthma Center and General Pediatrics at Cincinnati Children’s. They screen every child admitted for an asthma exacerbation with the standardized Childhood Asthma Risk Assessment Tool (CARAT). Based on those results, McDowell says, the Network team can identify their financial, housing, transportation, medication, and neighborhood needs. The team is using that information to design specific interventions that can meet patients’ needs within their communities. This could include partnerships with agencies that can provide environmental remediation services in the home, school-based health clinics, or sending community health workers into patients’ homes, she says. The team plans to examine its progress at the end of this year. The goal, McDowell says, is to reduce hospital admissions by two a month.

“Even if we haven’t completely met our goal,” she says, “we made some great progress and put some wonderful processes and teams into place to further this work as we move forward.”

Asthma Learning Health System

In March, Cincinnati Children’s went one step further toward comprehensive care for asthma at the population level, says Michael Seid, Ph.D., director of Health Outcomes and Quality Research in the Division of Pulmonary Medicine. The institution created the Asthma Learning Health System (ALHS) with the support of a one-year Academic and Research Committee grant.

“We’re bringing together more than 30 community-serving organizations, as well as patients and families, clinicians and researchers,” he says. “We hope to use novel techniques, including research, data and analytics, and clinical practice to improve asthma outcomes not just for the kids that are sick enough to be admitted to the hospital, but for all children with asthma in the community.” As a first step, ALHS created an 11-person steering committee dedicated to strengthening community relationships and organizing healthcare, environment, and community workgroups. They will provide valuable input that will help ALHS outline its core objectives and priorities.

“This steering committee will tell us whether we’re going fast enough, if we’re focusing on the right areas, and if we’re going in the right direction,” Seid says. “We’re a large organization, but we can’t fix everything. We need to shift power to the people who are affected by the changes we’re trying to make.” Overall, McDowell says, the ultimate goal is ensuring every child in southwestern Ohio has well-controlled asthma.

“We’re taking a wide view of the medical aspects and social aspects of asthma,” she says. “We’re stepping things up a level to control the disease rather than simply addressing things once the patient touches the healthcare system.”