Building a regional pediatric asthma learning health system in support of optimal, equitable outcomes

Abstract

Introduction: Asthma is characterized by preventable morbidity, cost, and inequity. We sought to build an Asthma Learning Health System (ALHS) to coordinate regional pediatric asthma improvement activities.

Methods: We generated quantitative and qualitative insights pertinent to a better, more equitable care delivery system. We used electronic health record data to calculate asthma hospitalization rates for youth in our region. We completed an "environmental scan" to catalog the breadth of asthma-related efforts occurring in our children's hospital and across the region. We supplemented the scan with group-level assessments and focus groups with parents, clinicians, and community partners. We used insights from this descriptive epidemiology to inform the definition of shared aims, drivers, measures, and prototype interventions.

Results: Greater Cincinnati's youth are hospitalized for asthma at a rate three times greater than the U.S. average. Black youth are hospitalized at a rate five times greater than non-Black youth. Certain neighborhoods bear the disproportionate burden of asthma morbidity. Across Cincinnati, there are many asthma-relevant activities that seek to confront this morbidity; however, efforts are largely disconnected. Qualitative insights highlighted the importance of cross-sector coordination, evidence-based acute and preventive care, healthy homes and neighborhoods, and accountability. These insights also led to a shared, regional aim: to equitably reduce asthma-related hospitalizations. Early interventions have included population-level pattern recognition, multidisciplinary asthma action huddles, and enhanced social needs screening and response.

Conclusion: Learning health system methods are uniquely suited to asthma's complexity. Our nascent ALHS provides a scaffold atop which we can pursue better, more equitable regional asthma outcomes.

Keywords: asthma; health equity; learning health systems; pediatrics; population health.

FIGURE 1

Environmental scan results, including clinical, research, and community‐based projects and teams with an asthma focus.

FIGURE 2

Depiction of variability in asthma hospitalization outcome by Hamilton County, Ohio neighborhood, measured as a rate per 100 000 children <18 years per year, using data from 2017 to 2021. The national asthma hospitalization for children was obtained from estimates published by the Centers for Disease Control and Prevention.

FIGURE 3

Asthma Learning Health System (ALHS) organizational structure.

FIGURE 4

Asthma Learning Health System Key Driver Diagram. The global aim is the output of our first design session's “newspaper headline” exercise. The aspirational SMART aim is focused on hospitalizations. However, we recognize that this aim is both aspirational and related to other measures that are not yet as feasible to measure at a population scale. Such additional, “under the surface,” measures are listed below the hospitalization‐focused SMART aim. ED, Emergency Department; SMART, Specific, Measurable, Achievable, Relevant, Time‐Bound.

FIGURE 5

Prototype data dashboard and data tool used to provide shared situational awareness for members of the asthma system, depicting geospatial distribution of asthma hospital admissions, racial inequities, and potential triggers like air quality and viral infections, alongside the interactive bottom pane which enables sorting by key sociodemographic and geographic factors. The bottom pane enables real‐time sorting based on clinic (gen peds = Cincinnati Children's Primary Care; Asthma HEN = Pulmonary Medicine; Allergy = Allergy Clinic), payer (HealthVine is a Medicaid Accountable Care Organization). ED, Emergency Department; HEN‐Health Equity Network; UC, Urgent Care.