Clinical Care Program for Childhood Asthma (CCP-Childhood Asthma); A Multidisciplinary Team Care at Samitivej International Children's Hospital

Background:Asthma is the most common chronic disease in childhood and is a common cause of hospitalization for children. In 2011, at Samitivej International Children’s hospital (SMICH), there were 210 asthmatic children aged less than 15 years old. 29 of them were hospitalized due to acute asthma exacerbation. One of them was needed to be in PICU and none was dead. A clinical care program to deliver integrated multidisciplinary and organized care plan with continuous quality improvement of hospital system is considered to be the standard care for asthmatic children.

Methods:Core team and childhood asthma framework were set up including Pediatric Allergists, Pediatric Pulmonologists, General Pediatricians, Pediatric Nurses at OPD, ER & ward including PICU, Pharmacists at SMICH, which aim to provide comprehensive clinical care program for childhood asthma (CCP-Childhood Asthma) in 2012. We enrolled children with diagnosis of asthma and acute wheezing at OPD/ER, evaluated and considered diagnosis of asthma, then started treatment and re-evaluated for clinical asthma controlled every 1-3 months as to GINA Guideline for Children. All general pediatricians and Pediatric nurses at OPD, ER and ward were trained and implemented about clinical pathway. We initiated Childhood Asthma Camp to provide education about disease to parents and caregivers, together with workshop for inhaler medicines used, self assessment with asthma action plan, and environmental allergen avoidance. Performance measurements included: 1. Administration of systemic corticosteroids during hospitalization within 12 hours, 2. Evaluation of inhaler medicines technique used correctly in each visit, 3. Pulmonary function testing in children older than 7 years old, and 4. Influenza vaccination annually, data were collected and analyzed yearly.

Results:Patients in CCP-Childhood Asthma at SMICH were enrolled from 81 children in year 2012 to 119 children in year 2014, the number of hospitalization from asthma exacerbation was decreased from 24 patients in year 2012 to 20 and 13 patients in year 2013 and 2014, respectively. All patients in CCP-Childhood Asthma were received systemic corticosteroids within 12 hours of hospitalization. No any patient was admitted in PICU. More than 80% of patients could demonstrate inhaler drugs used correctly and >60% of them received pulmonary function testing yearly. Influenza vaccination rate in asthmatic children increased from 30.8% in year 2012 to 57.6% and 63% in year 2013 and 2014, respectively. Our CCP-Childhood Asthma was accredited by Joint Commission International (JCI) from USA. in August 2012 which is the first clinical care program outside USA. certified by JCI.

Conclusion:Care of children with asthma, which is a chronic disease burdens to their families and needs a comprehensive multidisciplinary team care. This will help improving quality of care for childhood asthma.