Pediatric Asthma and Health Equity

Asthma is one of the most common chronic childhood diseases, affecting nearly 13% of children in Massachusetts, and it is a leading cause of childhood hospitalization and missed school. Children in certain communities, including many of the communities served by Boston Medical Center, tend to suffer more from asthma than others. However, with the right treatment and support, every child’s asthma is manageable. We believe that asthma should never prevent a child from attending school, playing sports, running outside, or reaching their goals.The Pediatric Asthma Program at Boston Medical Center works to improve and streamline care for all of our patients with asthma. Through regular screenings, care management, education, cross-department coordination, and ongoing quality improvement and evaluation, we aim to reduce day-to-day symptoms, Emergency Department visits, and hospitalizations for children with asthma.

Attached below is recent coverage about the work of the asthma program and its impact on primary care patients.

How BMC's Pediatric Asthma Program Works to Keep Children Out of Emergency Rooms | HealthCity

Please note: The Pediatric Asthma Program at Boston Medical Center is a quality improvement initiative. For more information on seeing a pediatric asthma specialist, please contact our Pediatric Pulmonary and Allergy Clinic for more information.

Our Key Accomplishments

Embedding a comprehensive asthma program within our primary care clinic
Creation of an Asthma Registry, which allows us to carefully monitor our 2,500 pediatric primary care patients with asthma - and provide extra outreach to children at highest risk
Screenings for asthma control ("ACT") at over 6,500 clinic visits since 2018 for children with a history of asthma or wheezing
Real-time, immediate action steps taken for patients with poorly controlled asthma identified through the ACT
Individualized asthma education with patients and families at more than 1,100 primary care, pulmonary, emergency room, and inpatient visits since 2017
Use of a novel acute asthma pathway to address acute asthma exacerbations in primary care
Intensive case management with a specialized asthma nurse practitioner for more than 200 patients since 2019
Collaboration with BMC Pharmacy to offer expedited service for patients treated for acute asthma exacerbations in clinic
Partnerships with school nurses, community health workers, the Boston Public Health Commission, and community health centers and hospitals across Greater Boston

Our Approach to Health Equity

Asthma affects children and families of all backgrounds, but we know that asthma disproportionately affects children and adolescents of minority racial/ethnic backgrounds and low income families. We use a systematic, multi-pronged approach to ensure that our patients with asthma do not slip through the cracks. We screen for asthma symptoms at all primary care appointments regardless of the reason for the visit. We offer services and written materials in multiple languages, and use IT solutions to integrate asthma into every part of the care process. We proactively support our highest risk patients, ensuring that those with a history of asthma complications receive targeted outreach and close follow-up – often with a specialist. We remove barriers to home management of asthma by providing any interested family with home delivery of chronic asthma medications. Finally, with the understanding that managing asthma doesn’t stop at the clinic door, we have built partnerships with the Boston Public Health Commission, local housing organizations, and schools to link families to critical supports and services.

Our Team

We are a multidisciplinary team of providers, nurses, medical assistants, pharmacy staff, and a program coordinator focused on enhancing pediatric asthma care in the primary care setting. We work closely with our colleagues across Pediatric Primary Care, all of whom are trained in treating childhood asthma, as well as our colleagues in the Pediatric Pulmonary and Allergy Clinic.

Robyn Cohen, MD MPH
Giovannie Bejin, CPNP-PC
Rachel Sagor, MD
Gina-Marie Giarusso, MS RN
Jude Teleau, RN
Jemelys Camacho, Medical Assistant Team Lead
Roshni Babal, MA

For questions, please contact:
Roshni Babal, Program Coordinator
Roshni.babal@bmc.org

Key Initiatives

Screening for Asthma Control

Research has shown that frequent checks on asthma control can help uncover problems before they worsen. We use the Asthma Control Test (ACT) to evaluate our pediatric patients’ asthma every time they come to BMC Pediatrics — not just for an appointment for asthma or a cough, but for a scheduled check-up, a stomach ache, or even a sprained ankle. These screenings help our primary care team identify and treat patients with poor asthma control, before they have an asthma attack.

Asthma Education

Our asthma educator is available to provide families with individualized, one-on-one teaching about their child’s asthma. These sessions can help families understand what happens in the lungs to a child with asthma, which medicines to use at which times, how to use inhaled medication correctly, when families need to call their child's doctor, and how to avoid asthma triggers.

Acute Asthma Pathway

We have developed an acute asthma pathway in primary care to support any patient wheezing in clinic older than 12 months of age. Through partnering with IT, we have made this pathway accessible via EPIC to have guidelines on treating acute asthma exacerbations in clinic based on patient's symptoms.

Asthma Care Management

Giovannie Bejin, CPNP-PC, provides intensive care management for patients with poor asthma control. NP Bejin reviews asthma treatment plans; discusses medication adherence and changes, symptoms, triggers, and other conditions (such as allergies) that may be affecting asthma; and makes referrals to specialists and community resources.

Research and Evaluation

We are conducting an ongoing quality improvement program to track our progress at asthma symptom screening with the ACT. We analyze weekly data to evaluate successes and find opportunities for improvement. We are also partnering with the Center for the Urban Child and Healthy Family to conduct a large-scale evaluation of our asthma efforts since 2017, exploring the impact of ACT symptom assessment on acute health care use (i.e., ER visits) and costs of care for our patients with asthma.

Wraparound Patient Supports

Partnership with the BMC Pharmacy to arrange monthly home delivery of chronic asthma medication
Referrals to the Boston Public Health Commission to arrange housing inspections for mice, cockroaches, mold, and other asthma triggers
Contact with school nurses for consistent asthma care and improved communication between families, schools, and the medical home
Coordinated care with Pulmonary and Allergy Asthma specialists, community health workers, and other community partners