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About Our Program

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The cornerstone of the IMPACT DC program is our clinical and educational intervention, targeted to children with frequent emergency department (ED) visits, hospitalizations, missed school days, and other markers of poorly controlled asthma. Our goal is to steer children away from episodic use of the ED for their asthma management, and towards more effective primary long-term asthma care and ultimately healthier lives. To that end, we not only provide services directly to families, but also work to strengthen the linkages among all those providing asthma care to the child – in the schools, community,and health care system.


The IMPACT DC model of care was validated in a prospective randomized clinical trial, published in the Archives of Pediatrics and Adolescent Medicine (2006). The study achieved several clinically and statistically significant outcomes:

  • Greater than 100 % increase in the use of controller medications
  • Nearly 50 % reduction in subsequent ED visits
  • Sustained improvements in numerous measures of quality of life
Intervention

The IMPACT DC Asthma Clinic provides comprehensive asthma education, medical consultation and care coordination using a novel approach that is consistent with current national guidelines for asthma care.

The clinic typically sees children within two weeks of an ED visit or hospitalization for an acute exacerbation, or by referral, for a 90-minute visit where they meet with an asthma educator and a physician or nurse practitioner. Taking advantage of the “teachable moment” that naturally occurs after the crisis of an asthma attack, clinic staff focus on three key elements of asthma care:

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Medical Care

  • Detailed assessment of asthma severity and control
  • Education on the basic anatomy and physiology of asthma with emphasis on its chronic nature
  • Prescription of controller medications if indicated
  • Device teaching (MDI/spacer, Diskus, nebulizer), as indicated
  • Education on self-monitoring (by symptoms and/or peak flow measurement)
  • Provision of a spacer and/or peak flow meter, as indicated
  • Completion of an individualized Asthma Action Plan


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Environmental Modification/Trigger Control
  • Education on the role of the environment and triggers in asthma
  • Specific education on the creation of a “safe sleep zone”
  • Provision of allergen-barrier pillow cover
  • Tailored education on the following, as individualized for the family:
    • Tobacco smoke
    • Dust
    • Molds
    • Pests
    • Pets
    • Seasonal allergens


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Care Coordination
  • Education on the role and importance of long-term asthma care with a primary care provider
  • Creation of an individualized patient report that is forwarded to the patient’s primary care provider (PCP) and school nurse, as well as to the patient and family
  • Completion of school forms sufficient to allow child to receive reliever medication at school
  • Assistance with scheduling of follow-up appointments with the PCP and, as needed, with sub-specialists (Allergy, Pulmonology) for further evaluation and treatment
  • Assistance with applications for prescription assistance programs
  • Referrals for financial counseling and public insurance, legal services, smoking cessation, and other family assistance programs

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