Inpatient asthma management by specialists keeps readmission rates low

From maintaining one of the nation’s lowest hospital readmission rates to cultivating high-impact quality improvement initiatives, Riley Children’s Health’s leadership in asthma is rooted in a decades-long practice of providing pulmonary specialty care to every patient hospitalized with the disease.

“For decades, Riley Children’s has been committed to providing expert care to children with asthma throughout the Riley experience,” said Nadia L. Krupp, MD, pediatric pulmonologist and director of the Asthma Program at Riley Children’s. “Almost all patients admitted to Riley Hospital for Children with a diagnosis of asthma benefit from the care of an asthma specialist. This practice allows our asthma specialists to evaluate each patient and intensively manage their care during their first hospitalization. As such, we help prevent readmission, particularly within the immediate post-discharge period when asthma patients are most vulnerable.”

In 2022, the inpatient asthma readmission rate at Riley Children’s was 0.65%, well below the national average of 1.59%. In fact, for each of the past 10 years, Riley Children’s has maintained an asthma readmission rate of 0 to 1.5%—below the national average of comparable children’s hospitals. The downward trend began in early 2013 with the launch of a multifaceted quality improvement initiative that resulted in a 79.3% reduction in 30-day readmissions in under than two years.

Prioritizing quality improvement

The creation of the Asthma Quality Council has enabled Riley Children’s to address complex quality improvement projects, providing meaningful and sustained improvements in asthma care from the Emergency Department (ED) through the hospital stay and outpatient follow-up. In addition to Riley pulmonology specialists, the quality council includes representatives from emergency medicine, respiratory therapy, nursing, pharmacy, IT and data services. Over the past 12 years, the council has developed standardized protocols for ED and inpatient care, and facilitated consistent discharge planning, outpatient follow-up and reductions in ICU utilization.

“The Riley Asthma Quality Council not only works to make asthma care better at Riley Children's, but also impacts care throughout the state,” Dr. Krupp said. “Many of the best practice protocols and treatment plans created at Riley Children's are available to hospitals throughout the Indiana University Health system. As a result, any child in the state can receive the same standard of asthma care at any IU Health facility.”

Leading High-Risk Asthma Program

For children with severe asthma, Riley Children’s delivers advanced, comprehensive care through its High-Risk Asthma Program. Established in 2000, the program is among the longest-running severe pediatric asthma clinics in the nation. It is also one of the largest, treating more than 300 patients in Indiana.

“Once children are enrolled in our High-Risk Asthma Program, we have been able to decrease their hospitalizations by more than 50%,” Dr. Krupp said. “In addition to frequent outpatient visits, intensive education and multidisciplinary subspecialist care, we offer virtual care, mental health screening and home spirometry. Our high-risk asthma population often faces a variety of challenges, so we offer a wide range of wraparound services, including social work, psychology and community partners that provide home environmental assessments, and a medical-legal partnership that helps families with housing, environmental remediation and school-related issues that can impact the health of children with asthma.”

Other notable features of the High-Risk Asthma Program at Riley Children’s:

• Founding member of the Severe Pediatric Asthma Consortium; develops best practice guidelines and fosters research initiatives
• One of less than five programs nationally to offer these multidisciplinary services: allergy, pulmonology, nursing, social work, respiratory therapy, medical-legal and psychology
• One of the first programs in the nation to include mental health screening for children with severe asthma and to add a clinical psychologist to the care team.

In asthma research, Riley Children’s is leading a five-year, $12 million Program Project (P01) Grant from the National Heart, Lung and Blood Institute. The grant, Scientific Innovation for Personalized Severe Asthma Management, is one of the few pediatric pulmonology-based P01s in the nation.