204 - Barriers and Facilitators to Asthma Care After Hospitalization across Free Standing Children’s Hospital and Community Hospitals

Poster Number: 204
Publication Number: 204.482

Background: Asthma care coordination for children after hospitalization occur at both freestanding children’s hospitals as well as community hospitals. While community hospitals care for majority of children hospitalized with asthma in the US, unique challenges and opportunities exist to optimize care coordination post discharge. Healthcare team engagement may provide valuable insight identifying unique barriers and facilitators at freestanding children’s hospital and community hospitals.

Objective: To characterize healthcare team’s barriers and facilitators of post-discharge asthma care coordination for children at free-standing children’s hospital (FSCH) and two community hospitals (CH) in a single urban regional network.

Design/Methods: In this qualitative study, structured interviews were conducted with health care providers for children with an asthma exacerbation requiring hospitalization. The interview guide included open-ended questions on evidence-based components of asthma care coordination: medications in hand upon discharge, communication with primary care providers, communication with schools, navigation support, and home trigger evaluation. Existing literature informed initial codes and novel codes were extracted from interviews. Interviews were analyzed with directed content analysis.

Results: Preliminary results include 13 healthcare members of pediatric asthma-care: 4 from free-standing children’s hospital and 9 from community hospitals. Stakeholders included pharmacists, nurse practitioners, hospitalists, and asthma care navigators across freestanding children’s and community hospitals. Of 12 themes (Table 1), the most frequent barriers included heavy clinical workloads for existing providers and challenges with school engagement; the most frequent facilitators included champions for collaboration with both inpatient hospital providers and primary care providers. In comparing themes across FSCH and CH (Table 2), established communication channels with pediatricians was a facilitator at CH and lack of established communication channels with pediatricians was a barrier at FSCH.

Conclusion(s): Unique barriers were identified at CH compared to FSCH to implement a multi-component care coordination program for the hospital-to-home transition for children admitted with an asthma exacerbation. Leveraging partnerships within a regional network between FSCH and CH may provide an opportunity to improve and standardize care coordination for the hospital-to-home transition for children with asthma.