In Maryland, students diagnosed with asthma miss an average of three days of school per year due to respiratory symptoms. To help manage this chronic condition, Johns Hopkins Pediatrics at Home, a division of Johns Hopkins Home Care Group, created a comprehensive care program powered by a mobile app.
The program includes an in-home environmental assessment, ongoing help to manage asthma, medication education and other standard care, as well as resources available through an app on a smart device. These resources include a digitized version of a personalized “Asthma Action Plan” developed by the patient’s pediatrician, educational materials and access to Pediatrics at Home’s clinicians. The bundle of services was developed in collaboration with Johns Hopkins startup Quantified Care.
The app provides remote patient monitoring of asthma by asking about the patient’s symptoms. Based on the answers, an algorithm categorizes the patient by risk, and shows which medication the patient should administer. It also sends the information to the patient’s nurse. If the assessment finds a patient is at high risk and requires medical attention, the nurse can contact the patient or their caregiver through the app or by phone, and relay any pertinent information back to the pediatrician. The patient or caregiver can also reach out to the nurse through the app at any time.
“Some patients ignore their symptoms until it becomes an emergency,” says Sue Huff, senior director of Pediatrics at Home. “This is an interactive way to intervene and encourage patients to take their medication and use inhalers at the right time.”
In 2018, Pediatrics at Home completed a feasibility study on the program with 78 patients between the ages of 5 and 21 from Johns Hopkins Community Physicians’ inner city locations. Results showed a 55 percent reduction in patients’ use of emergency department and hospital services during the 180 days after the start of the program, as compared with the 180 days prior to enrollment. Patient and caregiver satisfaction increased by 97 percent.
“Pediatrics at Home has created the most innovative program I have seen for pediatric asthma in the last 20 years,” says Michael Crocetti, chief of pediatrics for Johns Hopkins Community Physicians. “It is a scalable way to improve outcomes and have children with asthma and their caregivers take more responsibility for the management of their disease.”
Pediatrics at Home is working with local agencies, payers and stakeholders to secure additional funding to sustain and scale the program. Its feasibility pilot was funded by the Abell Foundation and the Maryland Health Care Commission.