Health Care Innovation Awards: Project Profile


Project Title: "Optimizing health outcomes for children with asthma in Delaware"
Geographic Reach: Delaware
Funding Amount: $3,697,300
Estimated 3-Year Savings: $4,743,184


Nemours/ Alfred I. duPont Hospital for Children, partnering with Delaware Health and Social Services, Division of Medicaid and Medical Assistance, and Division of Public Health, the South Wilmington Planning Network, Healthy Kids Collaboration in Kent County, Sussex County Health Promotion Coalition, and United Way of Delaware, received an award to enhance family-centered medical homes by adding services for children with asthma and developing a population health initiative in the neighborhoods surrounding targeted primary care practices. The intervention also increases coordination of services by integrating care with community support services and local government initiatives to provide healthier environments for children with asthma in schools, child care centers, and housing, and by deploying community health workers to serve as patient navigators and provide case management services to families with high needs. The goal of this model is to reduce asthma-related emergency room use and asthma-related hospitalization among pediatric Medicaid patients in Delaware by 50% by 2015 with incremental declines in 2013 and 2014. This goal will be accomplished by focusing on three distinct strategies: 1. Enhancement of the family-centered medical home by adding new services for children with asthma and developing a well-coordinated interdisciplinary approach to managing asthma care; 2. Development of a sustainable network of evidence-based supports and services surrounding each of the three targeted primary care sites, using the "integrator" model that Nemours has already adopted; and 3. Deployment of a "navigator" workforce that incorporates non-medical needs into the provision of care for children with asthma that promotes respiratory health and addresses environmental asthma triggers throughout the target communities.

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