Screening Social Determinants of Health in a Multidisciplinary Severe Asthma Clinical Program.

Asthma is the most common cause of chronic disease in children and has high healthcare utilization costs. Minority children living in poverty have a higher asthma burden. These health disparities are associated with the social determinants of health (SDH). A severe asthma clinic was implemented at Rady Children's Hospital in San Diego to determine whether a multidisciplinary approach, including an asthma home visit addressing SDH, would lead to decreased healthcare utilization in terms of emergency department (ED) visits and hospitalizations. METHODS: Patients with 2 or more ED visits in the past 6 months or 2 or more hospitalizations in the previous year were recruited to Rady Children's Hospital Severe Asthma Clinic. A multidisciplinary team evaluated each patient systematically. A subset of patients on capitated Medicaid insurance plans also had a comprehensive asthma home visit with community health workers as part of the Community Approach to Severe Asthma (CASA) program. RESULTS: A significant reduction in ED visits (75%, P < 0.001) and hospitalization days (73%, P < 0.001) was demonstrated in 74 Severe Asthma Clinic participants with 1 year of pre-/postdata to analyze. In a subset of 12 patients in the CASA program, further reductions in ED visits (90%, P = 0.002) were also demonstrated. Basic needs, including shelter, food, and assistance with utilities, were the most common domain of SDH identified and addressed in CASA participants. CONCLUSION: We demonstrate that a novel pediatric severe asthma clinic with a multidisciplinary approach, including actively addressing SDH, is associated with decreasing health care utilization.

Rethink Your Drink.

BACKGROUND: Sugar-sweetened beverages (SSBs) are linked to obesity; hospitals are a priority setting to reduce intake. This article describes the development, implementation, and results of a focused intervention to reduce SSB sales within a hospital setting. METHOD: After a formative research process, Rethink Your Drink was launched at a children's hospital in San Diego. The initiative consisted of an educational intervention using the stoplight system to categorize beverages as red, yellow, or green based on sugar content. Beverage sales data were collected for 3 months prior, during the 12-month intervention, and for 4 months after the intervention ended. RESULTS: Monthly red beverage sales decreased from an average of 56% during baseline to 32% at the end of the data collection period (p < .001). Monthly green beverage sales increased from an average of 12.2% during baseline to 38% at the end of the data collection period (p < .001). Sales revenue for all drinks remained constant. DISCUSSION: The intervention resulted in a decrease in SSB sales and an increase in sales of healthier beverage choices. Such interventions can play an important role in obesity prevention and may be more feasible for smaller hospitals with limited resources.