Shocking Rates of Pediatric Asthma in the Tennessee Valley are the Number One Cause of School Absence

Asthma is a chronic medical condition that affects the lungs.  Patients can experience frequent cough, shortness of breath, and chest pain or tightness on a regular basis.  Occasionally a patient with asthma will suffer an “asthma attack.”   During an attack the airways in the lungs become inflamed, make excess mucous, and become constricted.  An asthma attack causes significant trouble breathing and can lead to an emergency room visit, a hospital stay, or even death.  Infections, allergies, and irritants, such as cigarette smoke and pollution, can lead to an asthma attack.  Attacks can easily be prevented with regular doctor visits and effective and inexpensive medications.

7.1 million American children suffer from asthma, which is about 8% of all children, making it one of the most common chronic medical conditions of childhood.  Here in the Chattanooga area, however, 12.5% of our children have asthma, over 50% higher than the national average.  In fact, Chattanooga is the fifth worst city in the country for asthma according to the Asthma and Allergy Foundation of America.  WedMD places Chattanooga second.  These poor rankings are due to low air quality and high cigarette smoke exposure.  Such a staggeringly high rate of asthma in a city conducive to asthma attacks brings the scope of this local problem into focus when considering the following nationwide facts:

·        Asthma is the number one reason children miss school

·        Asthma is third most common reason for a child to spend the night in the hospital

·        Asthma costs our nation 56 billion dollars annually

·        157 children died from asthma in 2009

The most frustrating aspect of these alarming statistics lies in the relative ease in which asthma is treated and attacks are prevented.  Regular doctor visits and readily available medications virtually eliminate symptoms and prevent attacks.  In fact, a recent medical study showed that even 8% of elite athletes from the last five Olympics suffered from asthma.  These athletes have doctors, take their medicine regularly and are able to compete at the highest level of their sport.  Yet, in Chattanooga, one in five children does not have a primary care doctor.  7% of Hamilton County’s children have no insurance at all.  20% of babies in Chattanooga grow up breathing second hand cigarette smoke.  This area has childhood obesity rates 25% higher than national averages.  These factors all play a detrimental role in the lives of Chattanooga’s asthmatic children.

The Pediatric Healthcare Improvement Coalition—Tennessee Valley (PHIC—TV) is a community health partnership striving to decrease the negative impact of asthma on all Tennessee Valley children.  PHIC-TV is currently implementing a strategic initiative to define the asthma challenges for children and organize the means to address them.  Please invest in the ongoing work of PHIC-TV and get more information at healthychattanoogakids.blogspot.com.

Matthew Good, MD, FAAP

Chief of Staff, Children’s Hospital at Erlanger

Pediatric Healthcare Improvement Coalition – Tennessee Valley

P.O. Box 96

Signal Mountain, TN  37377

                                    Email: healthychattanoogakids@gmail.com

                                    Facebook: https://www.facebook.com/Healthychattanoogakids

                                    Twitter: https://twitter.com/PHIC_TN

                                    BlogSpot: http://healthychattanoogakids.blogspot.com/

Untreated Mental Health in Children a Major Driver for School Dropout, Crime and Suicide in Chattanooga

The Pediatric Healthcare Improvement Coalition of the Tennessee Valley (PHIC-TV) has identified Mental Health issues as one of the five major challenges faced by children, adolescents, their families and pediatricians in the greater Chattanooga area. The U.S. Department of Health and Human Services has described mental health as a “state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to change and to cope with adversity.”[i]  The term “mental health” can be broad and often encompasses “behavioral,” “neurodevelopmental,” “psychiatric,” “psychological,” “social-emotional,” and “substance abuse,” as well as adjustment to stressors such as child abuse, neglect, domestic violence, grief and loss.[ii] The genesis of mental health problems stem from biological factors and psychosocial environment as well as interaction between the two.

According to studies cited by the Tennessee Chapter of the American Academy of Pediatrics, “between 9.5% and 14.2% of children birth to age five display social-emotional problems that affect family functioning.” Additionally, “1 in 10 children have a diagnosed behavioral health disorder and more than twice as many children have behavioral health symptoms that cause impairment. Unfortunately, 4 out of 5 of these children do not receive the services they need to improve their behavioral and emotional health.”

The consequences of this unmet need take many forms. In education, students with serious emotional disturbances fail more classes, miss more days of school, have lower grades, and have a higher dropout rate than other students with disabilities.[iii] Interpersonal and educational issues compound over time leading to higher rates of substance abuse, criminal activity and incarceration, poor preparedness for employment, suicide, and a greater impact on social safety nets. The National Alliance on Mental Health’s Children’s Mental Health Fact Sheet[iv] notes:

·         Approximately 50% of students with a mental disorder age 14 and older drop out of high school; this is the highest dropout rate of any disability group

·         65% of boys and 74% of girls in juvenile detention have at least one mental disorder.

·         Suicide is the third leading cause of death in youth aged 15 – 24.

·         When children with untreated mental disorders become adults, they use more health care services and incur higher health care costs than other adults. Left untreated, childhood disorders are likely to persist and lead to a downward spiral of school failure, limited or non-existent employment opportunities, and poverty in adulthood. No other illnesses harm so many children so seriously.(emphasis added)

Given the large number of children and families impacted in the Tennessee Valley and the profound social and economic ramifications when untreated or undertreated, the Pediatric Health Improvement Coalition (PHIC-TV) believes mental health interventions and systems of care should be at the forefront of pediatric healthcare discussions.  Please support PHIC-TV and get more information at healthychattanoogakids.blogspot.com.

John Farrimond, MBA

President and CEO

Siskin Children’s Institute

Lois Kohrt, MBA

Administrative Director

Siskin Center for Developmental Pediatrics

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[i] U.S. Department of Health and Human Services (2001). Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Maryland.

[ii] Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community. Jane Meschan Foy, James Perrin and for the American Academy of Pediatrics Task Force on Mental Health. Pediatrics 2010;125;S75. DOI: 10.1542/peds.2010-788D

[iii] U.S. Department of Health and Human Services (2001). Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Maryland.

[iv] http://www.tnaap.org/BEHIP/prevalence_data.htm

The Chasm in Adolescent Medical Care: Psychiatric Disorders

"More than half of adolescents with psychiatric disorders receive no treatment of any sort, says a new study by E. Jane Costello, a Duke University professor of psychology and epidemiology and associate director of the Duke Center for Child and Family Policy. When treatment does occur, the providers are rarely mental health specialists, says the study, which was based on a survey of more than 10,000 American teenagers."

Read more from November 18, 2013 Duke University Press Release

http://today.duke.edu/2013/11/costello

The Family Centered Medical Home is Key to Pediatric Health

On a clear fall day in October of 2004, Bridget Lane took her new daughter Mary Alice to see her pediatrician.  She was a fussy 7-week-old that did not want to grow.  The reason for her lack of growth was quickly identified as an inability to digest and absorb the fat in her formula.  This was just one complication of a disease called Cystic Fibrosis.  Mary Alice’s parents are now experts in Cystic Fibrosis and the care of a child with a complex, chronic disease.  This is because of their exceptional dedication to Mary Alice and a medical care delivery structure called “the Family Centered Medical Home.”  This structure has been at the backbone of the care of children for over 40 years. 

The American Academy of Pediatrics set the “Medical Home” as the standard of Pediatric care in 1992 with a formal policy statement:

The goal of pediatricians is that the medical care of infants, children and adolescents ideally should be accessible, continuous, comprehensive, family-centered, coordinated and compassionate.  It should be delivered or directed by well-trained physicians who are able to manage or facilitate essentially all aspects of pediatric care.  The physicians should be known to the child and family and should be able to develop a relationship of mutual responsibility and trust with them.

A Medical Home model of healthcare means that the pediatrician's office serves as the "hub" of a busy wheel of care.  Most children need some specialized services over the course of their childhood, adolescent and young adult years.  The “spokes” of this care wheel could be an Orthopedist for a broken arm, a Speech Therapist for a language problem or a Nutritionist for dietary causes of obesity.  For children with chronic, complex diseases; there can be many spokes.  The patient has the best chance of preventing or effectively managing their health challenges if the Medical Home serves as the hub, keeping all providers in good communication.  A study published in the Journal of Maternal and Child Health in 2011 clearly showed reduced health care costs, more stable health and reduced Emergency Room visits for children with special health care needs who have a Medical Home.

Advances in medical technology have made it possible for doctors to cure or provide life-sustaining treatments to patients whose illnesses would have been lethal only a few decades ago. However, for many of these patients and their families, maintaining their best quality of life involves the care of many medical subspecialists, taking many medications, and using various therapy services and medical devices. Navigating this degree of medical support is overwhelming for most parents of medically complex children. Ideally, parents should be able to count on a team to support the coordinated care among the roster of medical subspecialists and services. This pediatric care team, known as the "Medical Home", synthesizes information coming in from subspecialists and other providers and ensures the parents' understanding of all ongoing issues. The Medical Home team spots opportunities for prevention, keeps problems simple before they get more serious, streamlines care, minimizes complications and eliminates unnecessary therapies.

Unfortunately, one out of every five children in the Tennessee Valley region does not have a primary care physician, let alone a “Medical Home.”  These children, often, need this type of care coordination and family support the most.  The 2007 National Survey of Children’s Health showed that as children get older in Tennessee the likelihood of a child being in a Medical Home decreases.  The percent of children in a medical home from birth to preschool in our region is 67.1% and drops to 54.5% by 12-17 years.  Another factor is family income.  In families who make more than $94,000 per year, three out of four have a Medical Home.  In contrast, only half of the children in families who make less than $24,000 per year have a Medical Home.  Race also has an impact.  Seven out of ten White children have a medical home while only five out of ten Hispanic and four out of ten Black children have a medical home.

Mike Lane, Mary Alice’s father says, “Being a parent of a child with a chronic illness, I understand the importance of exemplary healthcare.  Fortunately we have access to this benefit and as a result, our daughter is flourishing.”  The Lanes have had a Family Centered Medical Home to help navigate Mary Alice’s Pulmonologist, her Gastroenterologist, her Nutritional needs and her special medical equipment.  The Lane’s have seen the goals of the Medical Home realized in their child.  Mr. Lane continues, “Sadly, many children in our area are not as lucky.  It is our responsibility, both financially and morally, to provide the availability of adequate healthcare to all children.”

The Pediatric Health Improvement Coalition of the Tennessee Valley (PHIC-TV) believes that the adequate healthcare for children is in a Family Centered Medical Home.  PHIC-TV is an organization that is working to define why children in our region do not have Family Centered Medical Homes.  This organization is dedicated to breaking down barriers to our children to this type of care.  Please support the ongoing work of PHIC-TV by getting more information at healthychattanoogakids.blogspot.com or following on Twitter @PHIC_TV.

Alan Kohrt, MD, FAAP

Professor and Chair, Department of Pediatrics, UTCOM, Chattanooga

CEO, Children's Hospital at Erlanger

Kourtney Santucci, MD, FAAP

Hospitalist Physician, Children's Hospital at Erlanger

R. Allen Coffman, Jr., MD, FAAP

Pediatrician, Highland Pediatrics

President, Tennessee Chapter of the American Academy of Pediatrics

healthychattanoogakids@gmail.com

PHIC Working on Pediatric Healthcare in Chattanooga for the Next 30 Years

David Cook wrote an article today in the Chattanooga Times Free Press about the work of the Pediatric Health Improvement Coalition.  Check it out at http://www.timesfreepress.com/news/2013/nov/24/suggested-head-one-child-care-for-the-next-30/.

And, look for a new press release tomorrow morning on our blog about the importance of the patient centered medical home on pediatric care in Chattanooga.

Please Help Support The Pediatric Health Improvement Coalition of Tennessee

We need you to become part of the PHIC-TN partnership.  As a community, we can make our city a healthy home for all children.  If you would like to financially contribute, the Community Foundation of Greater Chattanooga has set up the Pediatric Health Fund.  Donation may be made electronically at https://cfgc.caritas247.com/Donate.aspx?dcid=PHF.
They may also be mailed to or dropped of at the Community Foundation of Greater Chattanooga's office.

Community Foundation of Greater Chattanooga

1270 Market St.

Chattanooga, TN 37402

phone: 423.265.0586

fax: 423.265.0587

email: info2@cfgc.org

Thank you.

Resources to Study Health Data About Our Region

The Annie E. Casey Foundation, 2013 KIDS COUNT data center


datacenter.kidscount.org   







The Kaiser Family Foundation, STATE HEALTH FACTS data center

statehealthfacts.org


The United Health Foundation and the American Public Health Association and Partnership for Prevention.  23rd Edition of America's Health Rankings: A Call to Action for Individuals and Their Communities.

americashealthrankings.org

University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.  County Health Rankings April 3, 2012.

countyhealthrankings.org

The Ochs Center for Metropolitan Studies.  State of the Chattanooga Region Report: Health.

http://www.ochscenter.org/documents/SOCRR2013_Health.pdf

Why Does The Chattanooga Region Need a Strategic Health Plan?

Southeast Tennessee is experiencing pervasive and complicated pediatric health challenges.  Our community is struggling with identifying the issues fueling these trends.  In addition, we lack an organized infrastructure that could develop and direct pediatric health resources to improve the region's health outcomes.

These pediatric health deficiencies have a dramatic, long-term impact our community.  Large cultural, geographic and socio-economic groups have limited access to care.  Many children are at a disadvantage due to poor maternal health, inadequate perinatal care, lower percentages of school readiness, obesity and increased impact of chronic disease.  These deficiencies exponentially increase the community's overall health cost, are barriers to improving the school system's performance, and limit the capability of our potential work force.

Many communities have recognized these identical challenges.  There is a well developed body of work analyzing community trends, identifying contributory factors and creating community-based approaches to address these problems.  We are also seeing aggressive and innovative restructuring of regional health care delivery occurring in all of Tennessee's major medical regions.  Chattanooga is critically off the pace for pediatric healthcare in this regard.

Pediatric Health Facts About Tennessee and the Tennessee Valley

Tennessee Pediatric Healthcare Improvement Coalition releases startling statistics about Chattanooga's children

Chattanooga, TN - The Pediatric Healthcare Improvement Coalition - Tennessee is releasing recent findings about the health of Chattanooga area children.

Ÿ         The infant mortality rate for African Americans in Hamilton County is 18%, which is greater than the infant mortality rates in Mexico, Bulgaria, Columbia, China, Jordan, Oman, Georgia, Moldova, Panama and Romania (TN is 7.9% for all populations and ranks 48^th nationally).

Ÿ         One of every ten live births in our region is low birth weight (<2500g).  This is 60% higher than national benchmarks.

Ÿ         One baby in five is born to a mother who smokes tobacco.

Ÿ         42% of Tennessee children are covered by TennCare and 7% have no insurance coverage.

Ÿ         Children in our region are 20% more likely to not have primary care than children nationally.

Ÿ         One out of every five South Chattanooga children and one out of every ten Ridgedale/Oak Grove/Clifton Hills neighborhood children are not ready to start kindergarten because of physical problems.

Ÿ         The number of children ages 2 to 17 with a parent who reports that a doctor has told them their child has autism, developmental delays, depression or anxiety, ADD/ADHD, or behavioral/conduct problem has increased from 16% to 21 % in the last 4 years.

Ÿ         20% of our region's children are obese (>95th percentile).  This is 26% more than the national average.  40% of 10 to 17-year-old males are overweight or obese in TN.

87% of obese adolescents become obese adults.

39% of obese adolescents become severely obese adults.

People who are obese have annual medical costs that are $1429 higher than those of normal weight.

Ÿ         Teen pregnancy rates are 5% higher in our region than across Tennessee and one and a half times the national benchmarks.

Ÿ         Chattanooga ranks the 5th worst asthma city in the United States, according to the Asthma and Allergy Foundation of America.  The American Lung Association of Chattanooga has found that asthma is the number one reason children miss school and parents miss work.

Ÿ         One out of every eight under 18-year-olds in Tennessee suffered from Asthma symptoms this last year (tied with Alabama and Delaware as worst).

The Pediatric Health Improvement Coalition Announces the Tennessee Valley Strategic Pediatric Health Planning Initiative

The Pediatric Healthcare Improvement Coalition - Tennessee (PHIC-TN) is a community health partnership.  The purpose is to improve the pediatric health of all Tennessee Valley children.  We are currently raising funds to begin a four phase strategic planning initiative.

In Phase I, PHIC-TN plans to complete an analysis of the Chattanooga pediatric healthcare market.  This will include defining the region's population health needs and demographic trends.  The analysis will map market share and quality of current ambulatory and in-patient offerings.  It will also model future demographic shifts, healthcare demand and the impact of healthcare reform.

Using the analysis in Phase I, Phase II will call on community leaders to develop a vision for pediatric healthcare.  A series of presentation forums and inclusive, participatory workshops will be used to bring community stakeholders, medical industry leaders and providers together to plan future goals.  These meetings will lead to a detailed plan for the development of a comprehensive care system over the next five years.  The final step of Phase II will be a gap analysis of the difference between the coalition's vision and the current pediatric healthcare resources.

Phase III will define pragmatic, efficient and sustainable delivery models for the region's comprehensive pediatric healthcare services.  This will include diagramming the options for local and regional alignment of pediatric providers, medical service vendors, in-patient facilities, community health-focused organizations, medical academics and payers.  The future vision of a comprehensive pediatric network in Chattanooga will be explored in terms of the integration of best practices, emerging innovations, impact of health care reform and other financial and regulatory pressures.  In Phase III, similar existing institutional examples will be cataloged.  We will also project community infrastructure modifications and/or expansion requirements.

Phase IV will complete a time and cost accounting of proposed alignment, operating and care delivery models.  Physician and other provider demand will be reconciled with resources and potential outcomes.  The Coalition will define requirements and capital costs of facility and other infrastructure needs.  We will produce a detailed impact plan on region healthcare outcomes.  This impact will be the basis of a development campaign to complete the community accepted recommendations of the Coalition.

Once our strategic planning campaign is complete, we will have a robust picture of our community and its pediatric health challenges.  Our health, cultural, religious, education, business, and political leaders will have a more singular view of the problems and potential solutions.  This data will empower the development of a cost-effective and efficient regional pediatric healthcare system.  This long-term, comprehensive road map will be resilient to the stress of current national changes as it meets the needs of all of our region's children.  Finally, PHIC-TN will begin a development program to implement a pediatric provider alignment, refine delivery of care systems and construct new facilities.

The Chattanooga region's children are among the unhealthiest in Tennessee and the nation.  Because of future progress based on this project, our children and the system that cares for them can become an example of community wellness.  Our city is a national leader in business development, natural beauty and cost of living.  It is time that we continue that narrative of excellence in the story of our children's health.  We have the health provider talent and leadership, we have the community commitment, we have the philanthropic heart, and we have the political leadership.  This project will provide a needed tool to congeal and energize these components so that Chattanooga can be what we desire: 

a world class city for all children.

The Pediatric Health Improvement Coalition of Tennessee

Healthy Chattanooga Kids is the blog of the Pediatric Health Improvement Coalition of the Tennessee  Valley(PHIC-TV).  PHIC-TV is a community partnership to improve the health of all Tennessee Valley children.