Addressing Knowledge Gaps and Increasing Productivity: Nurse-Led Telemedicine Education to Improve Pediatric Asthma Outcomes

Purpose: To describe the development of our innovative asthma nurse education telemedicine program, which provides patient/family-centered asthma education while generating volume and productivity for pediatric primary care nursing in a safety net hospital setting.
Background/significance: Boston Medical Center’s pediatric primary care implemented a comprehensive asthma quality improvement program to enhance guideline-based care, address barriers to home management, and improve outcomes for children in an urban safety net population. A pivotal member of the pediatric asthma team is the asthma nurse champion, who received specialized asthma educator training at the American Lung Association Asthma Educator Institute. In 2022, the nurse champion initiated asthma education telemedicine sessions to educate newly diagnosed patients and families, provide detailed guidance on treatment plan changes to SMART therapy (a major change to chronic asthma management in accordance with the 2020 NIH asthma guideline update), ensure access to home medications, and facilitate communication among families, providers, and pharmacies. These telemedicine visits not only expand nursing’s role in managing chronic illnesses through care coordination but also generate billable encounters, contributing to ambulatory care productivity and revenue. This innovative approach bridges gaps in care and strengthens support for pediatric asthma patients and their families.
Methods: This is a retrospective study of telemedicine encounters for asthma-led nurse education. Data from the asthma nurse champion’s program evaluation tracking database and billing data were reviewed. Descriptive statistics were used to describe the types of and indications for referrals received and the asthma education themes that are most discussed during those encounters. Encounter data were aggregated to tally the numbers of visits and describe overall program revenue-generating potential. We also describe asthma education interventions in relation to patient treatment adherence and understanding of treatment plan.
Results: From July 29, 2022, to May 31, 2024, 254 referrals were made for asthma nurse telemedicine education. 116 were directly requested by physicians and 128 were identified by the asthma program coordinator because of low asthma control test (ACT) scores identified during routine symptom surveillance screening which were not addressed by the provider during clinic visits. Of 254 referrals, the asthma nurse successfully contacted 246 patients (97%), scheduled 177 asthma education telehealth appointments (71%), and completed 174 asthma education sessions (70%) with parents and patients and caregivers. Billing data show that $20,880 was generated from these encounters.
Conclusions: The pediatric primary care asthma nurse champion provided 174 individualized, patient/family-centered telemedicine encounters, which presented new opportunities to optimize high-quality, guideline-adherent asthma care and demonstrate volume and obtain revenue for our safety net hospital practice. Future directions include expansion of billable encounters to a larger number of nursing colleagues both through telemedicine and in-person visits and evaluating clinical outcomes (i.e., reductions in asthma-related ED visits) in association with asthma nursing encounters.