Abstract for: Process Insights from Using Group Model Building to Address Emergency Department Use for Pediatric Asthma Treatment
The rate of emergency department (ED) use for the treatment of pediatric asthma in St. Louis has been four times higher than the rates in surrounding counties for over two decades. ED use for conditions that can be better managed in primary care facilities drains hospital resources, and creates significant stress and strain on families whose children need treatment. Several policies to address this complex problem involving social, health and health care system factors have failed to produce any long-term results. Insights into effective intervention require a deep understanding of the complex system in which the problem is situated. Thus, to address the problem, we organized group model building (GMB) sessions to bring stakeholders involved with various aspects of pediatric asthma treatment, care, and prevention to create a qualitative map of the structure driving persistently high ED use. Insights from the process include a shared understanding of the system boundaries, elements and feedback structures involved in pediatric asthma exacerbation and care, as well as an understanding of feedback and focus on endogenous drivers of system behavior among participants. Using the desired insights to drive the design of the sessions along with frequent reflection kept the GMB process productive and responsive.