ED-Based Initiative Improves Pediatric Asthma Outcomes
By Susan London
Elsevier Global Medical News
VANCOUVER, B.C. -- An initiative that promotes improved asthma education and care at the family and community levels has reduced health care use and morbidity among disadvantaged asthmatic children in Boston, according to Dr. Elizabeth R. Woods.
One year into the Community Asthma Initiative, there was a 65% reduction in the percentage of participating children making asthma-related emergency department visits, a 39% reduction in the percentage missing days of school because of asthma, and a 37% reduction in the percentage having limitations in physical activity because of the disease.
"The program demonstrates a successful model that can be replicated and is starting to be replicated in Massachusetts as well as nationally," Dr. Woods said at the annual meeting of the Pediatric Academic Societies. "It also promotes policy changes that substantially improve asthma education and care, case management, home visiting, and affordable medications."
The initiative targeted children from the four Boston neighborhoods with the highest asthma rates and the greatest health disparities. The children were identified through asthma-related emergency department visits or hospital admissions, or were referred by primary care providers.
They and their families received case management and home visits from providers who helped them develop an asthma action plan, performed an environmental assessment, and supplied products such as vacuum cleaners with high-efficiency particulate air (HEPA) filters and bedding casings. Providers also instructed families in pest control techniques and connected them to community resources.
In addition, the initiative targeted the community (families, providers, and teachers) through an educational campaign. Advocacy efforts were also launched to encourage payers to address prohibitively high copayments for asthma medications.
Dr. Woods and her colleagues evaluated the effects of the initiative by analyzing parental reports obtained at 6-month intervals and administrative data.
Results were based on 441 children who had received case management through the initiative, most of whom had also received home visits. They were 7.8 years old on average; 48% were African American, 45% were Latino/Hispanic, and 70% had public health insurance.
Between baseline and 12 months, the proportion of children making asthma-related emergency department visits fell from 63% to 22%, hospital admissions due to asthma fell from 51% to 10%, and the proportion of children who missed days of school because of asthma dropped from 93% to 56%. In addition, the proportion of children who had physical activity limitations due to asthma dropped from 55% to 35%.
The proportion of children with an up-to-date asthma action plan increased by 71% (from 49% to 84%).
In logistic regression analyses controlling for potential confounders, the children had significant 90%-100% reductions in the odds of each adverse outcome, noted Dr. Woods, a pediatrician at Children's Hospital Boston.
In the first year of the initiative, the cost of care per child was similar to that in a control neighborhood ($1,335 vs. $1,340). In the second year, it was approximately half as expensive in the initiative group ($750 vs. $1,322).