A randomized controlled trial of a pediatric asthma outreach program

• Published in: Journal of allergy and clinical immunology Vol. 103; no. 3; pp. 436 - 440
• Main Authors: Greineder, Dirk K., Loane, Kathleen C., Parks, Paula
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-03-1999; Elsevier
• Subjects: Adolescent; allergy; Asthma; Asthma - economics; Asthma - nursing; Asthma - psychology; Asthma - therapy; Biological and medical sciences; Boston; case management; Case Management - economics; Case Management - organization & administration; Child; Child, Preschool; Chronic obstructive pulmonary disease, asthma; Community-Institutional Relations; cost; Cost of Illness; Cost-Benefit Analysis; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Ethnic Groups; Female; General aspects; health education; Health Expenditures; Health Maintenance Organizations - economics; Hospitalization - statistics & numerical data; Humans; Infant; Male; managed care; Medical sciences; Nurses - economics; outreach; Patient Care Team - economics; Patient Education as Topic - economics; Planification. Prevention (methods). Intervention. Evaluation; Pneumology; Program Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; risk; Salaries and Fringe Benefits; United States; North America; America; health education; case management; AOP; EW; cost; outreach; CI; allergy; risk; managed care; Asthma; child; Human; Respiratory disease; Hospitalization; Health education; Statistical study; Cost benefit ratio; Prevention; Treatment; Health economy; Risk factor; Obstructive pulmonary disease; Emergency; Child; Public health
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/S0091-6749(99)70468-9

Background: Previous studies have shown that asthma education and case management may reduce asthma emergency care, hospitalizations, and expenditures.
Objective: We sought to study the effect of an asthma outreach program (AOP), a team-based, case-management intervention, on emergency ward (EW) and hospital use.
Methods: Fifty-seven patients aged 1 to 15 years with the diagnosis of asthma based on the usual clinical practice criteria who were continuously enrolled in a staff-model health maintenance organization for a period of at least 2 consecutive years were randomized into 2 intervention groups. The control group received a single intensive asthma education intervention, and the AOP group received the same initial education but then was followed-up by an asthma case management nurse throughout the intervention period.
Results: EW visits, hospitalizations, and total outside-of-health-plan expenditures (consisting of EW and hospital expenses, as well as miscellaneous costs, such as ambulance, durable medical equipment, tertiary referrals, and home care) were assessed from claims filed for a year before and after enrollment. Control group patients experienced significant reductions in EW visits (39%), hospitalizations (43%), and outside-of-health-plan costs (28%), possibly as a result of the baseline educational intervention received by all enrolled patients, in conjunction with regression to the mean. AOP group patients experienced significant reductions in EW visits, (73%,
P = .0002), hospitalizations (84%,
P = .0012), and outside-of-health-plan use (82%,
P < .0001). When compared with the control group, AOP group patients demonstrated additional significant reductions in EW visits (57%,
P < .05), hospitalizations (75%,
P < .05), and outside-of-health-plan use (71%,
P < .001). Estimates of direct savings to the health plan ranged from $7.69 to $11.67 for every dollar spent on the AOP nurse’s salary, depending on assumptions.
Conclusions: Asthma patients in a staff-model health maintenance organization decreased their resource use between 57% to 75% by participation in an AOP as compared with a randomized control group receiving only an educational intervention. Substantial savings were achieved compared with the cost of the AOP nurse. (J Allergy Clin Immunol 1999;103:436-40.)