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PEDIATRICS Vol. 105 No. 5 May 2000, pp. 1029-1035

Outcomes Evaluation of a Comprehensive Intervention Program for Asthmatic Children Enrolled in Medicaid

Received Jul 24, 1998; accepted Jul 15, 1999.

Cynthia Szelc Kelly*, Dagger , §, parallel , Ardythe L. MorrowDagger , §, parallel , Justine ShultsDagger , §, parallel , Nermina Nakasparallel , Gerald L. Strope*, Dagger , §, and Raymond D. AdelmanDagger , §

From the * Division of Pulmonary, Allergy and Immunology, Dagger  Department of Pediatrics, Eastern Virginia Medical School, § Children's Hospital of The King's Daughters, and parallel  Center for Pediatric Research, Norfolk, Virginia.

Objectives.  To evaluate health care and financial outcomes in a population of Medicaid-insured asthmatic children after a comprehensive asthma intervention program.

Design.  Controlled clinical trial.

Setting.  Pediatric allergy clinic in an urban, tertiary care children's hospital.

Subjects.  Eighty children, 2 to 16 years old, with a history of frequent use of emergent health care services for asthma.

Intervention.  Children in the intervention group received asthma education and medical treatment in the setting of a tertiary care pediatric allergy clinic. An asthma outreach nurse maintained monthly contact with the families enrolled in the intervention group.

Outcome Measures.  Emergency department (ED) visits, hospitalizations, and health care charges per patient in the year after enrollment.

Results.  Baseline demographics did not differ significantly between the 2 groups. In the year before the study, there were no significant differences between intervention and control children in ED visits (mean, 3.5 per patient), hospitalizations (mean, .6 per patient) or health care charges ($2969 per patient). During the study year, ED visits decreased to a mean of 1.7 per patient in the intervention group and 2.4 in controls, while hospitalizations decreased to a mean of .2 per patient in the intervention group and .5 in the controls. Average asthma health care charges decreased by $721/child/year in the intervention group and by $178/patient/year in the control group.

Conclusions.  A comprehensive asthma intervention program for Medicaid-insured asthmatic children can significantly improve health outcomes while reducing health care costs.asthma education, health care outcomes, Medicaid, asthma outreach, utilization. .




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