PURPOSE OF THE STUDY.
To evaluate the cost-effectiveness of a quality improvement (QI) program in decreasing asthma emergency department (ED) visits, hospitalizations, limitation of physical activity, patient missed school, and parent lost work.
Urban, low-income patients with asthma from 4 Boston-area zip codes were determined through records of ED visits or hospitalizations.
The selected families were given the option of increased care encompassing nurse care management and home visits. QI assessment centered on parent interviews at enrollment and at 6- and 12-month contacts. Administrative hospital information was used to evaluate ED visits and hospitalizations at enrollment and 1 to 2 years after enrollment. Hospital expenditures of the program were compared with hospital expenditures of a comparable neighboring community.
The program serviced 283 children (55% male; ∼40% African American, 52% Latino; 73% received Medicaid; 71% had household income <$25 000). The 12-month results demonstrated significant decline in any (≥1) asthma ED visits (68%), hospitalizations (85%), days of significant physical limitation (42.6%), missed school (41%), and parent lost work time (49.7%) (P < .0001 for all). There was a significant decline in hospital expenditures compared with comparable community costs (P < .0001), and the investment return was calculated at 1.46.
The study program generated enhanced health outcomes and cost-effectiveness and provided knowledge that will guide future advocacy to finance comprehensive asthma management.
Despite the limitations of this study, which was not randomized and did not have comparable hospital administrative data on controls, the community asthma program provided a cost-effective home chronic care model. This model of a medical home is a culturally sensitive program conjoining case management and home visits to facilitate the management of patients who require a higher level of care to achieve better control of their asthma.
- Copyright © 2012 by the American Academy of Pediatrics