Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care.

Abstract:

OBJECTIVES:The objective of this study was to assess the cost-effectiveness of a quality improvement (QI) program in reducing asthma emergency department (ED) visits, hospitalizations, limitation of physical activity, patient missed school, and parent missed work. METHODS:Urban, low-income patients with asthma from 4 zip codes were identified through logs of ED visits or hospitalizations, and offered enhanced care including nurse case management and home visits. QI evaluation focused on parent-completed interviews at enrollment, and at 6- and 12-month contacts. Hospital administrative data were used to assess ED visits and hospitalizations at enrollment, and 1 and 2 years after enrollment. Hospital costs of the program were compared with the hospital costs of a neighboring community with similar demographics. RESULTS:The program provided services to 283 children. Participants were 55.1% male; 39.6% African American, 52.3% Latino; 72.7% had Medicaid; 70.8% had a household income <$25 000. Twelve-month data show a significant decrease in any (≥1) asthma ED visits (68.0%) and hospitalizations (84.8%), and any days of limitation of physical activity (42.6%), patient missed school (41.0%), and parent missed work (49.7%) (all P < .0001). Patients with greatest functional impairment from ED visits, limitation of activity, and missed school were more likely to have any nurse home visit and greater number of home visits. There was a significant reduction in hospital costs compared with the comparison community (P < .0001), and a return on investment of 1.46. CONCLUSIONS:The program showed improved health outcomes and cost-effectiveness and generated information to guide advocacy efforts to finance comprehensive asthma care.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Woods ER,Bhaumik U,Sommer SJ,Ziniel SI,Kessler AJ,Chan E,Wilkinson RB,Sesma MN,Burack AB,Klements EM,Queenin LM,Dickerson DU,Nethersole S

doi

10.1542/peds.2010-3472

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

465-72

issue

3

eissn

0031-4005

issn

1098-4275

pii

peds.2010-3472

journal_volume

129

pub_type

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