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A randomized controlled trial of a pediatric asthma outreach program
D K Greineder1, K C Loane, P Parks
1Department of Allergy, Harvard Pilgrim Health Care, Boston, Mass. 02215, USA.
Insights
An asthma outreach program (AOP) significantly reduced emergency care and hospitalizations for pediatric asthma patients. This case management intervention demonstrated substantial cost savings for healthcare plans.
Area of Science:
- Pediatric Pulmonology
- Healthcare Management
- Public Health Interventions
Background:
- Asthma education and case management interventions have shown potential in reducing asthma-related emergency care, hospitalizations, and healthcare expenditures.
- Previous research suggests that comprehensive asthma management strategies can positively impact patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the impact of an asthma outreach program (AOP), a team-based case management approach, on emergency ward (EW) visits and overall hospital utilization in pediatric asthma patients.
- To assess the cost-effectiveness of the AOP intervention compared to standard educational interventions.
Main Methods:
- A randomized controlled trial involving 57 pediatric asthma patients (aged 1-15 years) enrolled in a health maintenance organization.
- Patients were randomized into two groups: a control group receiving intensive asthma education and an AOP group receiving initial education followed by ongoing case management by a nurse.
Main Results:
- The AOP group experienced significant reductions in EW visits (73%), hospitalizations (84%), and outside-of-health-plan costs (82%) compared to baseline.
- When compared to the control group, the AOP group showed additional significant reductions in EW visits (57%), hospitalizations (75%), and outside-of-health-plan use (71%).
- The AOP intervention yielded direct savings to the health plan ranging from $7.69 to $11.67 for every dollar spent on the case management nurse.
Conclusions:
- The asthma outreach program (AOP) significantly decreased resource utilization in pediatric asthma patients by 57% to 75% compared to a control group receiving only educational intervention.
- The AOP intervention proved to be highly cost-effective, generating substantial savings relative to the program's operational costs.
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.
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