A community-based asthma management program: effects on resource utilization and quality of life

The Waianae Coast Comprehensive Health Center (WCCHC) developed an integrated community-based asthma management program in an effort to reduce inappropriate medical utilization and improve quality of life in their pediatric asthma population.

Over a period of three years, eighty-eight children with asthma participated in the community-based asthma management program. During this time, an automated asthma tracking system was developed, the WCCHC established a standard system of care based on the National Asthma Education and Prevention Program Expert Panel Report Guidelines for the Diagnosis and Management of Asthma (NAEPP Asthma Guidelines) adapted for cultural sensitivity, and a coordinated team care approach was implemented in the asthma management program.

During the pilot study, forty children participated in the program. Among these forty individuals, there was a significant decrease in both per capita expenditures and asthma related visits after community health worker (CHW) intervention. Average per capita charges decreased from dollar 735 to dollar 181, Emergency Department (ED) visits decreased from 60 to 10, and the overall asthma related visits decreased from 1.5 to 0.25 per person after the initial CHW encounter. These results were replicated during the 2000-2001 intervention period where average per capita charges decreased from dollar 310 to dollar 129 and ED encounters dropped from 32 to 10 after the first CHW encounter. In addition, the number of high utilizers-defined as those presenting to the ED two or more times for asthma-related diagnoses- sharply decreased from 176 in 1998 to only 16 in 2001. Quality of life improved, with 72% fewer nighttime and 96% fewer daytime symptoms reported after CHW intervention during the pilot study. During the year 2000, symptoms during exercise and asthma related doctor visits decreased 59% and 67% respectively after CHW intervention.

The community-based asthma management program demonstrated success in improving utilization patterns and reducing asthma-related expense among program participants. Improvement was also noted in quality of life as expressed through frequency and time of asthma symptoms. Other health care institutions may also be positively impacted by developing multidisciplinary team implemented, culturally-adapted, and scientifically-based disease management programs.