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Pediatric asthma case management: a review of evidence and an experimental study design
Amanda Schulte1, Jeanne Musolf, John R Meurer
1Center for the Advancement of Urban Children, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital and Health System, Milwaukee, USA. aschulte@mail.mcw.edu
Insights
Effective asthma case management for children involves persistent, trusting family relationships. Home-based nurse interventions show cost-effectiveness for emergency department visits.
Area of Science:
- Pediatrics
- Public Health
- Nursing
Background:
- Childhood asthma is a complex, multifactorial disease.
- Existing case management approaches involve various professionals.
- The effectiveness and cost of nurse-led case management require further study.
Purpose of the Study:
- To review childhood asthma case management strategies.
- To present a randomized controlled study on nurse case management.
- To assess the cost and effectiveness of home-based nurse case management for children with asthma.
Main Methods:
- Review of existing literature on asthma case management.
- Randomized controlled trial of home-based nurse case management.
- Focus on children with asthma visiting the emergency department.
- Community coalition model for intervention delivery.
Main Results:
- Successful case management hinges on building trusting family relationships through persistent contact.
- Home-based nurse case management by a community coalition was assessed for cost and effectiveness.
- Positive outcomes can justify the expense of case management interventions for all stakeholders.
Conclusions:
- Nurse case management, characterized by dedicated family engagement, yields positive outcomes.
- Home-based interventions by community coalitions can be a cost-effective strategy for pediatric asthma care.
- Building trust is a critical component for successful asthma case management in children.
Abstract:
Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma case management by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse case management in a local community coalition. Evidence suggests the common factor for success involves case managers spending time contacting and patiently and persistently working with the family, thus building a trusting relationship. Although case management time is an expense for a health care payer, provider, and the child and family, the positive outcomes achieved can demonstrate the benefit of these interventions to all parties involved. The described experimental study assesses the cost and effectiveness of home-based nurse case management by a community coalition for children visiting an emergency department for asthma care.
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