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Effectiveness of an asthma management program in reducing disparities in care in urban children
Michelle M Cloutier1, Gloria A Jones, Vanessa Hinckson
1Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut, USA. mclouti@ccmckids.org
Insights
The Easy Breathing asthma management program significantly reduced hospitalizations and outpatient visits for Black and Hispanic children. However, benefits varied, with Hispanic children utilizing more services and Black children filling fewer prescriptions for inhaled corticosteroids.
Area of Science:
- Pediatric Asthma Management
- Health Disparities Research
- Public Health Interventions
Background:
- Asthma disproportionately affects urban minority children, contributing to health disparities.
- Understanding program effectiveness across different ethnic groups is crucial for equitable care.
- Previous interventions have shown varied success in reducing healthcare utilization.
Purpose of the Study:
- To evaluate the effectiveness of the Easy Breathing asthma management program in reducing healthcare service use among urban Black and Hispanic children.
- To identify ethnic-specific differences in program outcomes and their implications for health disparities.
Main Methods:
- Analysis of hospitalization rates, emergency department (ED) visits, outpatient visits (OPVs), and medication prescriptions (bronchodilators, inhaled corticosteroids [ICS]).
- Study population: 2,362 children receiving Medicaid enrolled in the Easy Breathing program (June 1998–May 2001).
- Statistical analysis: Generalized estimating equations with multivariate marginal Poisson regression, controlling for covariates.
Main Results:
- Significant reductions in hospitalization rates (53% for Black, 33% for Hispanic children) and OPVs for both groups post-intervention.
- Asthma-specific ED visits decreased for Hispanic children; ICS prescription rates increased for both groups, with a reduced bronchodilator-to-ICS ratio.
- Hispanic children showed higher prescription fill rates for bronchodilators and ICSs compared to Black children, who were more likely not to fill any asthma prescriptions.
Conclusions:
- The Easy Breathing program effectively reduced overall hospitalizations and OPVs in both Black and Hispanic children and ED visits in Hispanic children.
- Ethnic disparities persist, with Hispanic children utilizing more medical services and Black children demonstrating lower adherence to prescribed asthma medications (ICSs).
- Program benefits are not uniform across ethnic groups, highlighting the need for tailored approaches to address asthma care disparities.
Objective:
To examine differences in the effectiveness of a program to reduce use of health care services in urban-dwelling black and Hispanic children as a way to understand the origins of disparities.
Methods:
We examined hospitalization rates, emergency department (ED) visits, outpatient visits (OPVs), and bronchodilator and inhaled corticosteroid (ICS) prescriptions in 2,362 children receiving Medicaid who were enrolled in an asthma management program (Easy Breathing) from June 1, 1998, through May 31, 2001. We used generalized estimating equations to fit multivariate marginal Poisson regression models, controlling for sex, ethnicity, asthma severity, and secular trends.
Results:
Hospitalization rates were high and decreased 53% for black children and 33% for Hispanic children after the intervention. The ED visits decreased for Hispanic children, and OPVs decreased for both black and Hispanic children after Easy Breathing. The ICS prescription rates increased, with a decrease in the bronchodilator to ICS ratio from 5.81 to 2.16 in black children and from 4.74 to 2.17 in Hispanic children. Hispanic children filled more prescriptions for bronchodilators and ICSs (odds ratio, 1.29; 95% confidence interval, 1.05-1.59; P = .01; and odds ratio, 1.55; 95% confidence interval, 1.14-2.11; P = .005; respectively) 3 and 12 months after Easy Breathing. Black children were more likely than Hispanic children not to fill any asthma prescription. A total of 12% of children filled no asthma prescriptions.
Conclusions:
Hispanic children seek more medical services than black children, whereas black children fill fewer prescriptions for bronchodilators and ICSs than Hispanic children. Easy Breathing reduces overall hospitalizations and OPVs in black and Hispanic children and asthma-specific ED visits in Hispanic children; the benefits of Easy Breathing are different in Hispanic and black children.
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