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Published on: May 14, 2012
The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North
Melinda S Shuler1, Karin B Yeatts2, Donald W Russell1
1a Regional Asthma Disease Management Program, Mission Children's Hospital , Asheville , NC , USA .
Insights
The Regional Asthma Disease Management Program (RADMP) significantly reduced emergency visits and hospitalizations for rural children with asthma. This initiative improved lung function and decreased school absences, demonstrating effective asthma management strategies.
Area of Science:
- Public Health
- Pediatric Asthma Management
- Environmental Health
Background:
- Suboptimal asthma management affects many low-income children in rural North Carolina.
- The Regional Asthma Disease Management Program (RADMP) was developed to address these disparities.
- RADMP was a National Asthma Control Initiative (NACI) demonstration project.
Purpose of the Study:
- To evaluate the effectiveness of the RADMP in improving asthma outcomes for rural children.
- To assess the impact of community and individual interventions on healthcare utilization and clinical status.
Main Methods:
- An observational intervention conducted in 20 rural counties and on the Eastern Band Cherokee Indian Reservation (2009-2011).
- Interventions included community-wide asthma education, environmental assessments and remediation in homes and childcare facilities.
- Individual interventions involved clinical assessment and management for 50 children with persistent asthma.
Main Results:
- Significant reductions in asthma-related emergency department visits (158 to 4) and hospital admissions (62 to 1) were observed.
- Lung function improved, with increases in FVC (7.2%), FEV1 (13.2%), and FEF 25-75 (21.1%).
- Average school absences decreased from 17 to 8.8 days, with an estimated healthcare cost avoidance of $882,021.
Conclusions:
- The RADMP program demonstrated substantial improvements in healthcare utilization and clinical outcomes for rural children with asthma.
- Key outcomes included decreased emergency visits, hospitalizations, and school absences, alongside improved lung function.
- This NACI project highlighted the success of a multi-faceted approach to pediatric asthma management in underserved rural populations.
Background:
A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI).
Methods:
This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management.
Results:
Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021.
Conclusion:
The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.
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