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Reducing asthma exacerbations in vulnerable children through a medical-legal partnership
Anne S Mainardi1, Drew Harris2, Alice Rosenthal3
1Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of MedicineNew Haven, CT.
Insights
A Medical-Legal Partnership (MLP) significantly reduced asthma exacerbation encounters and hospitalizations in urban children. This intervention shows promise for decreasing health disparities in pediatric asthma care.
Area of Science:
- Pediatric Healthcare
- Health Disparities Research
- Public Health Interventions
Background:
- Asthma disproportionately affects children from low-income families, leading to worse health outcomes.
- Medical-Legal Partnerships (MLPs) integrate legal services within healthcare settings to address social determinants of health.
- This study investigated the impact of an MLP on asthma exacerbation rates in a vulnerable urban pediatric population.
Purpose of the Study:
- To evaluate the effectiveness of a Medical-Legal Partnership (MLP) intervention in reducing asthma exacerbation healthcare utilization.
- To assess changes in primary care, emergency department, and inpatient encounters for asthma exacerbations before and after MLP referral.
Main Methods:
- A retrospective study of 98 children with asthma referred to an MLP between 2013 and 2017.
- Comparison of healthcare utilization for asthma exacerbations in the year preceding and the year following MLP intervention.
- Analysis included encounters in primary care, emergency departments, and inpatient settings.
Main Results:
- Total asthma-related encounters per patient per year decreased by 44.2% (from 1.16 to 0.66, p < 0.01).
- Hospitalizations for asthma exacerbations saw a significant reduction of 69.7% (from 0.33 to 0.10 per patient per year, p < 0.01).
- Reductions in primary care and emergency department encounters were observed but did not reach statistical significance.
Conclusions:
- MLP intervention was associated with a significant decrease in asthma exacerbation encounters and hospitalizations in a pediatric population.
- MLPs represent a potential strategy for mitigating health disparities in children with asthma.
- Further research is needed to identify optimal MLP interventions and patient subgroups that benefit most.
Background:
Asthma health disparities are widely recognized, with worse outcomes in children from low income families. In a Medical-Legal Partnership (MLP), an attorney is embedded in a healthcare setting to address social determinants of health. We studied whether an MLP could impact asthma exacerbation rates in a vulnerable urban population at an academic children's hospital.
Methods:
The study population comprised children with asthma who were referred to the MLP between 2013 and 2017. We compared healthcare utilization for asthma exacerbations managed in primary care, emergency department and inpatient settings in the year before and year after MLP intervention.
Results:
98 children with asthma were included in the study. The mean total encounters per person per year decreased from 1.16 to 0.66 (relative reduction 44.2%, p < 0.01). The largest effect was on hospitalizations, with a reduction from 0.33 to 0.10 hospitalizations per patient per year (relative reduction 69.7%, p < 0.01). Encounters for asthma exacerbations in the primary care office and emergency department also decreased but these changes did not meet statistical significance.
Conclusion:
In a pediatric population with asthma, an MLP intervention was associated with a significant reduction in asthma exacerbation encounters and hospitalizations comparing the year before and after MLP intervention. Further studies are needed to better understand which interventions are most effective, and for which patient groups MLP referral would be particularly useful. MLPs may be an important way to reduce health disparities in patients with asthma and other chronic illnesses.
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