Nearly 1 in 10 children have asthma, according to government statistics, and in low-income parts of Boston, nearly 16 percent of children are affected. A program called the Community Asthma Initiative (CAI), developed and implemented in 2005 by clinicians at Children's Hospital Boston, demonstrates the potential to dramatically reduce hospitalization and emergency department visits for asthma -- improving patient outcomes and saving $1.46 per dollar spent through reduced hospital utilization.
A study reporting these outcomes and cost savings appears in the March 2012 Pediatrics (published online February 20).
The CAI is a community-based asthma care model targeting low-income families. It includes nurse case management and care coordination combined with home visits by a bilingual nurse or Community Health Worker to educate families about asthma, assess the home for asthma triggers, and provide materials and services to improve the home environment, such as encasements for bedding, HEPA vacuums and pest control.
The CAI team, led by Elizabeth Woods, MD, MPH, of the Division of Adolescent/Young Adult Medicine, and Shari Nethersole, MD, of the Office of Child Advocacy at Children's Hospital Boston, selected children from four low-income zip codes for the intervention because they had been hospitalized or had made emergency department (ED) visits for asthma. Of 562 eligible children identified, 283 families agreed to participate.
At enrollment, 43 percent of participating children had asthma scored as moderate or severe. Families received an average of 1.2 home visits during the year-long program. "The environmental issues have been much greater than expected, with high rates of pest infestation and dust and mold problems," Woods notes.
After 12 months in the program, the children had a 68 percent decrease from baseline in asthma-related ED visits and an 85 percent drop in hospitalizations. There was a 43 percent reduction in the percentage of children who had to limit physical activity on any day, a 41 percent reduction in reports of missed school days and a 50 percent reduction in parents having to miss work to care for their child. The percentage of children with an up-to-date asthma care plan rose from 53 percent at baseline to 82 percent at 12 months.
All of these improvements were evident within 6 months, and, among children who had follow-up, persisted for as long as two years.
The quality improvement intervention yielded a significant return on investment: When CAI patients were compared with nonparticipating children from four demographically similar communities, the CAI saved $1.46 for every dollar spent. The program cost $2,529 per child, but yielded a savings of $3,827 per child because of reduced ED visits and hospitalizations. "This is a remarkable savings to society and reflects better health outcomes for the children," says Woods.
"Our experience with CAI allowed us to work with community partners to develop a business case for reimbursement of these services by insurers," adds Nethersole.
The CAI has started working with Massachusetts Medicaid and other health care payers to develop and pilot a global or bundled payment system for asthma care. "We expect that the new payment models will incorporate these expanded education and home-visiting services and allow for more comprehensive care for children with high-risk asthma," says Nethersole.
The study was limited due to the lack of insurance data, and was unable to capture data on care at other hospitals, primary care sites and pharmacy claims. The authors believe their analysis underestimated the true cost savings, because it did not include physician fees or financial impacts on families. They suggest that further cost analyses incorporate insurance company data to capture other aspects of care.
The study was funded by a REACH US grant from Centers for Disease Control and Prevention, Healthy Tomorrows from the Health Resources and Services Administration and the Ludcke, BJ's, Covidien and Thoracic Foundations.
Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including nine members of the National Academy of Sciences, 11 members of the Institute of Medicine and nine members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 395 bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about research and clinical innovation at Children's, visit: http://vectorblog.org
Colleen Connolly | EurekAlert!
Resolving the mystery of preeclampsia
21.10.2016 | Universitätsklinikum Magdeburg
New potential cancer treatment using microwaves to target deep tumors
12.10.2016 | University of Texas at Arlington
Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.
"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...
In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.
A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...
By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.
"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...
COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.
In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...
'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.
Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...
14.10.2016 | Event News
14.10.2016 | Event News
12.10.2016 | Event News
21.10.2016 | Health and Medicine
21.10.2016 | Information Technology
21.10.2016 | Materials Sciences