Quality improvement program helps asthma outcomes, saves $1.46 per dollar spent
A program that provides home visits and education for families with children living with asthma has shown to dramatically reduce hospitalizations for the condition, meanwhile saving $1.46 in care for every $1 spent on prevention.
According to government statistics, nearly 1 in 10 children have asthma, and in low-income parts of Boston, nearly 16 percent of children are affected.
The Community Asthma Initiative (CAI), developed and implemented in 2005 by clinicians at Children’s Hospital Boston, has demonstrated the potential to reduce hospitalization and emergency department visits for asthma - improving patient outcomes and saving $1.46 per dollar spent through reduced hospital utilization, according to CAI team leader Elizabeth Woods, of the Division of Adolescent/Young Adult Medicine.
The CAI is a community-based asthma care model targeting low-income families, or those families at greatest risk for severe asthma attacks and hospitalizations. The program 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.
“It’s quite remarkable how many children can have an improved quality of life if we address environmental issues in the home,” said Woods.
According to Woods and CAI’s other team leader, Shari Nethersole from the Office of Child Advocacy at Children’s Hospital Boston, the program targeted 283 children with asthma in some of Boston’s poorest neighborhoods.
“The children chosen for the study were those at greatest risk that had a history of hospitalizations and emergency department visits,” said Woods. “Some children had severe asthma or some had poorly controlled asthma due to a lack of resources or environmental conditions.”
According to Woods, families received an average of 1.2 home visits during the year-long program. After 12 months in the program, the children had a 68 percent decrease from baseline in asthma-related emergency department visits and an 85 percent drop in hospitalizations. 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 six 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 in demographically similar communities, 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 hospitalizations.
Woods said that with fewer asthma hospitalizations, CAI could help make it possible for the hospital to care for other patients with more complicated problems and illnesses.
“Our experience with CAI allowed us to work with community partners to develop a business case for reimbursement of these services by insurers,” said Nethersole in a press release.
The CAI started working with Massachusetts Medicaid and other healthcare 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,” said Nethersole in a press release.
The study was funded by a 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.
