The 130th Annual Meeting of APHA

Abstract #41651

Helen Margellos, MPH¹, Daniel Johnson, MD², Paula Karnick, C-PNP², Abigail Silva, MPH¹, and Steven Whitman, PhD¹. (1) Sinai Health System, Sinai Urban Health Institute, California at 15th Street, K439, Chicago, IL 60608, 773-257-5259, marhe@sinai.org, (2) Department of Pediatrics, Sinai Health System, California at 15th Street, F444, Chicago, IL 60608

Background: Asthma is poorly controlled in inner-city children. Published studies suggest that increasing patient/family knowledge through asthma education (AE) improves asthma control. The value of case management (CM) is less understood. Objective: To compare the efficacy and cost-effectiveness of individualized, reinforced AE with/without CM to routine asthma care in inner-city children with asthma. Methods: 264 children from an inner-city hospital were randomized into 3 groups: G1 received routine care and one time AE (control group), G2 received G1 intervention with monthly, reinforced AE, G3 received G2 intervention plus CM. All subjects saw a pulmonologist upon enrollment to ensure proper medical treatment. Follow-up data were collected over 9 months. A preliminary cost-benefit analysis considered intervention costs and health resource utilization savings. Results: The three groups were comparable for gender (57% male), race/ethnicity (67% AA, 33% Hispanic), age (mean=4.5 years), and insurance type (91% Medicaid). Preliminary analysis shows all groups improving from the baseline to follow-up year for hospitalizations, hospital days (HD) and ED visits (ED). G3 improved more than G1 or G2 in HD (-2.2 vs. –1.2) and ED (-1.5 vs. -0.7). This trend was marginally significant (p<.15). Further, all groups experienced substantial cost savings from baseline to follow-up. G3 experienced the greatest savings (~$2500/child/year). Conclusions: Preliminary findings suggest intensive AE combined with CM most effectively improves asthma management in inner-city children. G1’s improvement reflects the effect proper medication and education alone can have on this population. The large cost savings are encouraging.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• List some of the obstacles which inner-city, low-income children face in properly managing their asthma
• Discuss the nature of interventions, which have been demonstrated to improve the control of asthma in an inner-city, low-income pediatric population
• Recognize the need to improve primary care physician practice in diagnosis and treatment of pediatric asthma
• Recognize the need for public policy action to effectively combat the problem of inner-city pediatric asthma.

Keywords: Asthma, Case Management

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.