The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61725

Nancy A. Snyder, RN, MS¹, Toshi Hayashi, PhD², Kasie Gee, MPH³, Julie Linderman, MPH¹, Jennifer Brand, MPH⁴, Mindy Benson, RN, PNP⁵, and Christy Rosenberg, MPH⁶. (1) Children's Medical Services Branch, California Department of Health Services, 1515 K Street, Room 400, Sacramento, CA 95814, (916) 327-2408, nsnyder@dhs.ca.gov, (2) Chronic Disease Epidemiology and Control Section, CDIC, California Department of Health Service, 601 North 7th Street, M. S. 725, Sacramento, CA 94234, (3) Chronic Disease Epidemiology and Control Section, CDIC, California Department of Health Services, 601 North 7th Street, M. S. 725, Sacramento, CA 94234, (4) Asthma and Allergy Foundation of America, Southern California Chapter, 5900 Wilshire Blvd., Suite 2330, Los Angeles, CA 90036, (5) Children's Hospital Oakland Ambulatory Department, 5220 Claremont Avenue, Oakland, CA 94616, (6) Council of Community Clinics, 7537 Metropolitan Drive, San Diego, CA 92108

Purpose: To address the special health care needs of children with asthma, the California Department of Health Services Childhood Asthma Initiative provides outpatient asthma treatment services (ATS) to uninsured children with persistent asthma, ages birth to five, to reduce morbidity and improve quality of life. ATS include assessment, treatment, care coordination, health insurance enrollment assistance, clinical quality improvement and community collaboration. The combined effects of asthma coordinator services (ACS-- in-home assessment, education and care/resource coordination by community health workers), and improved health care through ATS were evaluated.

Methods and Results: At each visit, using a standardized survey instrument, providers in seven ATS clinics collected data on the child's demographic characteristics, health insurance status, and asthma-related measures including asthma history, symptoms, severity, visit acuity, emergency visit/hospitalization rates, medications, charges, and quality of life indicators. Improvement was demonstrated in all asthma-related outcomes: average number of emergency visits per child (from 0.25 to 0.12, p=0.0009); children using appropriate levels of maintenance and quick-relief therapy (from 23% to 63%, p<0.0001); and caregivers missing at least one work-day in the last four weeks (from 21% to 12%, p=0.017).

Of 194 ATS enrolled children with at least two visits, 94 children also received ACS. At first and last visit, outcomes for those receiving both types of services were compared with those receiving only ATS services. Children in the combined group showed slightly greater improvement in almost all examined asthma-related outcomes.

Conclusions: Providing both access to ATS and ACS improves asthma-related outcomes compared with just providing quality ATS health care.

Learning Objectives:

• Learning objective: At the end of this session, participants will demonstrate understanding about a model program on quality clinical and in-home asthma services that results in improved asthma-related outcomes for children with persistent asthma, ages birth to five years.

Keywords: Asthma, Children With Special Needs

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.