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Home Visits for Asthma: Healthcare that Works

By Neil Wagner

A program developed in Boston has the potential to make asthma a lot less troublesome for children all over the country. Targeted to children in low-income families, the program substantially lowered emergency room visits, hospitalizations and school days missed due to asthma.

A key part of the program is a visit to the child's home by a nurse or other health care worker to make the home less likely to trigger asthma attacks. And according to a recently published study, the program pays for itself.

About 10% of U.S. children have asthma. This rate is much higher in many low-income areas. To help address this problem, clinicians at Children's Hospital in Boston developed a program called Community Asthma Initiative (CAI) in 2005. Using hospitalization and emergency department logs, 283 low-income children with asthma were identified and then enrolled.

The program starts by assigning each child a nurse as their case manager. But its centerpiece is a visit to the child's home.

There's a lot of territory covered during the home visit. A nurse or other health care worker assesses the home for asthma triggers and begins making arrangements to eliminate or reduce them. Dust, mold, mice and cockroaches are all known triggers for asthma attacks. Pest control, HEPA vacuums and encasements for bedding are some of the tools the nurse/case manager has to fight back with.

The nurse or health care worker also makes sure that parents and children understand the basics of managing asthma, including how to properly take their asthma medication and what to do in case of an unexpected asthma attack.

On average, each family received 1.2 home visits during the year-long program. And the effects were dramatic.

In the year after enrolling in the program, there was a 68% decrease in ER visits for asthma and an 85% decrease in hospitalizations due to asthma. Missed school days dropped by 41% and missed workdays of parents needing to care for their children dropped by 50%. And days where children had to limit their physical activity because of asthma decreased 43%.

All of these improvements were evident within six months.

The goal of the published study was to assess the cost-effectiveness of CAI. Comparisons with similar communities not served by the program suggest that the program saved $146 for every $100 that was spent on it. The program cost $2,825 per child but the savings from reduced hospitalizations and ER visits came to $3,827 per child. In other words, the program more than paid for itself.

It's hard to put a dollar figure on just how much it's worth when sick children become healthy again. According to the study, that's what CAI and programs modeled after it can do for children with asthma.

An article on the study was published online by Pediatrics.

April 21, 2012



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