Utilization patterns in an asthma intervention.
BACKGROUND
The National Cooperative Inner-City Asthma Study (NCICAS) tested a model of asthma management in which a master's degree-prepared social worker functioned as an asthma counselor. The NCICAS resulted in decreased symptom days and a trend toward fewer emergency department (ED) visits and hospital admissions in the intervention group compared with the control group.


OBJECTIVE
To determine whether a real-world implementation would give similar results to the NCICAS.


METHODS
Children with moderate or severe persistent asthma were enrolled in a 1-year program, the Inner-City Asthma Intervention (ICAI) program, modeled on the NCICAS. Since the program initially was not designed to be research, data were collected retrospectively. ED and hospital visits were compared 1 year before and after the intervention at 2 of the intervention sites, Children's Mercy Hospital (CMH) and Baystate Medical Center, to determine whether there was a significant change.


RESULTS
Data for 93 children from CMH and 77 from Baystate were evaluated. At CMH annual ED visits were 0.38 before, 0.42 during, and 0.41 after the intervention, whereas at Baystate ED visits were 0.09 before, 0.17 during, and 0.15 after the intervention. Mean hospitalizations at CMH increased from 0.06 before to 0.22 during and then decreased to 0.12 after (P > .05), whereas admissions at Baystate increased from 0.03 before to 0.05 during and 0.04 after the intervention.


CONCLUSIONS
Asthma self-management interventions can lead to decreases in asthma utilization under controlled circumstances. Further prospective studies are needed to determinewhether the ICAI intervention is effective under real-world conditions.
Portnoy
Jay M
JM
Department of Health Management, Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA. jportnoy@cmh.edu
Jennings
Donna
D
D000485:Allergens / Q000009:adverse effects; D000818:Animals; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D019090:Case Management; D002487:Centers for Disease Control and Prevention, U.S. / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003376:Counseling; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004781:Environmental Exposure; D005260:Female; D006078:Government Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D006284:Health Plan Implementation; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008923:Missouri; D010343:Patient Admission / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D015397:Program Evaluation; D012109:Research Support as Topic; D012189:Retrospective Studies; D012947:Social Work; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population
D000485:Allergens; D018927:Anti-Asthmatic Agents