Assessing the value of disease management: impact of 2 disease management strategies in an underserved asthma population.
BACKGROUND
The goal of disease management (DM) is to improve health outcomes and reduce cost through decreasing health care utilization. Although some studies have shown that DM improves asthma outcomes, these interventions have not been examined in a large randomized controlled trial.


OBJECTIVE
To compare the effectiveness of 2 previously successful DM programs with that of traditional care.


METHODS
Nine hundred two individuals with asthma (429 adults; 473 children) were randomly assigned to telephonic DM, augmented DM (ADM; DM plus in-home visits by a respiratory therapist), or traditional care. Data were collected at enrollment and at 6 and 12 months. Primary outcomes were time to first asthma-related event, quality of life (QOL), and rates of asthma-related health care utilization. Secondary outcomes included rate of controller medication initiation, number of oral corticosteroid bursts, asthma symptom scores, and number of school days missed.


RESULTS
There were no significant differences between groups in time to first asthma-related event or health care utilization. Adult participants in the ADM group had greater improvement in QOL (P = .04) and a decrease in asthma symptoms (P = .001) compared with other groups. Of children not receiving controller medications at enrollment (13%), those in the intervention groups were more likely to have controller medications initiated than the control group (P = .01). Otherwise, there were no differences in outcomes.


CONCLUSIONS
Overall, participation in asthma DM did not result in significant differences in utilization or clinical outcomes. The only significant impact was a higher rate of controllermedication initiation in children and improvement in asthma symptoms and QOL in adults who received ADM.
Galbreath
Autumn Dawn
AD
Department of Medicine, University of Texas Health Science Center at San Antonio, Texas 78229-3900, USA.
Smith
Brad
B
Wood
Pamela R
PR
Inscore
Stephen
S
Forkner
Emma
E
Vazquez
Marilu
M
Fallot
Andre
A
Ellis
Robert
R
Peters
Jay I
JI
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000178:diet therapy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D006282:Health Personnel; D006801:Humans; D008507:Medically Underserved Area; D054539:Medication Therapy Management; D008875:Middle Aged; D015397:Program Evaluation; D013689:Telephone; D013781:Texas; D016896:Treatment Outcome; D055815:Young Adult