title: Reduced clinic, emergency room, and hospital utilization after home environmental assessment and case management.
abstract: Allergists often suspect home environmental conditions are contributors to allergic disease. Case management can be an effective tool in managing asthmatic patients. To describe the impact of home environmental assessments and case management on the medical care utilization of patients with allergic disease the following studies were conducted. This study was designed to retrospectively examine health care utilization of pediatric patients that had a home environmental assessment recommended by a pediatric allergist as part of a comprehensive case management program. Subjects were chosen from pediatric patients who received home assessment after referral for case management by pediatric allergy specialists in a hospital-based clinic as indicated by high emergency room (ER) and hospital utilization. Case management included education, clinic visits, environmental assessment, and a single person responsible for following the subject's care. Home assessment included airborne spore collections, surface collections, and dust collection for evaluation of antigens. There were 25 subjects. Seventy-two percent were asthmatic and 12% were diagnosed with allergic rhinitis. In the year before entering the study these subjects experienced 47 ER visits, 22 hospitalizations, and 279 clinic visits. In the subsequent year they underwent 18 ER visits, 3 hospitalizations, and 172 clinic visits. Penicillium/Aspergillus levels were above 100 spores/m(3) of air in 94% of homes and above 1000 spores/m(3) in 74% of homes. Thirty-six percent of homes had Stachybotrys above 100 spores/m(3). Home environmental assessment and case management may reduce medical care utilization for children suffering from allergic rhinitis and asthma.
authors.affiliation: Section of Allergy/Asthma/Immunology, The Children's Mercy Hospital, Kansas City, Missouri 64108, USA. cbarnes@cmh.edu
authors.forename: Charles S
authors.initials: CS
authors.lastname: Barnes
authors.forename: Mercedes
authors.initials: M
authors.lastname: Amado
authors.forename: Jay M
authors.initials: JM
authors.lastname: Portnoy
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D015169:Colony Count, Microbial; D004391:Dust; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004781:Environmental Exposure; D005260:Female; D005658:Fungi / Q000502:physiology*; D006287:Health Planning Guidelines; D006760:Hospitalization / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D012189:Retrospective Studies
chemical_list: D004391:Dust